The healthcare system has always been one of the most crucial points of a country’s social security, especially in Hungary’s case. In the last 15-20 years the Hungarian healthcare system went through a lot of changes and the general consensus is that despite the state insurance, the services aren’t sufficient. However, according to satisfaction surveys, the public opinion is still positive, despite worsening to some extent.
Nevertheless, the health statistics doesn’t necessarily provide us such an optimistic picture. What has happened in the last two decades? Is it a Hungary specific problem or does the whole EU face similar difficulties? And what are some predictions for the future? In this article, we will try to find the answers to these questions.
How Does the Hungarian Healthcare System Work?
First it is important to get to know the Hungarian healthcare system. The legal foundations of the current system were introduced in 1997. All Hungarian citizens are provided with free healthcare services at all ambulatory and secondary hospitals regardless of their employment status. This is funded by the National Health Insurance Fund of Hungary (NEAK) and by the taxes of Hungarian employees (7% health insurance). However, there are some services that require co-payments, for example pharmaceuticals and dental care. Overall, most health care services in Hungary are free because they are supported partially by taxes.
The system theoretically works, however in practice there are numerous problems. First things first, the salary of doctors wasn’t adequate. Fortunately, during the last couple of years they have been increased by a large margin, but this serves only as a greater motivation, because the circumstances haven’t really changed. A respectable number of physicians also work abroad for these reasons.
Another vital part of the problematic healthcare system is the condition of hospitals. News and articles regularly feature crumbling, unhygienic and overall old buildings. One of the most notorious instances is a quiz, in which the reader has to decide if the pictures are from Chernobyl or from a currently operating Hungarian hospital.
The lack of doctors and technologically undeveloped hospitals lead to our most recent issue: the waiting lists. Initially waiting lists affected mostly bigger operations, but nowadays even getting an appointment to an X-ray or a dermatology examination can take months or worst-case scenario years.
As might be expected, there is also the option to seek out a private clinic; however, the prices are relatively high, at least compared to Hungarian wages. For example, a visit or consultation with a private doctor costs at least 50 euros which equals ca. 15 hours of work, while special surgeries can be easily priced at multiple thousands of euros.
As I said in the beginning, the public opinion is mostly negative, especially outside of Budapest, where the mentioned problems lead to shutting down departments e.g., pediatric and maternity wards. Despite these loud voices, according to the very few satisfaction surveys, most of the patients are satisfied with the state healthcare, giving it 71 points out of 100. In a 2001 survey, this rate was 79%.
What Do Statistics Say?
These cases might sound concerning, but what do statistics actually show? First, is there even any data we may consider as reliable regarding a country’s healthcare, and if yes, what are the best methods to research the quality of it?
One of the ways of measuring is with the help of crude death rates and life expectancy at birth rates. Crude death rates show us deaths per 1000 population, with this method we can compare countries with different overall population. For example, comparing the crude death rates of the EU and Hungary, we can see that the Union’s death rates were lower during the Covid (2020-2021), around 11.5 and 13%, while Hungary’s rates were almost always higher since the 1980s (ranging from 13 to 16). Life expectancy at birth rates gives us comparable results: the anticipated age in the last 20 years in Hungary was between 72 and 76, meanwhile in the EU’s score ranged from 73 to 80.
Death rates can be further analyzed with the help of causes of deaths statistics, which show what type of diseases or conditions are responsible for mortality. Unfortunately, Covid acted and still acts as a disturbance in the statistics, so for this reason, I will include data regarding Covid separately in a later section. By 2020, over 50% of deaths in all EU countries were caused by either circulatory diseases or cancer. The EU average rate reached 60%, while Hungary’s was around 70%, placing overall sixth among all EU countries.
These percentages might not show us an obvious conclusion, so further examination of standardized death rates for avoidable diseases / conditions may be necessary. First, it is important to mention that there are two main types of avoidable causes of mortality: preventable and treatable causes. According to Eurostat, by 2020 Hungary ranked overall as the third country with the highest standardized death rate for avoidable diseases / conditions in the EU.
In fact, for preventable mortality, it’s in second place, while in the category of treatable causes, it got placed as the fifth highest. These results where similar in 2017, the only difference is that Hungary held the first place with the highest preventable causes of mortality in the European Union. Altogether these data mean that the Hungarian healthcare absolutely could improve in avoiding (treating AND preventing) potentially lethal diseases.
Another potentially crucial information for us are healthcare personnel statistics, especially number of general medical practitioners and medical doctor graduates per 100 000 inhabitants. According to the 2021 doctor-patient rates, Hungary has the fourth lowest rate with 66,82 per 100 000 residents, while Portugal having the highest rate with 298.
Interestingly, the rates of graduates show us a different picture: Hungary’s score is above the EU average by a small percent, being among countries like Portugal, Austria, and Netherlands. The reason for this anomaly might be the migration of Hungarian medical practitioners. In the manner of a 2021 survey, in 2017, 16% of doctors younger than 40 left the country. Nowadays wages aren’t the main cause of this problem, but the condition of the Hungarian healthcare system.
Our last statistical component is the health expenditure as a percentage of GDP, which shows how much percent of the gross domestic product (GDP) was used for healthcare. Hungary spent 5,6% of its GDP for healthcare in 2021. This means that it was the fourth lowest in the whole EU, scoring really close to countries like Romania, Ireland and Luxembourg. For comparison, the EU average in 2021 was 8,1. Overall from these statistics we can see that Hungary performs worse than the EU average not just in death rates, but in life expectancy, causes of deaths, GDP expenditure and even doctor-patient rates.
What Did(n’t) Happen in the Hungarian Healthcare System in the Last 20 years?
The results of these statistics don’t provide us a positive picture about the Hungarian healthcare system, but what can be the reason(s) behind these numbers? For the answer(s) we have to explore the last 20 years of Hungary, mostly the period between 2002 and 2009, the last 2 terms of any left-wing government in Hungary and the Orbán regime from 2010.
It makes sense to start reminiscing with the 2004 referendum. During this time the governing party, the Hungarian Socialist Party (MSZP) was an advocate of giving out the control of hospitals to private companies to potentially raise the quality of the healthcare system. The main opposition, Fidesz (led by Viktor Orbán) raised objection against this future measure and eventually submitted a referendum petition. The final results showed that 65% of the voters were against privatization of hospital, so they remained state property.
The next vital milestone took place between 2006 and 2008. The Hungarian Socialist Party won again, this time the 2006 election, however, the health insurance fund didn’t meet the costs of the healthcare system. For this reason, the government had to support it from the central budget. This action wasn’t enough, and the remaining deficiency still was ca. (calculated via the 2007 euro-Hungarian Forint exchange rate) 420 million euros. To compensate the deficiency, the government established the so-called „visit fee.”
The visit fee’s purpose was to reduce the number of doctor-patient meetings. The visit fee’s price was around 1 euro per visit. There were cases, when this fee wasn’t required e.g., for underages; military personnel, for annual lung screening and others. According to some, visit fee could have been a great option against gratuity, however, the general consensus was furious about this action and eventually another referendum was held in 2008.
Besides the visit fee, the referendum contained another controversial topic: the hospital per diem rate to not to hold patients for an unnecessarily long time in the hospital. Due to the results of the referendum (84 and 82% of voters were against these actions) both measures were withdrawn. These fees remained to be the greatest criticism against this government and certainly were crucial topics for the next elections and eventually the downfall of the Hungarian Socialist Party.
The 2010 elections were dominated by Fidesz and its’ new coalition party KDNP, getting 68% of the votes. Unlike the previous government, Fidesz-KDNP started a grand-scale hospital socialization. Surprisingly, the new government discontinued the Ministry of Health, and it was merged with the Ministry of Human Resources, which was eventually fused into the Ministry of Interior in 2022. This means that for 13 years now, there is no Minister of Health, just a Secretary of State.
The healthcare system was seldom changed in the next few years, which resulted in the slow deterioration of the system. The most notable shortcomings of it are the previously mentioned long waiting lists, lack of doctors and old buildings. These were crucial problems before 2020, but then COVID-19 came and made things much, much worse.
The already overwhelmed Hungarian healthcare system suffered during the pandemic. There are a lot of sources for statistics, but overall Hungary is almost always in the top (or I should say worst) 5 countries with the highest mortality rate. According to official data, more than 48 thousand people died because of the virus in Hungary, which has a total population of 9,7 million people. However, the government led by Viktor Orbán made a huge business out of the pandemic. The first case is about mechanical ventilators, from which the government bought 17 thousand for ca. 900 million euros. The details of this deal are still unclear because the official documents likely got destroyed in 2021.
Allegedly, the machines were never used, because they didn’t correspond to EU regulations and there were not enough experts to operate them. Another incident was the vaccine case, in which Hungary bought 5 million doses of the Sinopharm vaccine for a whopping 30 euros each (150 million euros total), which is double the price of Pfizer-BioNTech vaccines purchased by the EU. This was reinforced by an official contract, which stated that the vaccines were obtained via a third-party company. Overall, the pandemic was a chaotic period for the Hungarian healthcare system, and it still hasn’t recovered totally from it.
Contrary to the 2010s, since COVID-19, the healthcare system has changed and still changes significantly. One of the first act was the criminalization of gratuity, which can lead to imprisonment since 2021. The government tried/tries to counter this issue by increasing the salaries of the doctors, but on the other hand, the circumstances of practicing got much worse. For example, since 2023, medical practitioners must work 20 hours per month in the state healthcare system to maintain their medical license. This measure means that the government practically admits the lack of doctors in the system. Furthermore, until the end of 2023, all state hospitals will be equipped with an access control system to monitor the working hours of medical practitioners.
The most recent and still in-process act is the modification of the general-practitioner services and duties. Prior to 2023, there were around 300 (medical) duty centres in the country, but with the new law, eventually only 102 would remain. Furthermore, from the start of 2023 until 2028, all GP services of towns with population under 1200 will be discontinued. These GP services and duties will be the task of the ambulance, which is already overwhelmed and there are multiple cases, when it took an hour or even multiple for the ambulance to arrive.
And at last, in recent days, a new healthcare related controversy came into view via an article published by investigative journalists of Direkt36, which covers the topic of HAIs, Healthcare-associated infections in Hungarian (mostly state) hospitals. The official reports of hospitals states that around 16 to 20 thousand patients get infected and furthermore, almost half of these result in death.
However, according to research conducted by the ECDC (European Centre for Disease Prevention and Control) in 2017 (before the pandemic!), more than 78,000 (quadruple of the results of the official reports) HAIs happen annually in Hungary. This means that the Hungarian government doesn’t notice or (more likely) doesn’t handle the problem properly, while still communicating the efficiency of the healthcare system. For example, the likeliness of HAIs between 2019 and 2021 nearly doubled. Essentially, one in 25 hospital patients get infected during their stay. However, the case is still running and by time, more and more information will be revealed and hopefully, the government will also take these into consideration.
Conclusions
Looking at the statistics and the last 2 decades of the Hungarian healthcare system, we can safely say that it was controversial throughout. The government’s main goal with it usually was to make more profit, especially during the covid pandemic. However, in the recent years Viktor Orbán’s decisions have been turning the system in a totally new direction. It seems like the mentioned new acts misinterpret the problems and focus on questionable solutions.
Forceful centralization may not be the best means to raise the rate of doctors. Furthermore, cutting down the number of GP services and duties might not be the a good motivator to get citizens to go to much-needed checkups or to vote for a government who has no regard for public health, for that matter. These measures could be reasonable ideas for saving money, but by observing the business cases of the current government, cost-effective acts may not be the strength of the Orbán regime. Overall, the Hungarian healthcare system is unstable, fragile and the future of it is exclusively in the hands of leading politicians.
