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  1. #1
    Miklos is offline Elite Member 511 points
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    Hungary's patience running out over doctors' tips

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    >From the Financial Times

    Hungary's patience running out over doctors' tips
    By Christopher Condon
    Published: March 9 2004 4:00 | Last Updated: March 9 2004 4:00

    As the birth of his first child approached last August, Balazs Nyiro, a 26-year-old computer programmer from Budapest, pondered a riddle that faces most Hungarians wanting to arrange medical treatment: how much should I tip the doctor?

    In a public healthcare system where treatment is supposedly free, the historic practice of tipping doctors as a small symbol of gratitude has become a passport for better, faster service.

    Innocently, Mr Nyiro launched an internet forum seeking advice on how much to pay. But by raising the topic publicly he shattered a Hungarian taboo - and sparked a national debate over the ethics of gratuities and social and political clout of doctors in Hungary.

    By December, Mr Nyiro's website was one of the most popular in Hungary, illustrating how frustrated Hungarians are with their healthcare system and the increasing formalisation of the tipping process. The furious response from doctors also revealed that they were the greatest obstacle to reform, keen to perpetuate a system that rewards an elite few while draining state resources.

    Dr Lajos Molnar, a hospital director in Budapest and prominent advocate of reform, comments: "Finally, someone has declared, 'The emperor has no clothes'."

    Hungary's healthcare system is suffering from years of underinvestment.

    The ministry of health has put forward a set of minor proposals to allow supplementary insurance funds. These would allow for extra services, such as private hospital rooms, although they would not scrap the tipping system.

    But root and branch proposals to reform the heart of the healthcare system are needed, say critics: the tipping system illustrates that doctors are not accountable and patients are not given the choice or level of service that they are promised. Further reforms have been resisted by the Hungarian Doctors Chamber, concerned that they would threaten their authority and autonomy. It is fear of angering the doctors that is holding back policymakers, says Dr Molnar.

    The doctors' group says it opposes including any for-profit elements in public healthcare, to protect the equal treatment of patients. It defends accepting tips as long as doctors do not demand money up front. But Dr Molnar says unequal treatment already exists and that senior doctors are protecting a system that lines their pockets.

    The practice of tipping started before the second world war. Uninsured rural residents traditionally paid for medical services with small amounts of cash or in kind, perhaps with homemade brandy, fresh eggs or sausage.

    Even after the communists created universal medical coverage in 1952, peasants continued the custom as a gratuity. The practice spread but amounts remained modest. The arrival of the free market in 1989, however, changed that dramatically.

    As some Hungarians became wealthier, they transformed tipping from a small symbol of gratitude to a passport for better, faster service.

    Today there are no official rates, as Mr Nyiro discovered. A check-up typically runs to Ft2,000-Ft5,000 ($10-$24, E8-E20, 5-13) and a baby delivery Ft50,000-Ft100,000. An average monthly after-tax salary is Ft89,000.

    Hungarians pay an estimated Ft50bn to Ft100bn to doctors annually in tips. But fewer than 20 per cent of doctors collect more than 80 per cent of all gratuities.

    Gratuities also distort investment decisions. For example, hospitals have
    ultrasound machines and CT scanners in abundance - with access jealously guarded by senior doctors because their use typically elicits a tip. Meanwhile, many hospitals have filthy toilets.

    Eventually, says Dr Molnar, public frustration will force politicians to back
    radical reforms.

    But perhaps doctors have delayed that day, as well. Threats of lawsuits from physicians named on Mr Nyiro's website have prompted him to close it.

  2. #2
    Miklos is offline Elite Member 511 points
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    ...

    Sad, but true.

    The website (www.halapenz.hu) caused outrage in Hungary. The column above fails to mention that the website was officially shut down, as the government's ombudsman on data protection intervened to keep patients from continuing to publish the names of doctors and the amounts of tips (bribes) expected

    Just for comparison, this would mean that if ValueMD were a Hungarian website, it would have to shut down over any criticism of any med school. Say what you wish about America, the 1st Amendent is truly a great law. As a result, someone decided to copy the info on the original webiste and set up a .com website: www.halapenz.com

    Also, the article does not include the fact, that the communist government actively supported the policy during communism, to keep doctor's salaries low.

    Worst of all, the system works against young doctors who do all of the scut work and get very little pay. It looks like many new graduates with appropriate language skills will consider positions abroad in the near future, especially following EU accession this year.

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