It’s no secret that the Hungarian healthcare system has many serious needs and problems that need resolving. This has been the case for decades, and those working in it have tried several times to draw attention to the issues that need to be addressed by those in authority. And those in authority are now trying to act, but healthcare professionals don't approve of the proposed changes. Why?
As of May 2022, the Ministry of Interior has been responsible for overseeing healthcare and education in Hungary. On Monday, they submitted a bill to amend the law on professional chambers in the health sector and the law on health care, and are requesting an urgent debate on it in Parliament, the ministry said in a statement. They wrote that the right to safe health care is a fundamental constitutional right, which the Hungarian Chamber of Doctors (Magyar Orvosi Kamara/MOK) is threatening when it "puts pressure on doctors not to sign the on-call contracts".
Why would doctors threaten to not sign their contracts?
Late last year, the government put together a proposal which they claimed would bring about the necessary changes in the country's healthcare system. State Secretary for Health Péter Takács discussed the proposal with the Presidium of the Hungarian Chamber of Doctors, the Hungarian Hospital Association and the Hungarian Chamber of Health Care Professionals on 10 November. The professional organizations then had 5 days to comment.
In the resolution issued on 15 November,
the MOK did not recommend the draft to be submitted to Parliament because they believe that without presenting the result of impact studies, the fast pace of the reform could jeopardize the security of healthcare and encourage some doctors to leave the state system.
They stated that they disagreed with the proposal on many points, the most important one being the reorganization and centralisation of medical on-call centers: instead of the current almost 300 on-call points throughout the country, there would only be 102 on-call centres nationwide in the future. They also added that although the government claims that the proposal aims to address long-standing problems, professional organizations believe it fails to do so and creates new problems or deepens existing ones instead.
In spite of this, Deputy Prime Minister Zsolt Semjén submitted the package on 16 November.
At the beginning of December, Parliament adopted the amendment without the government taking into account any of the MOK proposals when drafting the amendments. At the time, 4,500 doctors declared to the MOK that they were willing to file their resignations.
At the end of December, State Secretary Péter Takács and the MOK leadership held a live Facebook meeting to discuss the issues in question, without substantial results.
On 4 February, the extraordinary general assembly of delegates of MOK voted almost unanimously that general practitioners should not sign the new on-call contracts, and should deposit the resignations of their current ones, while hospital doctors should deposit the resignations of their voluntary overtime as a last-ditch effort to put pressure on the authorities.
In mid-February, MOK reported in a Facebook post that "MOK has recently received several reports that "colleagues working in primary care are under pressure and threats to sign on-call contracts".
By 20 February, only 10-20% of general practitioners in the two counties that were the first to switch to the new on-call system had signed their new contrats, while the others refused to do so.
In the town of Győr, for example, no GPs have signed on-call contracts, so residents and trainee specialists will be on call "for the time being only in March" at the local hospital.
Where things are now
The bill submitted on Monday has been posted on Parliament's website and includes, among other things, an amendment stipulating that doctors, dentists and health workers with higher medical qualifications can practice health care even if they are not members of the professional chamber corresponding to their qualification.
According to the Ministry of Interior, the Hungarian Chamber of Doctors is abusing its power and its threat of ethics proceedings is unprincipled and unacceptable. The ministry further states that the MOK should not threaten to expel any doctor from the Chamber, arguing that this behavior amounts to abuse and "jeopardizes the fundamental right of patients to safe healthcare, which is immoral". By obstructing the new on-call system and thus endangering healthcare, the Chamber is violating the fundamental rule of its democratic public nature and is disregarding its own objectives," the statement reads.
The Interior Ministry's bill aims to remove the potential for abuse of power as well as to remove the mandatory membership in the medical chamber, and intends to transfer ongoing ethics proceedings to the Health Science Council.
– they wrote.
A paragraph of the bill also states that once the bill has entered into force, physicians will have 30 days to declare whether they wish to retain their membership in the chamber. Those who do not make a declaration about their wish to retain their membership by this deadline will lose their membership at the end of the 30-day period, and the chamber will have to repay their prepaid membership fees to them. The proposal would thus clearly reduce the Chamber's ability to lobby.
At the government briefing on Saturday Gergely Gulyás, the Minister of the Prime Minister's Office, strongly criticized the Chamber, saying that the opinion of the Hungarian Chamber of Doctors is unprincipled, intolerable and openly abuses its power by threatening doctors.
The Chamber responded by saying that all Hungarian doctors who took part in the campaign to exert pressure on the authorities did so voluntarily and that, contrary to what was said at the government briefing, the Hungarian Medical Chamber would not initiate ethics proceedings against any GP for signing the on-call contract.
The MOK reacted to Gulyás' words in five points:
- All Hungarian doctors are participating in the campaign to exert pressure on the authorities are doing so voluntarily
- Contrary to what was said at the government briefing, the Hungarian Chamber of Doctors has not and will not initiate ethics proceedings against any GP for signing the on-call duty contract
- The Presidency of the Chamber has lodged an ethics complaint against a senior GP of a county collegiate who tried to persuade his GP colleagues to sign the contracts by threats, by judging them and by providing misleading information.
- The Hungarian Chamber of Doctors supports the principle of introducing a new on-call system.
- The refusal to sign the on-call contracts is a means of pressure by Hungarian doctors on the authorities so that they would accept the previously published demands of the medical profession which aims to develop a patient-centered, advanced and safe health care system.
On Monday afternoon, MOK called an extraordinary press conference, where President Gyula Kincses issued the following statement reacting to the bill submitted by the Ministry of Interior:
"Today, the government launched a brutal attack on the Hungarian Chamber of Doctors, which is built on lies. We will be filing a lawsuit against the Ministry of Interior for breach of trust because their statement contained untrue statements."
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