Summary
What could we done in order to eliminate gratitude payment problem from the Hungarian healthcare system?
Giving gratitude payment, or even bribing doctors is a real Hungaricum though it does not only exist in Hungary. This habit came to existence with the 1958 economic reforms in the socialist era when the government lowered the salary of medical workers.
The change of system did not treat the situation. Except for slight reforms in the healthcare system, bribing or giving gratitude payment to doctors is even nowadays a common phenomenon.
Even physicians from other EU-member states are unable to understand the concept of the bribe and even less to understand why do Hungarian medical workers tolerate this shameful situation.
Salaries of Hungarian physicians are far less then those in Western Europe. On the contrary, gratitude payment is only the privilage of the few. Dr Géza Gyenes chief secretary of the Hungarian Doctors Chamber said in an earlier interview that Pareto Principle came into effect concerning gratitude payments: 20 per cent of Hungarian doctors are lucky enough to get the 80 per cent of the whole amount given by patients.
Amongst the few private initiatives aiming at erasing healthcare from bribing and gratitude payment the site http://www.halapenz.hu/ was the one that came into light most and generated a long-lasting debate. It was estabilished in January 2004. The site was dedicated to mother-to-bes helping them to find the most suitable obstetritian of their needs and also included a guide for their bribe-rate. As the debate the site created among politicans and medical workers, it was only for a short period accesable on the internet. Dr Attila Péterfalvi, Parliamentary Commissioner for Data Protection and Freedom of Information, conducted an investigation on the liability of the homepage and finally found it illegal. In his opinion, the database with bribe-tarifs was published without the agreement of the doctors enlisted and in addition, without a legal autorization. Following the statement the homepage was shot down by the then owner. As a result the violation of law ended.
Dr József Telkes, after taking over the homepage opened a forum free to the public to generate a brainstorming to summarize public views on gratitude payment and also to find a solution to eliminate it from the Hungarian healthcare system. With the brainstorming they also succeeded in estabilishing an internet-based communication system that allows members to discuss their views on the products, services and institutions they meet in their everyday lives. As no database was created and the system itself is closed to the public and each member is responsible for the ‘authenticity and credibility of the experiences’ they share with others the new http://www.halapenz.hu/ site – hopefully – meets all the requirements of data protection in all aspects.
Recommendations for solving the problems
Giving gratitude payment, or even bribing doctors is a real Hungaricum though it does not only exist in Hungary. This habit came to existence with the 1958 economic reforms in the socialist era when the government lowered the salary of medical workers.
The change of system did not treat the situation. Except for slight reforms in the healthcare system, bribing or giving gratitude payment to doctors is even nowadays a common phenomenon.
Even physicians from other EU-member states are unable to understand the concept of the bribe and even less to understand why do Hungarian medical workers tolerate this shameful situation.
Salaries of Hungarian physicians are far less then those in Western Europe. On the contrary, gratitude payment is only the privilage of the few. Dr Géza Gyenes chief secretary of the Hungarian Doctors Chamber said in an earlier interview that Pareto Principle came into effect concerning gratitude payments: 20 per cent of Hungarian doctors are lucky enough to get the 80 per cent of the whole amount given by patients.
Amongst the few private initiatives aiming at erasing healthcare from bribing and gratitude payment the site http://www.halapenz.hu/ was the one that came into light most and generated a long-lasting debate. It was estabilished in January 2004. The site was dedicated to mother-to-bes helping them to find the most suitable obstetritian of their needs and also included a guide for their bribe-rate. As the debate the site created among politicans and medical workers, it was only for a short period accesable on the internet. Dr Attila Péterfalvi, Parliamentary Commissioner for Data Protection and Freedom of Information, conducted an investigation on the liability of the homepage and finally found it illegal. In his opinion, the database with bribe-tarifs was published without the agreement of the doctors enlisted and in addition, without a legal autorization. Following the statement the homepage was shot down by the then owner. As a result the violation of law ended.
Dr József Telkes, after taking over the homepage opened a forum free to the public to generate a brainstorming to summarize public views on gratitude payment and also to find a solution to eliminate it from the Hungarian healthcare system. With the brainstorming they also succeeded in estabilishing an internet-based communication system that allows members to discuss their views on the products, services and institutions they meet in their everyday lives. As no database was created and the system itself is closed to the public and each member is responsible for the ‘authenticity and credibility of the experiences’ they share with others the new http://www.halapenz.hu/ site – hopefully – meets all the requirements of data protection in all aspects.
Recommendations for solving the problems
Revising doctors’ salaries
The benefits of psychicans should be calculated accordingly to the social requirements they face. First and foremost, the main objective should be a payraise as their average salary right now is far less than the EU average.
On the one hand, the main motive of giving gratitude payment is the lack of an adequate and publicly available quality insurance. Consequently, patients want to buy high quality examination and treatment.
On the other hand, the motive of acceptance of gratitude payment is noting more but the general need of money. According to doctors it is difficult to reject it while their collegaues in the UK can earn at least three times more, in France six or seven times more than the wage of workers. In Hungary there is no such a great difference. The only thing Hungarian doctors can do is to keep trying to tolerate the continous inflation of their salary which they try to compensate by accepting gratitude payment.
The need of legal sanctions
An appropriate legal sactioning might have a blocking effect on receiving and giving gratitude payment.
On the forum, one of the most supported ideas was the need of legal sanctions and proper punishment of both giving ang getting gratitude money. As for the members it should result in a consistently severe punishment both in the case of the doctor and in that of the patient. A treatment which threatens the life and health of the patient, which is not properly conducted or postponed due to the lack of gratitude payment, should result in a criminal suit. However, law should differentiate between the bribe which is asked for by the doctor before the treatment and the literally gratitude payment given by a satisfied patient after the therapy.
Members of the forum disagree that instead of mopping up the government looks at gratitude payment as a potential source of revenue and intends to lay a tax on it.
Medical workers should pin up a ‘No Para’ badge to show that they have joined the group of those against gratitude money. (The word ‘para’ comes from the abbreviation of the Hungarian word ‘paraszolvencia’ which originates from the Greek ‘para’ – and the Latin ‘solventia’. It means gratitude money in Hungarian.)
Two-level healthcare service
‘Besides unarguable advantages of the free-of-charge healthcare system it can also end in a lack of attention to people’s own state of health. Why taking care if they are cured in any circumstanances?’
Members of the forum agreed that a two-level healthcare service would also contribute to elinimate gratitude money from the doctor-patient relationship. As an idea copying the Belgian healthinsurance system came into light. Fulfiling that a consequent standardization of out-patient care is needed, including the services everybody can get for free and the group of additional services what they need to pay for.
It also presumes a reforming of the Hungarian National Health Insurance Fund (Országos Egészségbiztosítási Pénztár – OEP). In an idealistic health insurance system the ‘health tax’ paid would be bookkeeped on an individual basis, this way people in question can get a quasi invoice from the treatments they got and from the rate the treatments represent. Additional services not included in out-patient care have to be paid for. This also results a transparency in the work of the Hungarian National Health Insurance Fund.
New investments to reform Hungarian healthcare
Members of the forum find the recent system unacceptable in which the ‘health tax’ paid by only one third of the people covers the insurance of the whole population.
The remedy to the recent situation can be both a complete structural change and new sources of investment. As an idea funds such as excise tax on insanitary products and VAT-s should be built in the healthcare financing system.
Private capital can be used for expenditures, structure and service development, members of the forum suggest. They would also give a green light to the estabilishment of alternative health insurance companies. With a radical and more centralized change in using state resources the effectiveness of the structure could be increased significantly.
Ratification of the Act on the legal status of the Doctors in Hungary
The bill introduced by the Hungarian Doctors Chamber is essential to the elimination of the existance of gratitude payments. By the help of the bill the recently in effect but also obsolate act concerning the legal status of medical workers would be set in order. According to the members of the forum creating the freelance physician status would result in a ‘revolutionary‘change in the Hungarian healthcare system. Another change could come with the opportunity to a direct contract between the Hungarian National Health Insurance Fund and family doctors. That means eventually that any kind of payments doctors recieve would be given directly by the fund itself.
Prevention
An efficiently functioning healthcare system with lower expenditues can take the burden off doctors and that of the infrastructure itself. That can be achieved only with a significant improvement of the quality of people’s lives. The goverment should sponsor health-prevention programs, including environmental and occupational safety projects, amongst others. Non-profit service clubs are also worth finantial aids.
posted by Jóska at 2:14 AM
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