|
Hungary Health
The modern social welfare system was largely a product
of the
1970s and 1980s, although setting of goals, initial
planning, and
more modest coverage for citizens began in previous
decades.
Amendments to the Constitution in 1972 guaranteed
universal
assistance for the ill, the aged, and the disabled. The
Public
Health Act of 1972 specifically guaranteed that beginning
in 1975
all persons would have free medical care as a right of
citizenship. The Social Insurance Act of 1975 provided
that
insurance conditions and benefits, which had been
different for
various occupational groups, become uniformly applied to
all
citizens. In 1982 even those persons involved in private
economic
activity became eligible for full social insurance
coverage
(including generous sickness and disability pay), instead
of
being limited to pension and accident coverage.
The social welfare system expanded steadily. According
to
official statistics, the percentage of the population's
income
represented by social benefits in cash (including social
insurance payments) and kind (including free health care)
was
17.4 percent in 1960, 22.8 percent in 1970, 27.3 percent
in 1975,
and 32 percent in 1980.
The state health care system was highly centralized.
Increasingly specialized and sophisticated services were
available at the level of the district (the country had
4,374
districts in 1984), municipality, county, region, and
nation.
Each district had a designated physician to whom its
inhabitants
first turned for care under the public health system. If
an
ailing person required a specialist, the district
physician made
the appropriate referral. In the 1980s, the availability
of
physicians, nurses, and hospital beds was high by
international
standards. In 1986 the country had 31,154 physicians, or
about
one physician per 299 inhabitants (up from one physician
per 909
inhabitants in 1950, one per 637 inhabitants in 1960, one
per 439
inhabitants in 1970, and one per 398 inhabitants in 1974).
The
country had 100 hospital beds per 10,000 inhabitants (up
from
55.8 beds per 10,000 inhabitants in 1950, 71.1 in 1960,
and 85.5
in 1974). The country had 3,801 dentists and dental
surgeons,
43,579 nurses, 57,277 other health personnel, and 4,506
pharmacists.
Although by the 1980s about 99 percent of the
population
participated in the social insurance system and could
receive
free medical services and hospital care, much private
practice
was allowed. In 1984 more than 3,600 health service
doctors
engaged in private practice, treating private patients
during
their free time. Many of them had very lucrative private
practices. Many persons in upper-income groups, who could
afford
the high price of private medical care, chose to use the
services
of a private physician rather than one assigned to them by
the
health service. Public opinion considered the care given
by
private physicians to be of higher quality than that
provided by
the health service.
In the 1980s, the public engaged in much frank and
apparently
uncensored discussion about serious shortcomings in health
care.
Complaints concerned the aging of hospital facilities, the
disrepair of their equipment, the shortages of basic
medications,
and the inadequate training of low-paid medical personnel.
Western analysts estimated that Hungary spent only 3.3
percent of
its gross national product specifically on health service
(the 6
percent figure listed in most statistical data actually
included
some social services). This percentage was the lowest of
any East
European country except Romania (in comparison, the United
States
spent 11 percent of GNP on health care). Critics judged
the
health system to be substandard, unreliable, and
increasingly
tainted by the practice of offering gratuities to medical
personnel to ensure quality care. They warned that the
achievements of past years were jeopardized by the current
neglect.
Certain trends in the general health of the population
indeed
gave health authorities reason for concern in the 1980s.
Life
expectancy at birth was the lowest among thirty-three
developed
countries rated by the World Health Organization. In 1986
the
infant mortality rate was 19 per 1,000 live births (see
table 4,
Appendix). This figure showed an improvement over the 1970
rate
of 35.9 per 1,000. However, the infant mortality rate
remained
among the highest for industrialized countries with
developed
health systems. In 1985, according to Minister of Defense
Ferenc
Karpati, 10 to 11 percent of young males were unfit for
military
service, and another 4 to 5 percent could not undergo
strenuous
physical training. Among conscripts accepted for service,
3 to 4
percent were discharged before the end of their training
for
health reasons, primarily because of physical or nervous
disorders.
Health authorities had other special concerns less
directly
related to the health care system. One such problem was
the
country's high suicide rate. In the mid-1980s, the suicide
rate
was 44 per 100,000 inhabitants, the highest suicide rate
in the
world. (The country with the second highest suicide rate,
Austria, reported 26.9 suicides per 100,000 inhabitants in
1984.)
The very high suicide rate had a lengthy history,
confirmed by
statistics dating back more than a century. Since the late
1960s,
however, the rate had risen noticeably. Hungarian experts
cited
as factors contributing to the troubling situation
alcoholism,
mental illness, the growing number of elderly people, the
disorienting effect of urban life, stress, and the
weakening of
family and community bonds as a result of rapid
modernization.
The high suicide rate among people over age sixty was
thought to
result from the economic stagnation and inflation of the
1980s,
which made it difficult for people to subsist on small
pensions.
In the mid-1980s, the authorities were also discussing
the
growing incidence of substance abuse. The incidence of
alcoholism
had increased during the previous generation, and a high
percentage of suicide victims were alcoholics. As of 1986,
consumption of alcohol per person per year was 11.7
liters;
consumption of hard liquor (4.8 liters per person) was the
second
highest in the world. Authorities had increased the price
of hard
liquor five times between 1973 and 1986, but despite these
measures, excessive alcohol consumption remained a
problem.
Although less salient than alcoholism, drug addiction was
also
becoming a source of some concern and was discussed in the
press.
Acquired immune deficiency syndrome (AIDS), a serious
health
threat associated with drug use in many countries, was not
a
major health concern in Hungary in the late 1980s.
According to
government statistics released in early 1989, the first
AIDS
patient entered a Budapest hospital in 1985. During the
following
four years, the country had twelve AIDS-related deaths.
In the 1980s, another source of anxiety for both health
authorities and the general public was the downward trend
projected for the country's population
(see Structure
, this ch.).
As early as 1973, concern about the slowdown in population
growth
had led to the introduction of a comprehensive population
policy.
Supplemental provisions had broadened the coverage in
subsequent
years. The policy mandated generous pregnancy and
maternity
allowances. Working mothers enjoyed a twenty-week
maternity leave
with full pay. After the twenty weeks had elapsed, the
mother
could receive an allowance to enable her to raise the
child at
home until it reached the age of three; the amount of the
allowance varied according to the number of children and
amounted
to about 25 to 40 percent of national average earnings per
month.
In addition, working mothers had access to unpaid days off
(prorated according to the number and ages of the children
involved) or other benefits to enable them to take care of
a sick
child. Additional ongoing family allowances were available
for
families with two or more children. In spite of this
assistance,
child rearing was a large expense to families. The various
forms
of assistance, while clearly beneficial to young families,
actually amounted to only 15 to 20 percent of
child-rearing
costs.
Data as of September 1989
|
