the compromise healthcare proposal of the coalition has appeared in the press
as a victory for the Alliance of Free Democrats (SZDSZ), in almost every
respect it reflects the will of the Hungarian Socialist Party (MSZP). The
opposition party Fidesz, relying on the resistance of the public to the
proposal, has attacked it as the introduction of privatisation of healthcare
and the multi-insurer model. In fact the debate on the healthcare model has
only really now got underway, and the stakes could be upped by Fidesz’s
healthcare reform draft, the basic principles of which have been accepted by
the governing parties, is the best example of how it is an oversimplification
to reduce the reorganisation of healthcare to a one insurer versus a
multi-insurer model or to state-owned versus private. The model that has been drawn
up does not fall into any of these categories.
new system, whilst retaining unified social insurance, competing healthcare
insurance funds will also be set up which will allow private capital (49%), but
the state will maintain majority ownership (51%). The National Health Insurance
Fund (OEP) will be discontinued in its current form, in parallel with which a
central organisation will be established to handle revenue from healthcare
contributions, and to redistribute the revenue to the healthcare funds based on
a fixed per head quota system. The five to seven healthcare funds which emerge
will have between six months and a year to compete for patients countrywide,
and will then be allocated a region by lots.
was widely reported in the press that the compromise is close to the SZDSZ’s
proposal, in reality in every respect it reflects the MSZP’s plans. According
to the new model there will be (heavily restricted) competition only on the
level of the healthcare funds, not the insurers: There will remain a central
state-owned healthcare insurer, but several funds will emerge. The competing
funds, unlike under the SZDSZ’s earlier proposal, will participate in
supplementary care only and not in basic care. Moreover the funds cannot be regarded
as autonomous market players, since the state will be the majority owner. This
means that the “competition” will be between predominantly state players.
supplementary care will take place in a regional system which the MSZP has long
been pushing for. Although the insurers will theoretically have a countrywide
sphere of activity, in practice care will be organised on a regional basis.
professional reaction cannot be described as favourable. Insurers cannot see
why it is worth entering into the funds, and according to healthcare experts
the new model is unworkable, since patients will not exercise their right to a
choice of healthcare fund.
numerous questions arising in both professional and political circles, the most
important is why is it worthwhile for investors to enter into the funds?
According to government politicians, investors can gain a minority stake in the
regional funds, but cannot achieve profits in the short-term. Moreover, private
companies have to assume an enormous risk due to being allocated a region by
lots if they enter the market. The risk is increased by the prospect that
opposition party Fidesz, as it has suggested, would reinstate the former system
if it gets into government.
MSZP crippled in political fight
the coalition row over the health insurance model has died down, the dispute
between the government and the opposition has been reignited. Fidesz had
prepared for the campaign against the new model in advance and, even before the
content of the agreement was made public, made statements rejecting the
“privatisation” of healthcare and social insurance. The government finds itself
in a difficult situation when facing the Fidesz attacks since the conflicting
messages of the coalition partners weaken each other. The MSZP, taking on
Fidesz, identifies the model with social insurance operating under unified
state supervision, the continuance of basic care and therefore the realisation
of the solidarity principle. At the same time, SZDSZ politicians are speaking
of success owing to the appearance of private capital and market attitudes –
and by stressing these points reinforce the arguments of Fidesz, which is
attacking the privatisation of healthcare.
divergent coalition messages are likely to pose a bigger problem for the MSZP.
Although public opinion is still malleable, it emerges as a certainty from
polls that a market-oriented multi-insurer healthcare model based entirely on
private insurers is extremely unpopular among large sections of voters,
including the MSZP voting camp (its level of support, according to polls, is
around five per cent). The results are mixed in terms of the acceptance of the
“mixed model”: whilst according to the Medián survey at the end of April the
majority of voters were in favour (55 per cent), the Századvég poll at the end
of June showed the figure of those supporting the joint presence of state and
private insurers as 29%, whilst research commissioned by the SZDSZ indicated
that almost two-thirds of voters (60 per cent) were in favour.
ignorance about the question emphasises the role of political campaigns.
Differently phrased questions used in the polls can result in drastically
different responses, and the messages of the parties can mould considerably the
thinking of voters – determining whether there is relative public consensus in
favour of or against the new model.
Selling mixed messages
question now is whether the MSZP will succeed in convincing voters that the
“mixed model” will improve healthcare services and not force anyone out of the
system, or whether Fidesz will manage to get across the view that the
“multi-insurer, market model” created by the governing parties will lead to the
less well-off members of society, amounting to several million people, being
excluded from healthcare services.
coalition compromise therefore signals just the start of the debate rather than
the end. The stakes are high, since when it comes to the 2010 elections, how
voters judge the reforms – and in particular the healthcare reform which has
provoked the greatest indignation – will be crucial. If Fidesz, as is expected,
makes the rejection of the multi-insurer model a referendum topic, that will
further increase the significance of the healthcare reorganisation.