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Care suffers as Hungary hemorrhages doctors

With nearly 2,000 physicians’ positions unfilled, and health professionals emigrating at a high rate, Hungarian health care is on the verge of collapse. But the government has no plans for meaningful reform.

Budapest’s trauma hospital in District VIII.

The mass emigration of Hungarian healthcare professionals seems unstoppable. A survey by Szinapszis, a research firm shows that 70% of medical graduates plan to work abroad, and two-thirds of them would do so for at least five years or for good. Given the existing meager pay, low social appreciation and what many say are the unbearable working conditions in the sector, it is no wonder health workers are leaving.

Hungarian healthcare workers applying for certificates to work abroad in H1 of 2015

Source: Health Registration and Training Centre (ENKK)

The exodus is a heavy loss for the Hungarian healthcare system. According to government data, positions for 1,917 doctors and 4,088 specialized staff cannot be filled. And the future prognosis is not good.

Medical students were asked: How critical (on a scale of 1-5) do you believe the situation of the following factors are in Hungarian health care?

5 (most important)
1 (least important)
Being overwhelmed
Low pay
Doctors’ emigration
Source: Medical Student Survey conducted by Szinapszis Kft. at the order of Hungarian Resident Doctor’s Association (MRSZ) , June 2014.

Hungarian health care was already underfunded and struggling by the 1980s, but solutions are expensive and require a lot of political goodwill. No Hungarian government since then has been up to the task of overhauling the system.

In the current administration, health care is not dealt with by a separate ministry, but is instead delegated to a state secretariat. As economist Balázs Rékassy pointed out in a recent interview with Radio Lánchíd, this means that the state secretary in charge has no opportunity to speak up in government meetings and his job is restricted to executing government decisions. “No sign is visible that there is any serious will for radical change or to mobilize more resources,” he said.

In fact, the position of the state secretary for health care was vacant for more than a month, another unusual thing in the case of such a key sector. In mid-October, Dr. Zoltán Ónodi-Szűcs was appointed, but it’s wishful thinking to expect him to do more than seek to keep conflicts at bay.

“The new healthcare secretary will not be supported if he does not understand how serious the situation is due to the lack of healthcare workers,” Dr. Tamás Dénes, chairman of the Hungarian Resident Doctors’ Association (MRSZ) told the Budapest Business Journal.

A shortage of funding and a surplus of soft corruption

It is common wisdom that a substantial salary raise with immediate effect is the highest priority. Real wages in the sector slumped by 13% between 2006 and 2013, and average pay is the lowest of all industries in Hungary.

“The system needs around HUF 150-180 billion extra after-tax funding which is 0.5% of Hungary’s GDP,” Dénes estimates. Hungary’s spending on health care, including private expenditure, accounts for only 7.4% of GDP, someway behind the OECD average of 8.9%.

However, fatter salary slips are only a start.

Current unacceptable practices must be tackled with equal determination, as health care is based on the abundance of the so-called “gratitude money” patients give to doctors and nurses in the hope of getting improved or faster care.

“This makes our life unpredictable, which frustrates everyone, and junior doctors do not want to live and work in such a system,” Dénes noted. “Some government has got to be brave enough to change this soft-corrupt system.”

It’s up to us too

Dénes maintains that improvement won’t happen without citizen engagement. “Everybody needs to make it clear that the healthcare system is important enough to get more funds from the central budget, Dénes said.

“People can press their MP to make the government change some of its priorities.”

The Hungarian Resident Doctors’ Association does its part in raising awareness. It makes proposals based on surveys of its members, some of which have been taken up as government policy. As a member of a group called Honestly About Health Care, it has organized two demonstrations in 2015, but since not much happened as a result, now as a last resort a strike is being considered.

The campaign is dubbed “Two hours for your life”. “This is a plan of a two-hour-strike that would increase by one hour every six months, should the government’s attitude not change towards salaries,” Dénes said.

It is not only hospitals that are in trouble; there are 231 general physician (GP) posts vacant in the country, meaning that 300,000 people don’t have access to primary care. And those who do have GPs find them overwhelmed. On top of that, 30% are older than 65 and, since such positions are not popular with junior doctors, the situation is bound to get worse.

“Altering primary care will take around ten years and a lot of money. But afterwards it will save a lot for the budget,” Dénes said.

“Our healthcare services may fare better than those in Africa, but compared to Austria they are not so great. There are not enough nurses and doctors to ensure patients’ safety anymore. There is no time for hesitation.”