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The Budapest Sun's columnist, Paul M. James shares his embarrassment, caused by a unique phenomenon of the Hungarian health care.
One of the first curiosities an expat (funny how we don’t use the term foreigner or immigrant, isn’t it?) comes across in Hungary are the local peculiarities involved in seeing a doctor. Now I am not talking about the quaint, somewhat metro sexual, white clogs (eh?) that male doctors wear accompanied by open-neck shirts revealing greying, hairy chests and gold medallions. Indeed, on my first visit to a hospital, I thought I had run into an audition set for Saturday Night Fever. Nor I am referring to the female doctors who appear to take great delight in wearing a certain type of transparent trousers which best exhibits their VPL (In certain cases, this could produce false blood pressure readings).
No, I am writing in regard to the tradition that a consultation with a doctor or surgeon normally involves the payment of a gratuity (hála-pénz). For instance, when my wife was pregnant she would pay her gynaecologist an amount each time she consulted him before the birth, actually on twelve occasions, and a much larger sum after the birth. The amount which should be paid is open to conjecture but is usually arrived at by talking to friends. A website also exists that informs you of the expected payment for different types of operation. Effectively, therefore, one pays twice both in National Insurance Contributions and cash.
Once you establish contact with the kind of doctor you need, easier said than done in that many seem to be both monumentally busy and in a constant state of movement, the question of gratuity rears its head. For a greenhorn patient, the first encounter can be a little, shall we say, embarrassing.
I remember putting the money into an envelope (to cowardly disguise the total in case it was too low), laying it on the desk between us and offering a long-winded, mumbled account of how I had heard about the custom of handing over cash. My doctor remained po-faced but responded with a slight rising of the eye-brows and the quick-handed swiftness of a professional magician and, before you could say abracadabra, the money had disappeared into thin air. Indeed, there is an old Hungarian joke that goes something like this:
Doctor: “Did you put something in my pocket?”
Patient: “No!”
Doctor: “Why not?”
Obviously, this somewhat seedy money transfer is equally humiliating for the doctors and, when one thinks of both the training and huge level of responsibility they undertake, one feels genuine sympathy for their predicament. Successive governments have systematically failed to raise the level of real salaries in the Health Service, conveniently letting the burden of payment fall onto the patient.
However, as is usually the case in Hungary, alternative views persist. Some politicians argue that it is difficult to reform a system where entrenched people in key positions, with good, established reputations and thus a high rate of referral, actually do very well from the status quo. A friend of mine has a father-in-law who is a well-respected eye-specialist. In addition to his weekly consultation fees, he normally carries out around twenty-four operations a week, mainly in removing cataracts, and is given between thirty and fifty thousand forints a time. I don’t think I need to do the maths for you. Senior Gynaecologists and Cardiologists may be able to expect double this amount.
Of course, the great majority of Health Service employees are not so fortunate and carry out their jobs in difficult, stressful circumstances which bear little comparison with their counterparts in Western Europe and the U.S. The dedication and ethical values of these people keep an imperfect system alive in the face of poor rewards and excessive workloads.
Paul M. James
21.11.2008
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