Hungarian Health Reform: Back to the Future?

Hungary's so-called "reform" in the health sector has the potential to do more harm than good

It has been over a week since one of the most contentious parts of Hungary's health reform package thus far -- the so-called visit fee -- was implemented. Although the mass media paid close attention to its effects, the introduction of this latest aspect of Hungary's health care reform was an anti-climax of sorts. Most people were resigned to the fact, and although there was some confusion here and there, generally the visit fee system was implemented without any major problems.

This is not to say, however, that people aren't upset by it. Media reports calculate that the system costs more than it would actually bring in because of the extra administration and, for large hospitals, the additional investment of special machines as well as computer hardware and software. Indeed, some have pointed to a blatant conflict of interest when it was revealed that a company in where the Economics Minister was formerly employed happens to produce these special machines.

Aside from this, there is the actual cost to the end user. Although the government claims that the visit fee is nominal, for many it's not so. At present the visit fee is 300 HUF, which is approximately 1.20 EUR or 1.50 USD which, in fact, is not that much. Yet a person doesn't always simply go to the doctor and then return home cured. Take, for instance, the following scenario: a person goes to the doctor (visit fee: 300 HUF) who then decides that a blood test is necessary. The next morning the patient returns to the hospital for the blood test (visit fee: 300 HUF). Naturally, the blood test isn't ready immediately, so later he revisits the doctor (visit fee: 300) who concludes that the problem isn't serious, yet writes out a prescription for antibiotics (prescription fee: 300 HUF). This scenario isn't uncommon, and in the end this nominal fee turns out to be not simply 300 HUF but 1,200 HUF.

According to Agnes Horvath, the state secretary for the Ministry of Health, the ultimate purpose of Hungary's health reform is to "bring the country's health sector up to the 21st century". Yet it's ironic that the government is actually going in the opposite direction, using archaic -- some would even say Draconian -- methods in order to achieve its objective. For example, one of the main points of focus for Hungary's health care reform is to reduce the amount of money the state spends subsidising medication. One "innovative" idea is to fine doctors for not prescribing the cheapest medication, even though the doctor may feel that another, more expensive medication with the same active ingredient would be better. Likewise, pharmacists are also fined if they are unable to provide such medication and recommend another, more expensive type. How using archaic methods such as penalising doctors for not prescribing the cheapest medication will modernise Hungary's health care system remains to be seen.

In conjunction with this, the implementation of a prescription fee and visit fee appears to be a simplistic approach to solving the problem of Hungarians using too much medication and going to the doctor too frequently. While from a strict business perspective such fees may seem to make perfect sense, charging "nominal" fees for medical services and medication avoids the real question of why people in Hungary use the health services and take medication so often.

Whether the government wishes to admit it or not, the population is very sick. This has been proven time and again in myriad statistics conducted by the ESO (European Statistical Office), the WHO (the World Health Organisation), the OECD, the UN, and others. Hungary is akin to most third world countries when it comes to health; the state of health of the average Hungarian male, for instance, is at 1927 levels. Meanwhile, Hungary's standard of living has plummeted to levels not seen since the late 1970s (ironically, Hungary in the early 1970s was more or less equal to Austria but has since fallen behind substantially). Thanks to lax environmental laws which have poisoned the air and water throughout the country, coupled with an overly competitive business culture in which stress is regarded as a necessary evil, such statistics aren't all that surprising.

In addition to this, one reason why Hungarians end up popping so many pills has to do with the government itself. More could be done to reduce the use of medication by banning the advertisement of medications on state radio and television. Indeed, the Hungarian state radio station Kossuth Radio appears to advertise nothing else; it perhaps would be more appropriate to call it Big Pharma Radio. It seems as long as Hungarians consume over-the-counter drugs which aren't subsidised by the state, popping pills isn't a problem.

Aside from this, Hungary's health reforms may end up actually posing a threat to public health. Epidemics and the spread of contagious diseases are much more likely since some people will now think twice about going to the doctor in order to save money. Hungary already has a bad record in this respect: Salmonella is twice the European average and there are frequent outbreaks of contagious diseases, such as hepatitis.

While the stated goal of Hungary's health reform is to make health care more efficient, it's clear that the introduction of various user fees, no matter how "nominal", is a guise in order to get people accustomed to a private, "user pays" health care system. In other words, the government is gradually weaning people away from the concept of universal, state-sponsored health-care and pushing them toward a fully privatised, pay-as-you-go health care system.

Health-care reforms a cover for property speculation

Yet this is only one aspect to the health-care reforms initiated by the government. There is another, more knavish one which has to do with the closing of hospitals.

The government has decided to significantly cut the number of beds, arguing that nation-wide hospitals are actually under utilised. As a result, it has proposed a programme for rationalising the amount of hospital beds available. This means some hospitals and medical institutions will close.

The problem here is there appears to be no clear criteria about which institutions would close and which would not. In some cases, as with the Hungarian Railway Worker's hospital (known as the MAV hospital), not only is the institution operating at full capacity, but in terms of its operating budget it has no debt whatsoever. Not only this, the hospital was built using contributions from the railway workers, thus it didn't rely on the state for funding.

There are myriad other examples of hospitals and institutions which have been threatened with closure for no explicable reason. In some cases, as with the Sport hospital in Budapest, it had undergone an expensive renovation and modernisation programme which is yet to be finished. Many hospitals and institutions are in a similar situation: after spending millions on recent renovations, they now face closure.

According to media reports, one reason for this wave of closures is property speculation. Most people believe that the so-called "reforms" are a cover for government plans to sell off prime real estate to the highest bidder. Considering that hospitals in Budapest slated for closure, such as the MAV, the Sport, and the Children's Sanatorium, are all located on prime real estate, that is, either in the Buda hills overlooking the city or conveniently located within the city itself, it's hard for people not to believe that some sort of wheeling and dealing is going on. Also, since there doesn't seem to be any clear nor consistent criteria for these closures, the feeling that this is all being done for the sake of property speculation is that much stronger.

This is all the more incomprehensible to those who had lived through the depression and the years prior to the Second World War. Hungary was a poor country then -- much poorer than today -- and yet not only was it able to maintain many hospitals, it was even able to build new ones. Furthermore, what most people are unable to understand is what kind of "reform" actually destroys instead of improves. As far as most Hungarians are concerned, things will get worse in terms of health care, not better.

In the end, the introduction of archaic and Draconian measures coupled with unclear objectives and criteria have all contributed to a negative view of Hungary's health care reform. Indubitably, most are aware of the need for reform, and support progressive moves in this direction. But not in the way it has been going so far. For most, Hungary's health care reform appears to be taking a step in the wrong direction.

Unfortunately, for seniors and those who are middle-aged, the damage has already been done. Their health has been ruined by the decline of communism and the advent of capitalism. Introducing various user fees and closing hospitals will do little to change the situation; these generations must slowly die out. The least the government can do is to allow them to live the rest of their lives in dignity.

In the meantime, however, there are the younger and upcoming generations to think about. Yet what they need now isn't less investment in health care, but more. Moreover, this investment should be a multi-faceted, with emphasis on education and living a healthy lifestyle so that they won't be ask sick as their parents. In turn, they won't need to rely on health services or medication as much as their parents do.

Health care reform is a long-term approach which requires foresight and innovative thinking. Sadly, as the education sector is going through their own set of reforms, with similar narrow-minded and short term objectives which focus on economic rationalisation (in the form of school closures) above all else, the likelihood of this happening is not very high. (John Horvath)