For a Healthy Partnership

The PRIMUS Private Healthcare Providers Association was established in March 2017 by twelve key members of the domestic private healthcare sector with the intention of promoting the emergence of an ethically functioning, private healthcare sector that fully complies with patient safety requirements.

“When PRIMUS was established, our primary objectives were to clean up the sector,” the Association’s President György Leitner recalls to Diplomacy&Trade. “The big players formulating PRIMUS realized that there was an ‘uneven battlefield’ and set the objective of encouraging others to play by the regulations. They established a kind of certification process in which the operation of these companies is closely monitored (e.g. by surprise visits or audits) by third party firms, it is examined how patient-orientated they are, what service quality and professionalism they provide,” he adds.
While witnessing major changes in Hungarian healthcare, György Leitner believes it is important that the Association have a say in these matters and they can express their views, for instance, on how state provision and private care should supplement each other “because we believe there is synergy between these two rather than competition. We have already expressed our opinion on new taxation rules, like the changes this January in the KATA taxation, which influences our relationship with our contracted doctors very negatively.”

A changing private sector
The private healthcare sector provides for about 50% of the outpatient care in Hungary. Approaching this issue from the patients’ point of view, the President points out that more than 60% of the patients have visited private healthcare providers in the past two years. So, it is quite a widespread phenomenon, unlike 10-15 years ago when these kinds of services were the privilege of the rich – nowadays it is for ordinary people also. “In terms of money, we are talking about HUF 400-420 billion on an annual basis. It is a very fragmented sector: there are thousands of smaller or bigger providers and 60% of this turnover is generated by small ‘apartment clinics’ where there is only a single practice like gynecology or dermatology. In the past couple of years, there have been major developments with a lot of bigger providers emerging. These companies are now controlling roughly 25% of the total market. Over the next five years, we can expect a much more balanced private healthcare sector. There has also been a major change in terms of what services are provided. We all remember that 15-20 years ago, it was primarily gynecology, dentistry, dermatology and also some beauty care, including plastic surgery, provided by the private actors. The situation is not like that anymore. In the past ten years, basically all sorts of outpatient specialists like diagnostic imaging have appeared on the scene. Moreover, it is not only outpatient care but also inpatient services, like one day surgery or even more complicated types of even oncology or orthopedic surgery, are provided by the private sector, so, now it is more widespread and more integrated vertically,” he highlights.

More changes needed
Statistical data show that the Hungarian government is spending less and less of the country’s GDP on public healthcare. As to how much and in what areas private healthcare service providers can take advantage of this underfinancing, the PRIMUS President says that “yes, indeed, this state spending is one of the lowest proportions in the European Union, with below 5% of the GDP. Another 2-2.5% is spent privately, which is not so healthy from the point of view of accessing services. In the past years, especially since this January, there have been some changes in terms of salary increases for nurses and doctors – something that I think should be further increased. On the other hand, how Hungarians are spending their money on private healthcare is unhealthy as well because it is on an out-of-pocket basis and not on a sort of insurance basis where you pay a monthly fee and thus save for the time when you are really in need of services from a private healthcare provider.”

In need of private health insurance
As György Leitner notes, private health insurance in Hungary is in an embryonic stage. “All in all, the private Hungarian health insurance market is pretty small compared to the size of the country. Only corporate private insurance has achieved a certain level, so, it would be very much needed and required that a more mature individual private health insurance market emerges. There would be several criteria for that: first of all, there should be incentives by the state with tax holiday, for instance, for those who engage in private health insurance. There should also be developments from the supply side, although, it is a chicken or egg story: the medical service sector should also catch up, create a countrywide coverage and a nationwide product for private individuals. I hope that those in government will realize that this would be great supplement in terms of funding of the entire healthcare system in this country,” he explains.

The impact of the pandemic
“Many of the bigger actors in this sector play a part in providing healthcare for the public during the pandemic, including my company Affidea, a diagnostic imaging company, providing publicly financed services in several hospitals. We are basically operating under pandemic conditions in these institutions, so we take our share in this regard. The other element is how much burden we can take off the shoulders of the public health system during this unfortunate situation when patients are in need of care other than COVID-19. It is natural and understandable and the private sector offers its help and support to the state care system, sharing some of the burden by offering personnel and infrastructure,” György Leitner stresses.

Public-private partnership
Last November, it was raised at a healthcare conference in Budapest that there is an urgent need to rethink the role of private healthcare providers and the framework for their cooperation with the public health system. The PRIMUS President is of the view that there is certainly a willingness on the part of the government to have a clearer situation concerning a more transparent provision of public and private healthcare services. “However, there definitely are some areas where they mix. It happens when a doctor is taking his or her private patients into the public system and uses public infrastructure for the benefit of his or her own. That is not good. New regulations try to target and ban such activities. This is very positive. Another, more difficult area is when big private care companies are providing – and have provided for decades – services like diagnostic imaging, an accredited laboratory or dialysis, partnering with the state healthcare system on the basis of transparent regulations on prices set by the state. I do think that in these examples, this is a very positive and progressive partnership that we are hoping to maintain and even develop further.”