Kester Eddy in Budapest -

When, in the spring of 2012, news came through that the department in the Budapest hospital where he worked was to close, Dr Gabor was forced into a decision. “I was a relatively young specialist. I had two options: either to go back and start again from zero, working my way up – or I go abroad. The latter had been a possibility, in the back of my mind, for some time,” he tells bne IntelliNews.

Attracted by promises of good conditions and a salary several multiples that of anything legally available in Hungary, Dr Gabor – he declines to reveal his surname – sent off his curriculum vitae for a job in Sweden. “It was a case of now or never,” he says.

Nine months later, having negotiated several interviews and successfully completed a gruelling, 16-week intensive Swedish language course, Dr Gabor, along with his wife and two children, began a new life in Scandinavia. Despite some aspects of the deal turning out a little less rosy “than it read in the brochure”, he has “no regrets whatsoever” with the move, he says.

A personal success, no doubt: but Dr Gabor's emigration is part of a wider trend in Hungary with potential social, economic and political implications.

Exodus

Certainly for Tamas Denes, president of the Hungarian Residents Association, a grouping of doctors seeking reform in the healthcare sector, it is story heard all too often. “There has been an exodus of healthcare staff into Western Europe and even the USA. The biggest problem of the system in Hungary right now is the lack of nurses and doctors,” says Dr Denes, a general surgeon who, somewhat ironically, graduated in his native Romania before emigrating to Hungary.

The fundamental reason for the exodus – which Denes estimates equates to an average loss of 1,000, often younger, doctors annually over recent years – is the appallingly low salaries, along with working conditions in the Hungarian public healthcare sector. “The average monthly take-home pay for a doctor [of ten years experience] is around HUF150,000 (€500),” he says. “In 2011, we have conducted a survey doctors working abroad, asking why they left and why they have not returned. The first answer was always low salaries, and the second the working environment.”

If anything, the situation for nurses is even worse, with an average monthly take-home check of around €400, according to Laszlo Kiss, president of the Independent Healthcare Union. “They have to raise salaries, nurses are leaving. The sector is missing about 24,000-26,000 staff, around one-third of its full complement. The depleted staff are terribly overworked,” Kiss, a veteran of 38 years in the sector, tells bne IntelliNews.

The result of the staff shortages is long waiting lists for operations, otherwise dedicated healthcare staff frustrated and dispirited, and, ultimately, a genuine risk to lives of patients, says Dr Denes. “Nurses are the front line of medical care, but often there are not enough on duty, especially at night. If they don't call me, I shan't see the patient. But patients often don't understand, they don't feel any danger. They see someone [a medical worker], but often these are not properly trained specialists [needed for that patient's conditions],” he says.

Given the often desperate state of affairs, it is little wonder that illicit payments in the form of so-called 'gratitude money' continue to be widespread, further complicating healthcare issues – making some in the service considerable sums and creating vested interests opposed to reform. “Politicians tell us: The doctors? I play tennis every weekend with a doctor, and he is a millionaire! This is what they see. This is the level [of doctor] they meet,” says Denes, who admits that, given such encounters, it is little wonder politicians are reluctant to further fund healthcare spending.

Improving pay

Asked to comment on the sector for this article, the Ministry of Human Resources, which now oversees the health sector, responded with a detailed, if somewhat bewildering, list of measures it says have been, or will be implemented to address the challenges.

These vary from the largely symbolic – such as declaring July 1 a holiday for health workers – to the more substantial, such as salary increases implemented in 2012 and 2013 that lifted the monthly payments for those with university degrees by some HUF41,000 (€140), with more promised for 2016.

The ministry also emphasised a package of 'scholarships' payments, varying between €330-650 per month, designed to boost incomes for healthcare graduates and discourage any thoughts of immediate emigration.

The government “treats the situation of health care workers as a special priority,” and, aware of their “generous contribution to society”, has made “every possible effort in the past 5 years, in the light of the country’s economic performance, to improve their situation,” the ministry said.

Nevertheless, it admits that despite the improved pay conditions the average pre-tax earnings of healthcare professionals (ie. those with university degrees), including bonuses, is only 90% of the national average (some €740, pre-tax). The average earnings of others in the sector amount to 78% of the national average.

And despite the government measures – real or symbolic – healthcare workers appear increasingly frustrated, holding a number of public protests this year, including two, ironically, on their very own July 1 public holiday.

Could the issue further damage the Fidesz government's already weakened public support? So far, the evidence is against that. Dr Denes, for example, was aghast that after declaring at a press conference that patients' lives are endangered due to the lack of properly qualified staff, the public reaction was inconsequential. “There is something wrong when people protest on the streets against an internet tax, but then do nothing on this [healthcare news],” he says.

But Peter Kreko, an analyst with Political Capital, a Budapest-based think tank, thinks differently. “In a country where there are practically 3mn pensioners and we have healthcare indicators which are not very good, then these pensioners are highly exposed to the sector and its problems,” Kreko tells bne IntelliNews.

As an example of the implications, he points to the Tapolca by-election, won by Jobbik, on Hungary's radical right, last spring, where a major issue in the campaign was the proposed closure of the local hospital, which the Jobbik candidate skillfully exploited.

With the summer vacation period in full swing, and the evening news dominated by stories of illegal migration, the troubles in the health sector have largely gravitated to the back-burner. But Kreko insists they will not go away. “The government is trying to dampen the flames, but more and more flames are popping up,” he says, “I think it's increasingly a political problem.”