PostScript spends a lot of time talking about industry payments to physicians – often bribes by another name. So when we ran across this article in the Economist Budapest diary about bribes to doctors – from patients – we were intrigued. (Inside the link, scroll down a bit to the Thursday post).
In Hungary, it seems it’s customary for obstetricians to receive a halapenz, or “gratitude money,” after making deliveries. That’s why it’s “easy to spot the gynecologists and obstetricians' vehicles in the hospital car parks—they are usually the row of shiny new Audis, BMWs and Mercedes,” writes the Economist. The medical tipping is a vestige of the Soviet rule (when doctors pay was slashed) and is done, to some extent, in all specialties, with an estimated 20 percent of Hungarian physicians pocketing such handouts from patients.
The article is full of interesting nuggets about the Hungarian health care system (including the shutdown of a disclosure website that outed doctors accepting halapenz and published their going rates). For instance, Hungarians go to the doctor 12.6 times per year, to the British’s 5.1 and Americans’ 3.8 – so the Hungarian government has created a 300 forint surcharge for each visit – despite the fact the health care system is managed and paid for by the state. And Hungarians have 9.7 children per thousand citizens, compared to 14 children per 1000 in the United States.
The correspondent writes:
Perhaps Hungarians might have more children if it did not cost so much. Doctors often charge around 7,000 forint for each monthly examination. Birth costs around 80,000 forint—more than the monthly minimum wage—for the doctor, and perhaps another 10,000 forint for the midwife. This even though the patients and their employers have already paid their social insurance and the medical staff are state employees, working in state hospitals.
Of course, the lower birthrate may have nothing to do with the price of Hungarian prenatal care. And the correspondent seems to imply that 14 births per 1000 is a just-right sort of number, without addressing the personal/private/government breakdown of birthing costs in the U.S. (According to the Healthcare Cost and Utilization Project, the average hospital cost for a U.S. birth in 2003 was $8,300, or 1,426,272 forint today – not including regular prenatal checkups or complications.)
Still, it’s a fascinating glimpse into the strange personal spending required in a post-Soviet socialized health care system.