The Hungarian government has resolved to reform the healthcare system radically, and a bill submitted in March 2003 will allow hospitals and surgeries to operate as business companies with private investors. The Hungarian Chamber of Physicians (MOK), which originally opposed the bill, eventually reached a compromise with the government whereby doctors would become share-owners in the new service provider companies through a preferential scheme. However, the Democratic Union of Health and Social Care Employees (EDDSZ) totally refuses 'globalised healthcare' and any termination of the public employee status of healthcare workers. To support its goals, EDDSZ has staged demonstration and petitioned parliament.
Following several draft versions and a series of consultations, the coalition government of the Hungarian Socialist Party (Magyar Szocialista Párt, MSZP) and the liberal Alliance of Free Democrats (Szabad Demokraták Szövetsége, SZDSZ) submitted a bill on 'healthcare service providers and organisation of public health service' to parliament in March 2003.
Undoubtedly, the bill represents a major development in the history of the long-delayed reform of the Hungarian public healthcare system. The similar 'hospital law' of the previous government led by the centre-right Alliance of Young Democrats-Hungarian Civic Party (Fiatal Demokraták Szövetsége-Magyar Polgári Párt, FIDESZ-MPP) allowed only for the conversion of state-run institutions into not-for-profit organisations and the outsourcing of certain services to private companies. The new bill, however, does not impose any restrictions in terms of either legal forms of organisation or ownership structure. Thus state-run hospitals and surgeries can be transformed into business companies and, in a joint venture ownership structure, private investors can raise the capital required by a public entity. The government’s arguments for privatisation focus on the involvement of private capital which it considers vital in order to be able to provide better and faster services. The need for additional investments in buildings, medical equipment and know-how in the run-down public institutions has long been widely recognised. The bill does not directly affect either the employment status of workers in this sector or the public responsibility for service provision and its public financing. However, along with the current draft legislation on 'hospital privatisation', a separate bill has also been prepared in order to re-regulate the legal status of doctors and other employees, whose public service employee status would be terminated in the event of employment by non-state service providers.
The bill met with fierce opposition from both the Hungarian Chamber of Physicians (Magyar Orvosi Kamara, MOK) and the Democratic Union of Health and Social Care Employees (Egészségügyi és Szociális Ágazatban Dolgozók Demokratikus Szakszervezete, EDDSZ), the two largest interest representation organisations in the sector. EDDSZ is a member organisation of the Trade Unions’ Cooperation Forum (Szakszervezetek Együttműködési Fóruma, SZEF), the biggest public sector union confederation in Hungary (HU0306101N).
The initial standpoint of MOK objected to the fact that profit-oriented businesses would participate in running publicly-financed hospitals and surgeries in general, and in particular that businesses that manufacture or trade goods used by healthcare providers might acquire partial ownership. Should privatisation be implemented, MOK also demanded that the law on the legal status of physicians should come into force together with the law on privatisation. Following face-to-face negotiations between MOK and the Prime Minister, MOK has now basically accepted the concept of the reform. The Prime Minister has promised that the government will establish a special loan scheme in order to help doctors and other professionals to become owners of their own institutions in the event of privatisation. There will also be procedures to ensure preferential treatment for incumbent employees of an institution over outside bidders in tendering for publicly-funded medical service provision. The Prime Minister has also promised that MOK will have an institutionalised say on the implementation of the law. He has accepted that in private hospitals and surgeries a power of veto should be given to 'bodies of professional leadership of institutions' in cases when a decision by the owners would effect areas of medical practice.
EDDSZ, however, completely rejects the reform package. The president of the union claims that the draft serves the interests of neither patients nor employees in the sector. The union refuses any form of privatisation, especially investment by companies that supply the goods used by healthcare providers. The union insists on maintaining public service employee status in healthcare institutions. Additionally, the union blames the government for not holding meaningful consultations on the union’s proposals on reforming the healthcare system. On 29 May 2003, EDDSZ, together with several civic/civil society organisations staged a protest demonstration against 'globalised healthcare' in front of the building of Ministry of Health, Social and Family Affairs (Egészségügyi, Szociális és Családügyi Minisztérium, ESZCSM). The union wants to suspend the legislative procedure on the bill. In an attempt to achieve its goal, it has started collecting signatures to hold a referendum on the privatisation of hospitals and to demand that parliament decide on the bill by qualified majority vote. The Hungarian Democratic Forum (Magyar Demokrata Fórum, MDF), the junior opposition party, promptly expressed its support for the union’s initiative. Should this initiative be successful, in the current highly divided political scene it might have a disastrous impact on the government’s reform plans, and might block any major reform of healthcare in the short term.