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Well-connected doctors benefit from the system

It is a commonplace practice to come down on the poor state of the Hungarian healthcare system and how badly it is financed. Still, as we found, there is plenty of money to go around for the doctors with the right relations. We unraveled a common practice that seems to be widespread across the whole country.

Healthcare centres – formally referred to as “health houses” – are meant to serve as a convenience to citizens, since they are a hub not only for general practitioners but also various medical specialists who may be needed for additional examinations. In the past, the financing was simple. The doctors working there signed a contract with the state health fund and got their compensation according to the treatments they provided. This income was used to pay assistants and to cover the rents for the health house premises.

Eventually, the doctors figured out ways to get their hands on more money. We conducted a case study in one specific town which we cannot name here as we are not in possession of all the evidence, and it would not currently stand up to court scrutiny. The practice is nonetheless an accurate portrayal of how money is syphoned out of the central healthcare budget.

The story we explored saw the town of a mayor set up a company, which was then approved to operate the health facility. The mayor is a doctor, so he had inside knowledge of the system. Our sources told us that the arrangement was in no way surprising, given the mayor’s extensive range of political contacts.

After renovations to the building, many GPs were ousted and new specialist practitioners were invited. They signed their respective deals with the company rather than directly with the state.

This new arrangement now allows for a range of options enabling them to stick their hands in the till. For instance, a sick child is brought in for examination, the doctor tells the mother that treatment is available, but there is a waiting list that is several months long, the doctor then offers the mother the chance to do the test or the treatment in his private practice much sooner, however, this isn’t covered by the state insurance. Patients are generally easily convinced to take this option. However, should they try to look into the details of their social security spending which they can do through a dedicated government portal, they would often find that the doctor also charged the private treatment to the state fund, thereby receiving double pay.

Having the full range of specialist practitioners under single control also allows the doctors to “rotate” patients. Elderly people are especially susceptible to having their district doctor prescribe a cardiology screening, for example. The cardiologist then may find it necessary to send the patient for a psychological evaluation as well, and so on. The costs of the various treatments and tests are charged to the state fund and allows additional money-taking by integrating with the private practice offers.

The system can also work the other way. If doctors refuse to fall in line, their colleagues may then easily suffocate their practices by never sending them any patients for treatment, and drying up their funding in the process.

The practices are well known, but given that they often take place in small towns where everybody knows one another, people are cautious and avoid angering those in power, so there are never any complaints.

Original article in Hungarian

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