Hálapénz – the plague of Hungarian healthcare finally has a cure

Hálapénz, studying in Budapest

By Bence Takács

Gifting or tipping as gratuity for health services– or as Hungarians call it hálapénz, is inseparable from the current state of the Hungarian health system. The literal translation of the word is ‘gratitude-money’ or ‘gratuity-money’, a phrase uniquely embedded in most Hungarian people’s minds. Looking back at an article published more than a decade ago on Hungarian news portal Napi.hu, the title roughly translates to: “Hálapénz was here before, it is here now, and it is not going anywhere”. One can gauge at the level of skepticism received on its abolishment, and the apathy in public opinions just by reading this headline from 2007.

It is public knowledge and common sense, that there is nothing gratuitous about tipping for a potentially lifesaving surgery, or as a matter fact, any kind of medical procedure. People undeniably tip the doctors because of the embedded fear caused from a well-established habit. To put it mildly, the state of the Hungarian healthcare system is not something anyone would want to experience as over the years this custom has brought the reputation of the medical system further down. Finally, after nearly 70 years, this draconian custom which has been giving anxiety for approximately three generations now, is finally about to end. The Hungarian government is determined to issue a ban starting from January 1, 2021.

The amount of tipping can vary depending on the type of procedure, and of course, the doctor’s willingness to accept the payment. A Hungarian online magazine civilhetes.net published an informative list about estimated tariffs back in 2017. The comprehensive list has suggestions that for a brain surgery one would have to tip a doctor 150 thousand forints, while smaller surgeries such as a knee operation can cost anywhere between 10 to 30 thousand forints in tip. Interestingly, the most expensive item on the list is giving birth, with a suggestive amount of 200,000 forints in tip.

There are multiple theories and myths surrounding this custom such as whether we should give the money in advance or after the procedure. While it can also depend on the type of surgery, it seems like the more frequent practice is giving the money after the procedure, thus potentially avoiding any judgement from the doctors if they are not corrupt. In this way patients can still secure their future treatments and check-ups. This also begs for the question; Are patients at least partially responsible for keeping this custom going on for so long? Of course, in dire situations like medical emergencies, people tend to prioritize their health and take any extra steps that are needed.

As mentioned before, one of the overlooked aspects of this custom is that it can also be uncomfortable and awkward for those who receive these payments. Sometimes patients insist on giving it despite a doctors’ unwillingness to accept anything. An obvious consequence of this legislation, however, is the reduced income for doctors and medical professionals in Hungary. According to a Hungarian portal specialized in providing up-to-date data about wages, called fizetesek.hu, 90 percent of those who are doctors and healthcare workers have an average salary of 867,000 forints as of October 2020. As part of the same anti-tipping agenda, doctors’ wages will be

increased by a substantial amount in the next year couple of years. From the 1st of January 2021, average wages for those doctors who are over the age of 41 will most likely be around 1.6 million forints according to calculations made by a financial site Azenpenzem.hu. The projected maximum salary for the same age bracket for 2023 will be around 2.8 million forints. The question is, however, if this increase will be enough to compensate for the missing payments made my desperate patients in the past. Another huge part of the legislation is the restrictions in private practices. Doctors who are not working in private clinics (with the exception of a few) can only practice privately if they acquire a special authorization in advance. While it seems like these changes are really about to take place, we still have to wait to see how it unfolds in reality. This comprehensive plan will have an impact on doctors and medical workers in many different ways. Hopefully these changes will not trigger a departure of medical professionals to other countries due a potential decrease in their overall wage, and the plan can benefit both sides in the long run.

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