---

Density of medical doctors per 10,000 population (2012-2020): 60.6
Density of nursing and midwifery personnel per 10,000 population (2012-2020): 69.2
Density of dentists per 10,000 population (2012-2020): 7.4
Density of pharmacists per 10,000 population (2012-2020): 8.4

Source: World health statistics 2022: monitoring health for the SDGs, sustainable development
goals. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.

---

Remuneration of Doctors, Ratio to Average Wage, 2019
General Practitioners: 1.9
Specialists: 2.7

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

---

Remuneration of Hospital Nurses, Ratio to Average Wage, 2019: 1.1
Remuneration of Hospital Nurses, USD PPP, 2019: 27.3

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

---

“As outlined in Section 4, Hungary has experienced workforce shortages for many years. Shortages of health care professionals are more pronounced in certain professions – such as nurses – and in less populated areas (Figure 16).

“In response, the government has introduced several policies. Since 2011, medical residents can apply for a financial scholarship on the condition that they work in Hungary for 10 years. Health care professionals have also received several wage increases, most recently under the new public sector employment contract, which provides doctors, dentists and pharmacists with a 120 % pay rise by 2023 (Box 4). The latest pay increase will be paid for in part using funds from Europe’s Recovery and Resilience Facility.”

---

“On 6 October 2020, the Hungarian Parliament passed a law on the new legal status of public health service employees. Under this act, health care professionals must sign a new employment contract to work in the public system. Key changes resulting from the new contract are:

“· Health care workers will no longer be able to work in both the public and private sectors, although exceptions may be granted in specific circumstances

“· Doctors, dentists and pharmacists will receive a wage increase of approximately 120 % by 2023

“· All forms of informal payments to health professionals will be criminalised, with the exception of small gifts worth less than 5 % of the minimum wage that are gifted after treatment

“The new employment contract was met with resistance from various health care workforce organisations; however, only 3-5 % refused to sign the contract by the deadline.”

---

“Health systems of the world rely on a mix of public and private in the financing and provision of services [1]. Their co-existence seems to be inevitable, but often generates unwanted outcomes [2]. For instance, physicians may provide preferential access to public services for patients, who were already seen in their private practice and paid, or they may withhold their performance to increase waiting times in the public sector and refer patients to their private practice, which generates more income than their public employment salary [3,4]. In some countries, this may not take the form of a real exit to the formal private sector, but works within the boundaries of the public providers through informal payment (IP), or various other informal economic activities [5–8].

“In Hungary, both IPs and the downsides of “dual” or “double” practice are well-known and considered to be an obstacle to getting closer to universal health coverage [9,10]. There have been debates about how to eliminate these practices to improve equity, financial protection, transparency and efficiency. However, until recently, when a new employment regulation was pushed through the parliament over two days, the government did not intervene directly in the health system to address the problem.

“The new regulation, Act C of 2020 on the Employment Status of Health Workers, represents a comprehensive overhaul of the existing public employee status. The previous status was replaced by an arrangement similar to the employment regulation of the armed forces, which takes defence employees out of the scope of general Labour Code and imposes several restrictions on their work-related civil liberties, such as the freedom to choose one’s workplace or to work part time in addition to their main employment [11–13]. The preamble of the Act states that the objectives of the legislation are the improvement of the safety and security of health care, the development of the health system, the regulation of the employment status of health professionals and their financial compensation. In fact, the law attempts to eliminate informal economic activities by bringing the employment of health workers under strict central control [14]. The provisions of the Act, such as the criminalization of IPs, or the regulation of situations of conflict of interest, imply a strong intention from the government to make the underlying care processes more transparent, affordable and reliable. Whether this outcome is realistic to expect has been debated ever since the bill was passed on 6 October 2020 [15].

“While the scope of the Act covers only the personnel of public providers (all of them, not only health professionals) [14], if implemented, it will have a profound impact on all health care players. This includes private providers, since it limits health workers to practice multiple jobs in parallel.”

Source: Gaal, P., Velkey, Z., Szerencses, V., & Webb, E. (2021). The 2020 reform of the employment status of Hungarian health workers: Will it eliminate informal payments and separate the public and private sectors from each other? Health policy (Amsterdam, Netherlands), 125(7), 833–840. https://doi.org/10.1016/j.healthpol.2021.04.014

---

“Act C of 2020 attempts to address the public-private concerns by introducing a new employment status, compulsory for all health workers in public providers, which imposes several restrictions on standard labour freedoms. The Act also eliminates IPs by prohibition and introduces a spectacular pay raise for physicians (Table 2). Both measures strengthen central control over the health workforce with regulation, and the success of the regulation depends on not only the capacities to detect and punish violators, but also on the legitimacy of regulations and voluntary compliance to avoid mass violations that can weaken and/or overwhelm enforcement efforts. It seems that the wage increase should serve as the “carrot”, a financial incentive to facilitate implementation by making health workers accept the “stick”.

“Prohibition and enforcement are by no means a new idea to tackle IPs, but linking it to the militarization of health service delivery, such as the involuntary transfers, the strictly controlled labour relations and the limitation of side-jobs, certainly is, at least in Hungary. The employment model of the Semashko system was similar, but not totally comparable in this respect, since full-time public employment was the only option then [16,44].”

Source: Gaal, P., Velkey, Z., Szerencses, V., & Webb, E. (2021). The 2020 reform of the employment status of Hungarian health workers: Will it eliminate informal payments and separate the public and private sectors from each other? Health policy (Amsterdam, Netherlands), 125(7), 833–840. https://doi.org/10.1016/j.healthpol.2021.04.014

---

“Eventually, the final deadline for health workers of all the hospitals to sign the new labour contract was postponed until 1 March 2021 [47]. During the period between the passing of the law and this implementation deadline, it became clear that the reception of the policy had been overwhelmingly negative among professional organizations, trade unions, and individual health workers alike. The largest trade unions formed an alliance named “Partnership for the Health Care” demanding a new law based on a wide-scale social consultation [48]. In addition to the antidemocratic process, they criticised the extensive curtailment of the individual and collective labour rights of employees and their interest representation organizations. The Alliance of the Unions of Medical Universities highlighted the wage tensions the discriminatory pay increase would create among doctors, academics and other health workers, who had to face the restrictions, but were left out of the financial compensation part of the law [13]. The Chamber of Hungarian Health Care Professionals (with a compulsory membership to all practicing paramedical workers) implemented a survey among their members, and out of the more than 30,000 respondents, 31.3% said that they would not sign the new contract, and instead leave the profession or work abroad, another 62.7% said that they did not know, and only 6% provided a positive answer [49]. In addition, they initiated a petition, signed by about 24,000 within a week, addressed to the Prime Minister, Minister of Interior, Minister of Human Capacities, the President of the National Assembly and the President of its Welfare Committee, to take allied health professionals out of the scope of law [50]. Even the Hungarian Medical Chamber, which, with a compulsory membership for all practicing physicians and dentists, represents the medical society, expressed its dissatisfaction with the legislation, the limited time to comment, and the restrictions, which they thought would destabilize the health system [51]. A survey of 7,739 members found that 77% would reject signing the new contract, and 5,110 even signed with their name [52]. The interest representation organizations of private providers also protested and called for an urgent renegotiation, emphasizing that the policy would shrink available capacities, increase waiting times, elevate prices in the private sector and make patients even more vulnerable during the already trying times of the COVID-19 pandemic [53].”

Source: Gaal, P., Velkey, Z., Szerencses, V., & Webb, E. (2021). The 2020 reform of the employment status of Hungarian health workers: Will it eliminate informal payments and separate the public and private sectors from each other? Health policy (Amsterdam, Netherlands), 125(7), 833–840. https://doi.org/10.1016/j.healthpol.2021.04.014

---

World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

---

Page last updated August 27, 2022 by Doug McVay, Editor.