Fraternity-Testvériség, 2010 (88. évfolyam, 1-4. szám)
2010-04-01 / 2. szám
of privatization in the pharmaceutical, dentistry and family physician areas. Private sector development is faster for ambulatory and diagnostic services but is negligible for outpatient and hospital care, areas where costs and reimbursement mechanisms have remained largely in the public sector. Now private physicians act as independent contractors to health agencies, and private companies provide many former inpatient testing for local hospitals lacking their own services. Rural women and the elderly have experienced greater disadvantages than most. Women have experienced greater job loss, declining incomes, and deteriorating social environments, and their economic vulnerability is increasing at the same time that they are increasingly responsible for supporting themselves and their families. As in America, the family structure has become more diverse. The age at marriage has increased for both sexes, the mean age of childbearing has increased, the numbers and proportion of babies born out of wedlock have increased, and widowhood is more prevalent. The numbers and proportion of divorced persons have climbed steadily, and a greater proportion of women are living alone. A significantly larger proportion of families with children are headed by women so the country is experiencing a feminization of poverty because women are largely responsible for supporting themselves and their children at the very time their economic opportunities are limited. Women have been much more likely to exit the labor force since I989, and we know that housewives, women on parental leave, widows, and divorcees have significantly elevated risks of faring poorly. It’s ironic that there’s no organized movement to improve these women’s common plight, but it is probably due to the fact that these women do not embrace feminist ideals, and both men and women are more comfortable with a gender division in which women work in the home and men work in the labor market. At the same time that women are increasingly responsible for their own and their children’s economic support, they are disadvantaged in the labor market and Summer 2010 social welfare programs supporting rearing of the children are being withdrawn. The health care dilemmas in many cases mirror those in the U.S. but the Hungarian health insurance system guarantees free access for all necessary medical care except for non-essential services such as cosmetic surgery and private hospital rooms. Thus, utilization of health services is high. Hungary spends $600 per capita annually on health care compared to almost $4,000 in the US. (In terms of GDP, this translates to 6.4% for Hungary.) HMO’s are currently being tested in 10 centers around the country. At the present time, individuals have the freedom to choose their own family physician, the first point of contact for sick people, who are then referred to hospitals, clinics and/or diagnostic centers and labs for exams and tests. There are forty doctors for every 10,000 people so there are relatively high numbers of doctors, but the numbers of nurses are lower than in other developed countries, and nurses are less trained than their U.S. counterparts. Production and distribution of health aid products have been fully privatized. Currently, the country’s major goals in health care are to improve public health so outpatient services will be privatized in stages and to increase the efficiency of financing healthcare providers so the nature of financing health care services will be reviewed. The country would also like to eliminate regional differences so copayments will be extended, increasing the role of households in financing products and services. It would also like to improve income levels for healthcare workers to attract qualified personnel and maintain service quality. The 50% higher salary for doctors than the average Hungarian salary compares to a 3 to 1 ratio in Western Europe, which amounts to $300-350 per month. Ninety percent of family physicians operate as private entrepreneurs contracted to the local government; 5-10% are salaried state employees. Approximately 7,000 doctors practice with an average of 1500-1600 people registered with each doctor. Currently, 155 hospitals are located in Hungary, mostly owned by local governments. One private hospital that operates without government financing is located outside Budapest. It has 60 beds. Currently, there are 38 physicians and 80 hospital beds per 10,000 people. The government promises to reduce the number of people served by 20%. In 1994, a pilot program was begun to provide in-home nursing care to non-critical patients. Harris Health Services from Ft. Worth, Texas was the first organization to successfully introduce home care service in Hungary. Now nurses and physiotherapists can participate in a 12-month externship in the US to train for home health care delivery. In Budapest, there are 40 home care organizations employing 400 skilled nurses. Home health care is provided based on diagnosis- related recommendations (prescription by doctor), but home care is regarded mainly as a replacement for inpatient care and designed to reduce the length of hospital stays. Doctors can proscribe up to 14 home visits for 1 illness in a year without co-payment by the patient, but most home visits are for stroke related rehabilitation, chronic diseases (ulcers), and hip-replacement/fractures. Therefore, there is a growing demand for old age homes based on Hungary’s aging population. Currently, homes care for approximately 60,000 persons (less than 1% of the population), and day-care institutions are few. Organizations like The Hungarian Reformed Federation are helping to educate their members about current conditions in Hungary, especially as many consider retiring there and need to be aware of the plight of their elderly friends and relatives. Resources The People Left Behind, Vulnerable Rural Populations in the Post-Socialist Transformation; David L. Brown and Kai A. Schafft, Cornell University, Ithaca, NY, 2000 US and Foreign Commercial Service and U.S. Dept, of State, 2000; US Dept, of Commerce, International Trade Administration, Commercial Service
