Hungary is experiencing a deepening crisis in healthcare, but it is possible for parties of different interests to work together
Over the past seven years Hungary has witnessed an over-politicisation of public services, including healthcare. Hungary has a tax funded, universal state healthcare system, but there has been a gradual switch from a social insurance (Bismarckian) model to a centrally controlled national health service. The country’s insufficient public spending on health (5.2% of GDP in 2017), low salaries, and deteriorating working conditions have meant that several thousand doctors and nurses have emigrated to the UK and Germany, leading to prolonged waiting lists for diagnostic tests and elective surgeries.
Driven by necessity, more and more people are turning to private service providers or paying for care out-of-pocket in public institutions. The current right wing government’s scope for action in health has been limited by the fact that while in opposition they gained political legitimacy through a massive anti-reform campaign and a successful referendum to abolish symbolic user charges. As a result, Prime Minister Orbán has neglected healthcare.
The Ministry of Health has been replaced by a Ministry of Human Capacities, which has health as just one of its several portfolios. Parliament does not have a health select committee. Public spending has brutally decreased. Consequently, both access to and the quality of health services has deteriorated, while demand for private health services has increased. The financial burden put on patients has grown, with out-of-pocket payment levels reaching one third of all health expenditures. More than 25% of low income households face unmet needs—a higher share than in most other EU countries (1). Not surprisingly, mortality that is potentially preventable given effective and timely healthcare is two and a half times higher than the average of old EU member states (EU15) (2). Only Albania has surpassed Hungary for the prevalence of “gratuity money” informally paid to doctors and nurses by patients in exchange for more attentive care (2).
Due to the lack of forums for democratic debate and independent media in Hungary, criticism of health policy remains mainly on websites and in everyday conversations. Therefore, one of the authors of this commentary (Gyula Kincses) turned to the 10 political parties with measurable support and asked them to appoint an expert to participate in drafting a jointly acceptable policy on health. The invitation was accepted by nine out of the 10 parties—only the ruling party (Fidesz) refused to join.
Nevertheless, the participants declared that they would only cover policy goals and did not want to tackle party politics. In the meantime, one more small opposition group has been involved. The 10 parties agreed on a position paper, (3) which sets out a common set of values and major strategic directions.
The document outlines several concrete commitments, which include restoring the Ministry for Health and the constitutional protection of social security, as well as improving healthcare resources by increasing health spending to the European average over a period of four years. The parties also agreed that the gratuity money system should be eliminated by increasing the salaries of health personnel, improving patient education, and creating legal payment options for surplus services. There was also recognition of the need for the transparent public reporting of health quality and performance indicators. An overarching aim is to increase life expectancy in Hungary over two parliamentary cycles (eight years) so that it is close to the EU average. The full document (in Hungarian) can be accessed here.
The referred working paper reflects WHO-informed principles of modern health policy, but as the ruling party Fidesz has not taken part in the negotiating process, there is no chance of the recommendations being implemented in the short term. However, courageous actions by professional and patient organisations can contribute to making these commitments a reality even if the current ruling party remains in power.
In Hungary there is strong division among political groups, and this has been the first case of opposition parties from the far right to the liberal left—with different views and ideological backgrounds—being able to develop a common position on a significant policy issue. At least some political forces understood that health should be withdrawn from the battles of party politics, and recognised the importance of evidence informed planning through joint learning.
This approach may reduce the risk of populistic promises in the upcoming election period and beyond. It has also shown that the deepening crisis in healthcare can create a common platform for parties of different interests to convene around. This development has proved that health can be a unifying issue in an era of polarised politics.
Mihály Kökény is a senior fellow of the Global Health Centre at the Graduate Institute of International and Development Studies, Geneva, and a lecturer at the University of Debrecen, Faculty of Public Health in Hungary (on global health and health policy). He was minister for health of Hungary (1996-1998, 2003-2004) and chairman of WHO’s executive board (2010-2011).
Competing interests: None declared
Gyula Kincses is an independent health policy analyst. He was secretary of state in the Ministry of Health of Hungary (2007-2008).
Competing interest: None declared
References:
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- State of health in the EU. Hungary. Country profile. Companion report. 2017. Available: https://ec.europa.eu/health/sites/health/files/state/docs/chp_hu_english.pdf (accessed on22 January 2018)
- Euro Health Consumer Index. Health Consumer Powerhouse, 2017. Available: https://healthpowerhouse.com/files/EHCI_2016/EHCI_2016_report.pdf (accessed on 15 December 2017)
- Közös céljaink és vállalásaink az egészségügy területén (Our shared goals and commitments in the field of health). In Hungarian: http://www.kincsesgyula.hu/dokumentumok/kozos_minimum_final.pdf (accessed on 15 December 2017)