Settling a Long Overdue Debt

Hungarian Prime Minister Viktor Orbán’s announcement that the government will throw its weight behind the massive salary increase proposed by the Hungarian Chamber of Doctors came as a huge surprise. Following the swift approval by Parliament of the bill regulating doctors’ salary increase, there is increasing doubt that doctors will accept the conditions set by the government in exchange for a bigger paycheck.

On October 6, Hungary’s Parliament approved a significant multi-stage salary increase for doctors starting next year. The move comes after Orbán’s surprise announcement on Saturday that the government and the Hungarian Chamber of Doctors (MOK) have agreed to raise doctors’ wages by an “unprecedented” rate and to “phase out” gratuity payments. The government submitted the bill on Monday and 24 hours later lawmakers passed it.

The initial plan
The rapid, seemingly unstoppable spread of coronavirus infections in Hungary may have been a factor in the Cabinet’s decision to increase doctors’ wages. Orbán warned that “the pandemic is on the rise and the trend will remain so until a vaccine is in hand.” Last week’s Brussels summit made it clear that a vaccine cannot be expected before mid-2021, he added. The country’s health care system is expected to come under enormous pressure as the number of daily infections increases and the rise in the average age of those infected means that more and more elderly patients will need hospital care.
The government agreed with MOK that such an effort will be impossible to maintain without a wage hike, Orbán said. The two sides have also agreed to “phase out” gratuity payments from the health-care system.
Under the original MOK proposal, the increases would result in significantly higher gross monthly wages, with a resident doctor earning HUF 687,837, while those working in the healthcare sector as a specialist for more than 10 years, would earn HUF 1,399,247 and those working as doctors for more than 40 years, would take home around HUF 2,380,057. According to the plans of the government, doctors would receive more than half of the promised salary increase from January 2021 and the remainder in 2022-2023. Doctors who receive a significant salary increase may temporarily be transferred to another institution and will not be allowed to take on a second job (i.e. run a private practice). The bill also stipulates that offering and accepting gratitude money will be punished.

Controversial solution
Differences of opinion started emerging immediately after the bill was passed. MOK argued that the bill differs in many respects from what had previously been agreed upon, while according to the government, no substantive change had been made, and the organization had agreed to all the additions.
While the Chamber agrees with the restriction on taking on a second job, they asked the government to lay out its terms and criteria in more detail. Many doctors voiced their concern regarding the restriction, as there are many who take on duties in other departments of a hospital and fear that they will not be able to continue doing this. The Chamber also noted that it disagrees with the paragraph that “a government decree may lay down additional conditions for the establishment of health service duties” for doctors because this gives the government virtually free rein to make restrictive provisions in the future. Meanwhile the government argues that the Chamber has essentially agreed to all the government-proposed amendments, Gergely Gulyás, head of the Prime Minister’s office told MTI.

Dilemma for doctors
The bill forces doctors to make an extremely difficult decision: either work for the state or run a private practice. Doing both (a widespread practice) will no longer be possible for most. The decision, in turn, will determine the quality of public and private health care service for millions of Hungarians. In addition, if doctors are not allowed to have a second job, the operation of some smaller rural hospitals may not be possible, as these are typically the places where doctors worked on a contractual basis. Even though salaries in the state system will increase considerably, many doctors are concerned that the workload will be severe (lack of staff, overtime, etc.), especially as it is unclear how many doctors will choose to remain in the state-run health care system. The decision of some doctors may also depend on the extent to which they benefited from the system of gratitude payments.
The government’s latest move upsets a poor balance in health care, which is based on extremely low wages, a huge workload, gratitude payments, the possibility of having more than one job, and the use of state health-care facilities for private practice patients. Many doctors are faced with a monumental decision that is set to shape of the future of Hungarian health care for decades to come.