Will Czech health reform meet fate of Hungarian one?

Petr Holub
2. 5. 2008 14:30
Health reform topples the government in Hungary
Health Minister and healthcare reform mastermind Tomáš Julínek
Health Minister and healthcare reform mastermind Tomáš Julínek | Foto: Tomáš Adamec, Aktuálně.cz

Analysis - The coalition government of Ferenc Gyurcsány in Hungary fell due to protests of unsatisfaction with the reform of the healthcare sector, seen widely as unsuccessful.

This fact can be a wake-up call for Czech Health Minister Tomáš Julínek, since the reform he is implementing is practically the same as the program introduced in Hungary.

The only major difference is that the Hungarian government began one year earlier.

Charges, privatization

Medical services in Hungary have introduced co-payments in the beginning of 2007. Monetarily, the fees practically equaled those introduced in the Czech Republic a year later. The effect was also similar, with the number of visits dropping - to general practitioner´s by one quarter, to specialized doctors by one fifth.

Only the number of visits to pediatrists remained the same because the patients did not have to pay the fees there.

With the fees, earnings in the healthcare sector increased by 80 million euros while insurance companies saved 240 million euros, ending the year with a positive financial balance for the first time in history.

Ferenc Gyurcsány
Ferenc Gyurcsány | Foto: Roman Staněk, Aktuálně.cz

The next step of the Hungarian healthcare reform that was to be introduced this January was privatization of insurance companies - again, the same goal as in the case of the Czech reform.

However, Socialist and Liberal fractions in the government were not able to reach a consensus over the reform.

In the end, they have decided to divide the only public insurance company into 22 regional branches, selling 49 per cent of their shares to private stockholders. Similarly as in the Czech Republic, Hungarian insurance companies were allowed to attract clients only by offering special services, not by setting low insurance rates.

Criticized by the opposition

Ágnes Horvath from the Liberal Party, who was at the time Hungarian Health Minister, was expecting that no more than seven or eight insurance companies would survive the competition.

The Hungarian parliament was to approve the law on insurance companies' privatization last fall, being sharply criticized by the opposition party member Fidész for not enabling a public debate on the issue to take place. As in the Czech Republic, the opposition feared that the reform would make health care less readily available.

Besides, it was not clear to many what the competition between insurance companies will look like when the state would control majority of shares.

The hearing was eventually postponed and the reform was approved by parliament in January of this year.

80 per cent against the reform

However, it eventually became clear that this was the last success the advocates of the reform had.

In March, Fidész introduced a plebiscite on the abolition of the charges for health care, as well as university fees that were planned by Gyurcsány's government for next year. In the referendum, 80 per cent have backed Fidész's proposal. 

A fee-machine
A fee-machine | Foto: Ondřej Besperát

Prime Minister Gyurcsány reacted to the unrest in the country by sacking Health Minister Ágnes Horváth. In addition, the plan to privatize insurance companies was abandoned as well, since the opposition would not have any problems in ruining the plan with another plebiscite.

At the same time, opinion polls showed a remarkable fall in popularity of the ruling coalition parties, with the Socialists having ten per cent, and the Liberals only two per cent.

General question of state's role

Eventually, the Liberals reacted to the dismisal of their minister and the suspension of the reform by leaving the government. However, at the same time they promised they won't attempt on toppling the government. 

"The struggle over the healthcare sector was important and necessary," said András Szigetvári, an analyst for the Der Standard daily, adding that the issue incorporated the major political antagonism all European countries are presently dealing with.

"It is a question of what role the state should play in the most fundamental sectors, such as health care, education, or pensions. And how fair should be the distribution between the rich and the poor, between the sick and the healthy," explained Szigetvári.

According to him, there was no clear answer that came out of Hungary's ordeal. Citizens have refused the reform that was aimed at implementing market principles in the healthcare sector, however the plebiscite was rather weak and introduced only a mixed system still controlled by the state.

No referendum in the Czech Republic

In a few months, the Czech Republic is to show Europe its stance on a healthcare system.

The main difference between Czech and Hungarian health care systems is in their budget. In Hungary the total sum of insurance collected is roughly 130 billion CZK, which equals to 5 billion euro, while in the Czech Republic it is 200 billion CZK, which is about 8 billion euro.  

On the one hand, this means that the issue of healthcare reform is not as pressing as in Hungary, on the other hand it means that the privatization promises more lucrative profits.

In addition, the Czech health reform is not threatened by a referendum. However, upcoming elections for regional councils and the Senate in the fall can serve as a plebiscite - people will have a chance to  approve the current government's policies with their votes.

 

Právě se děje

Další zprávy