Prime Minister Viktor Orbán, whose Fidesz party won a parliamentary majority of 68% in Hungary’s April 2010 elections, is facing a quandary in healthcare. Fidesz ascended to hitherto unknown levels of popularity in 2008 by attacking the Socialist-led government’s efforts to raise the level of private-sector financing in the medical system. The party forced the Socialists to cancel their policy of requiring patients to pay a HUF 300 (€1.06) co-pay for doctor’s visits, then strong-armed the administration into revoking its plan to open the health-insurance system to private investment. Fidesz’s populist, anti-market zeal appealed directly to the values instilled under communism, when Hungarians had a right to unlimited state-financed medical provision. Fidesz now faces a rude awakening: Payroll contributions to the health insurance fund will be nearly half of what they were in 2007, meaning Hungarian taxpayers will cover nearly half of 2010 medical spending. Meanwhile, health-related overspending was equivalent to nearly a quarter of Hungary’s budget deficit in 2009 and may reach similar levels this year. The Orbán administration now has to figure out how to keep its campaign promise to “save healthcare” without significant help from private sector. Failure will play directly into the hands of the far-right Jobbik party.
- Hungary’s state-run Health Insurance Fund, which provides medical coverage for almost all Hungarians, came to HUF 1.42 trillion (€5.1 billion) in 20091. Fidesz considers this insufficient. The administration promises to “improve” the gap between Hungary’s level of health spending and that of neighboring countries, or roughly HUF 300 billion2. Fidesz is rather foggy on where the money is going to come from.
- After having won a battle to prevent private companies from providing health insurance and opposing private hospital operators, Fidesz has all but cut itself off from the possibility of raising the quality of health provision through private investment.
- Fidesz’s main pledges are to improve living conditions for medical workers and to help hospitals pay off their debt. The Hungarian Hospital Association has asked for HUF 235 billion in additional funds every year to prevent the system from going bankrupt.3
- Private investors are unlikely to try entering Hungary’s hospital or health-insurance markets. Previous efforts have ended dismally: For example, the European Bank for Reconstruction and Development last year withdrew a €4 million investment in private hospital operator HospInvest, which is now bankrupt.
- Unless Fidesz takes action – unlikely, given that local elections are due in October 2010 – the country’s healthcare deficit may approach 1% of GDP this year. This presents a significant risk to Hungary’s ability to keep its 2010 budget-deficit target of 3.8% of GDP.
- The new state secretary for healthcare, Miklós Szócska, holds a master’s degree in public administration from Harvard University and taught health-services management at the university level. His record suggests that profligate spending is unlikely.
- Still, nothing in Fidesz’s program addresses any of the key money-wasting factors: Excessive use of medical services, excessive drug consumption, rampant bribery of doctors, and barriers to private investment.
- If Fidesz’s healthcare-related promises are left unfulfilled, the ultranationalist Jobbik party will get an opportunity to start promoting its own populist healthcare program.
- Constant chaos. Hungary’s healthcare system has been in a state of financial and professional disarray for virtually the entire two decades since communism collapsed. While Hungarians have access to most modern healthcare technologies, they may have to travel some distance for treatment. Patients have access to the most modern drugs, but financing is tough: The state health insurer spent HUF 343.8 billion on medicines in 2009, more than double the amount it spent in 2000. Facilities are inadequate, with some 80% of equipment in need of replacement, by Fidesz’s estimates.4
- Doctors as Serfs. The average Hungarian doctor earns about HUF 377,000 (€1,400) a month before tax, according to Hungary’s National Institute for Strategic Health Research (ESKI). Take-home pay is roughly half. Starting physicians can expect to take home just HUF 100,000 (€372) a month5. Two-thirds of medical students want to leave Hungary for western countries where they can earn up to 10 times as much, according to a survey by the Hungarian Residents Association6. Fidesz reckons 2,500 doctors left the sector since 2006.7
In an effort to stem this medical brain-drain, former Health Minister Tamás Székely in December 2009 issued an order requiring doctors who do residencies at publicly funded universities to remain in Hungary for at least four years after completing their studies, or pay back the money taxpayers spent on their residency – as much as HUF 3.8 million8. The Residents Association condemned Székely’s order, saying it reduces doctors to a serf-like state, “tied to the land.”
- Bribery. Hungarians, along with most other people in the former Soviet bloc, grew accustomed to paying doctors “gratitude money” in order to get medical services that were otherwise hard to get under communism. The practice has now evolved into a mild form of extortion by which doctors and nurses can supplement their meager incomes. Patients shell out cash for fear that caregivers will not pay attention to them in life-or-death situations.
Hungarians forked over an estimated HUF 73 billion (€274 million) in illicit medical payments in 2008, according to a survey by Budapest’s Corvinus University9. That’s more money than the state health insurer devoted to financing general practitioners that same year10. And doctors usually do not declare bribes or pay tax on them.
- Pill poppers. Hungarians, especially the elderly, have a cultural predisposition to overmedicating. Trouble is, taxpayers have to subsidize the drugs. Hungarians devoted 32.4% of their total health spending to drugs in 2008, more than any other country in the Organization for Economic Cooperation and Development11. The average OECD member spent 18.4% of its healthcare budget on pharmaceuticals that year.
- Frequent doctor’s visits. Communists preached that the state would take care of people’s health, which encouraged trips to the doctor. The average Hungarian visited his physician 11.3 times in 2008; the only European OECD members who went more often in 2008 were the Czechs at 11.4 visits and the Slovaks at 12.1. The average OECD citizen went to the doctor 7.6 times that year.12
- High unhealthy population, low life expectancy. Frequent trips to the doctor and plenty of drugs are doing little to help Hungarians lead healthier lives. Some 19.2% of Hungarians in 2008 said they considered their health condition to be “bad” or “very bad” – a higher rate any other EU country save Portugal and more than double the EU average of 9.5%13. Life expectancy at birth was 73.8 years in 2008 – the lowest of any OECD country save Turkey.
- Indebted Hospitals. Many of Hungary’s hospitals cannot get by on the financing they receive from the state insurer. Almost all facilities are owned by municipalities or county governments, which have lost much of their tax base thanks to the global financial crisis. Before the April 2010 elections, Fidesz estimated that hospitals’ aggregate debt came to HUF 140 billion14; a survey by the Hungarian Hospital Association estimates that the sum was more like HUF 60-70 billion in the first quarter of 2010.15
- The low number of active workers undermines health finances. Hungary pays for medical care primarily through payroll contributions. However, the proportion of working-age adults who actively contribute to Hungary’s economy is the lowest in the region – 61.5% in 2007, almost 10% lower than the EU average of 71%. This means roughly 3 million Hungarians and their employers are paying healthcare premiums for the entire 10 million-strong population.
- Toward a “British System.” The state health insurance fund will get HUF 617 billion, or 44.9% of its financing needs from the central budget – a record level since 1990 (see graph below).16 The growth is a result of former Socialist Prime Minister Gordon Bajnai’s decision to cut compulsory payroll contributions last year. This increases the state health system’s dependence on the budget and the politicians that devise it; it also forces people who pay taxes to assume a greater share of the healthcare burden for the inactives.
Fidesz’s Record: Toppling Liberal Healthcare Reform
In 2006, the year Socialist Prime Minister Ferenc Gyurcsány won reelection, spending at Hungary’s state-monopoly health insurer was growing at a drastic rate, fueled by the cost of new technology, drugs and spendthrift policies. State expenditures on medicine alone more than doubled between 2000 and 2006.17
Healthcare had long been regarded as the “third rail” of politics, killing the careers of those politicians who dared touch it. Gyurcsány, perhaps wisely, handed the health portfolio to his coalition partner, the Alliance of Free Democrats (SZDSZ).
Health Ministers Lajos Molnár (2006-2007) and Ágnes Horváth (2007-2008) implemented a raft of reforms aimed at ending runaway medical spending. Key features included:
- Discouraging unnecessary consumption of drugs and medical services. The coalition passed a law requiring patients to pay a fee of HUF 300 per doctor’s visit or hospital night. Drug subsidies were slashed by as much as 50% and patients were required to pay a minimum of HUF 300 per package of medicine out of pocket. The Health Ministry also adopted measures aimed at encouraging doctors to prescribe generic drugs instead of expensive brand-name treatments.
- Closing hospitals, cutting excess bed capacity and reorganizing services. The Health Ministry shut down six state-run hospitals. It also cut the number of acute-care beds from 5.5 to 4.1 per 1,000 people between 2006 and 2007, according to OECD data. The OECD average was 3.8 beds per 1,000 people in 2008.
- Replacing the state-monopoly health insurer with a system of well-regulated, profit-oriented health insurers that would function as public-private partnerships. The state would remain in control, but private investors would be able to purchase stakes of up to 49% in each insurer. Since these companies would be profit-oriented, they would eliminate wasteful spending. Since they would compete with each other for premiums, they would seek to provide patients with the best service. And they would have the freedom to choose the hospitals with which they would sign contracts, giving hospitals an incentive to improve service, the Health Ministry argued.
- Creating the Health Insurance Supervisory Authority (EBF) to monitor the quality of care, enforce patients’ rights and to investigate insurance-related complaints. This is the first such body since 1990.
The reforms incited widespread furor. Per-capita public spending on medical care dropped 9.8% between 2006 and 2007 in real terms – the biggest single-year drop in any OECD country over the previous decade (although much of the decline stems from the ministry’s success in promoting cheaper generic alternatives to brand-name drugs).18 People resented having to pay for doctor’s visits that used to be “free.” Many were also angry about hospital closings.
Fidesz seized upon this anger. Party activists collected signatures for a referendum aimed at striking down the HUF 300 visit fees. Key referendum supporters included doctors, civic groups and the Hungarian Communist Workers Party. Hungarians voted to abolish the fees by more than 80% on March 9, 2008.
The government’s health-insurance overhaul was also in Fidesz’s crosshairs. Fidesz and its media allies spread fears that private health insurers would deny care to the sick and elderly in a relentless quest for profit. Moreover, insurance companies themselves rejected the idea of public-private partnerships: It not only left the state in control, but also limited profit and capped operating costs. “These seasoned insurance experts buried their heads in their hands, describing it as a ‘hybrid solution’ that would be worse than if things stayed the same,” said Péter Mihályi, a former adviser to the Health Ministry.19
When Fidesz’s allies threatened to organize a second referendum on the government’s insurance reforms, the Socialists promptly revoked their own law, restoring the state health insurer’s monopoly status. PM Gyurcsány fired Health Minister Horváth in March 2008, prompting the Free Democrats to bolt the coalition. The Socialists had to carry on with a minority government. Game, set and match to Fidesz.
HospInvest: The Pitfalls of the Hungarian Health Market
“I actually believed there was going to be reform. That was my gullibility,” said Gábor Kollányi, president of HospInvest ZRt.20 At the beginning of 2009, HospInvest was the biggest private operator of hospitals in Hungary, with contracts to run six municipal facilities. Today, the company is bankrupt, owing at least HUF 3.3 billion (€11.5 million) to creditors as of July 2009.21 HospInvest’s story serves as a cautionary tale for companies that fail to understand Hungarians’ antipathy toward profit-oriented healthcare.
Kollányi got into the hospital-operating business thinking HospInvest could outperform Hungary’s state-operated medical institutions and do it more cost-effectively. HospInvest was counting on the Gyurcsány administration to change regulations so that corporate hospital operators would qualify for the same financing opportunities as state-run institutions, Kollányi said. The idea looked so promising that the European Bank for Reconstruction and Development (EBRD), the international finance organization created by the European Union, bought a minority stake in HospInvest for €4 million and pledged millions more.
It was not to last. Anger over the Gyurcsány administration’s co-pays, hospital closures and drug reforms touched off a wave of anti-capital sentiment. Fidesz and its media cohorts relentlessly attacked Kollányi and his business. Promised hospital-finance reforms did not materialize: For example, HospInvest was forced to pay local business taxes from which state-run hospitals were exempt. The company made losses just like other hospitals – the difference was, state-run hospitals knew that they would eventually be bailed out. With the prospects for expansion growing dim, the EBRD pulled out in March 2009. Fidesz’s referendum “had serious consequences for the ability of HospInvest to expand its business,” the EBRD said in a statement.22
HospInvest declared bankruptcy in July 2009. HospInvest’s former competitor, Medisyst Kft., announced that it, too, was leaving the hospital-operating business the following November. Kollányi insists his fate was not tied to any political party: “The [Socialist] government’s healthcare policies drove us to failure, and the [Fidesz] opposition supplied the accompanying music,” he said.23
“Nobody is going to try to operate hospitals for the time being,” said former Health Minister István Mikola, now Fidesz parliamentary Health Committee president, in an interview with Magyar Nemzet. “Private investors are getting out of the business. When they started out, they didn’t understand that the economic system is not set up for them to get a return on their investments.”24
Fidesz faces a funding crunch for health services. Insurance contributions from employers and employees are at a record low level since 1990 and the government will have a tough time finding new sources of funds. While Minister of National Resources Miklós Réthelyi has floated the possibility of private companies operating hospitals for municipalities, Fidesz leaders strongly oppose such a setup: The medical section of Fidesz’s 2007 manifesto begins with the words “healthcare is not a business.”25 Having rejected the idea of profit-oriented health insurance or hospital operators, the government is facing a financial fiasco.
- The National Health Insurance Fund’s budget for 2010 is HUF 1.45 trillion, which includes a forecast that expenditures will outstrip revenue by HUF 72.9 billion.
- The deficit goal may prove ambitious: The state insurer overspent payroll contributions by HUF 149.6 billion last year, trampling its original deficit forecast by more than 800%.26
- When the 2009 health deficit is combined with annual debts run up by hospitals, Hungary’s total healthcare deficit comes to HUF 229.6 billion, or 0.9 percent of GDP for 2009.27
- The situation for 2010 looks dimmer. The National Health Insurance Fund overspent its budget by HUF 43.4 billion in first five months of 2010, 43% more than planned and 4% more than the deficit for the first five months of 2009.
- The fund’s deficit target for 2010 is HUF 72.9 billion; it has thus reached 60% of its deficit target in the first five months.
- As a result of the economic crisis, a high inactive population and the Socialists’ fiscal decisions, employee-employer payroll contributions will cover only 42.7% of total government health expenditures this year – a record low since communism collapsed in 1990. Nearly 45% will come from taxes, with the rest coming from other sources.
- Hungary’s GDP is expected to rise just 0.5% in 2010. Assuming that the state health insurer pulls off the (highly unlikely) feat of keeping its deficit target and hospital debt levels reach around 80 billion, healthcare overspending will make up at least 0.6% of GDP for the year. If the situation is similar to last year’s, the healthcare deficit will be closer to 1% of GDP.
- Hungary’s budget-deficit target for 2010 is 3.8% of GDP.
The annual healthcare deficit is calculated by adding the amount of overspending at the state insurer to estimated hospital debts at the end of each year. The hospitals owed an estimated HUF 62 billion in 2007, HUF 55.8 billion in 2008 and HUF 80 billion in 2009. The Hungarian Hospital Association estimates that the debt level will reach HUF 80 billion again this year.
In 2007, when the Free Democrat reform package was in force, the annual healthcare deficit was equivalent to 0.1% of GDP. This rose to 0.2% in 2008 and 0.9% in 2009. If the state health insurer’s overspending remains at its current level vis á vis 2009 (+4%), the annual deficit will rise to HUF 235.5 billion, or 0.9% of forecast GDP by year’s end.
Fidesz built its medical platform around left-wing principles that leave state bodies in charge of hospitals and health insurance.
- The party’s election manifesto promotes the idea of raising Hungary’s level of healthcare spending to the levels of neighboring countries as a percentage of GDP. That essentially means raising health-care spending by 1% of GDP, or HUF 300 billion, by Fidesz’s own estimates.
- With unemployment currently topping 10% and real wages falling, it remains unclear where Fidesz will get the money.
Miklós Réthelyi. a 71-year-old medical research professor, is Minister of National Resources, heading a the brand-new ministry that oversees healthcare, welfare and education. Réthelyi was rector at Budapest’s Semmelweis University from 1990-1994 and director of the university’s Department of Anatomy, Histology and Embryology from 1994-2004.
- After years of tension at the Health Ministry, Réthelyi was probably chosen for his scientific pedigree and affable personality, not his political expertise.
- Political experience includes stints as department head at the Welfare Ministry in 1990 and in the Education Ministry from 1998-1999.
- Director of Semmelweis University’s Health Services Management Training Center from 1995-2000.
- Réthelyi has dedicated the bulk of his career to research at Budapest’s Semmelweis University, penning snappy titles such as “Neurochemical Architecture of the Filum Terminale in the Rat.”
- Since healthcare no longer has its own dedicated ministry, financing may become less transparent.
The state secretary responsible for health affairs is Miklós Szócska, who just stepped down as director of the Semmelweis University’s Health Services Management Training Center – the same position Réthelyi once held. Thus far, his public comments have largely eschewed specifics.
- Holds a master’s in public administration from Harvard University’s John F. Kennedy School of Government.
- Is “absolutely not thinking about privatization” of state health facilities, but would consider accepting private investment “if it serves the development of the healthcare system and doesn’t interfere with equal access to care.”28
- Opposed the Gyurcsány administration’s market-oriented healthcare reforms. Szócska hailed the referendum against the HUF 300 co-pays as a “nuclear weapon” that wiped out the chances for private health insurance.29
- Proposes to “rethink hospital consolidation,” both in structural and financial terms.30 Szócska criticized the Gyurcsány government’s decision to close institutions such as the National Psychiatric and Neurological Institute.31
- Opposes forcing doctors to pay back the money taxpayers spent on their residencies should they leave the country.
- Plans to shut down the Health Insurance Supervisory Authority in September 2010, although he considers patients’ rights an important issue.32
- Szócska can be overruled by Réthelyi when it comes to legislation or decrees.
- In 2005, Szócska co-authored a paper that laid out criteria for “feasible change and reform” in Hungarian healthcare.33 Recommendations included:
- A clear roadmap for healthcare reform that is effectively communicated. The authors found that “lack of information on the future state of change is the most important cause of organizational resistance.”
- A new system of pro-reform incentives for health workers. Szócska’s article calls this the “most complex policy challenge,” made all the more difficult by the pervasive culture of bribery in the health system.
- Competent management of change. “The change manager has personal change-management competencies, experience of implementing change and credibility among the employees, and this is maintained throughout the change process,” the paper states.
Key Spending Priorities
The issue of medical provision is so sensitive that Fidesz is unlikely to change the status quo until after the October 2010 municipal elections. The following are a list of medical priorities Fidesz has listed.
- Hospitals. Réthelyi said consolidating hospital finances was one of his top priorities. The Hungarian Hospital Association estimated the net debt of hospitals at around HUF 60-70 billion in the first quarter of 2010. Réthelyi said the association has already asked for HUF 235 billion a year for the next three years.34
Fidesz parliamentary Health Committee President István Mikola has said the state may also need to expenses at certain “key” hospitals.35 Fidesz has ruled out closing any hospitals and says cutting the number of acute-care beds will not save any money.
- Doctors. Réthelyi listed “solving the problems for resident doctors” as one of the most pressing items on his agenda. Fidesz proposes “wide-ranging negotiations” to develop a new “career model” for medical professionals that will keep them in the country.
Most doctors would stay in Hungary if the state raised take-home pay to HUF 200,000 for new doctors and HUF 400,000 for medics who have completed their residencies, according to Residents Association chief Magor Papp. That would mean doubling or even tripling total salaries, he estimates.36
A 20% across-the-board raise for medical professionals would cost the state roughly HUF 100 billion, according to an estimate by economist Eszter Sinkó.37
- Pharmaceuticals. Fidesz wants to sign long-term supply contracts with drugmakers that will last “several years.” Fidesz reckons this will allow the state to pay lower prices for drugs, while drugmakers will reap savings from lower marketing expenditures.38
- Region-based health care. Fidesz has proposed to make healthcare more flexible by setting priorities on a region-by-region basis. This means examining health indicators on and using the numbers to determine funding on a region-by-region basis.39
- Bribery. Fidesz proposes to wipe out this kind of corruption by raising doctor’s salaries. The party has also talked about making doctors freelancers instead of public employees; this means they would be able to contract with hospitals as they please.
Fidesz has put a priority on overhauling Hungary’s hugely expensive system of municipalities and has streamlined the government ministry system. They may also divert funding from other projects: “There’s nothing saying we have to spend HUF 600-700 billion to build the fourth metro line,” Health Committee President Mikola said in an interview with Magyar Nemzet. “We could have consolidated the entire health-provision system with that kind of money.”40 These measures would free up more cash for health care, but it is unclear how much.
Ministry of National Resources staff are currently developing a “healthcare action plan” that should be complete by September, Réthelyi said in a June 23 interview with the Hírszerző news portal. Orbán’s cabinet is also talking about “what is in store for healthcare,” and officials are holding talks with doctors, he said.41
Orbán June 8 announced a plan to impose a tax a surtax on banks and other financial institutions that aims to raise HUF 200 billion. No one has ever said any of this would go to fund healthcare.
In an interview with Világgazdaság, State Secretary Szócska said he believes greater efficiency in healthcare organization will yield savings.42 He plans to solicit ideas for reforms from health workers at the deruglacio.hu website.
Who Would Profit from a Fidesz Health Failure?
Fidesz’s promise to “save healthcare” loomed large in the 2010 campaign. The problem is, “salvation” means different things to different people. Should Fidesz fail improve the system to people’s expectations, which parliamentary party would stand to profit?
- The Socialists discredited themselves with the 2006-2008 reforms.
- Politics Can Be Different (LMP) has no healthcare platform to speak of.
- Jobbik has the medical expertise and the anti-establishment bona fides to pick up voters dissatisfied with Fidesz’s healthcare performance.
Jobbik’s healthcare platform is built around the same populist platitudes that Fidesz embraced whilst trashing the Socialist-Free Democrat reforms in 2008. Its election manifesto says:
- The core of Jobbik’s health philosophy is people- and community-centered care that doesn’t ask what is good for profit, money and competition.
- Equal access to healthcare for everyone along with better conditions.
- Expected outcome: An average lifespan increase of 10 years.43
Jobbik’s healthcare agenda is headed by MP Géza Gyenes, former general secretary of the Hungarian Chamber of Doctors. This gives Jobbik credibility that the other parties lack.
- Gyenes fought stridently against the Socialists’ plans to “privatize” health insurance and says he “hates” bribery.
- Gyenes also appeals to Hungarians’ perception of being cheated by the political elite. Two days before the first round of the 2010 elections, he said a policy of “deliberate genocide” had taken place against the Hungarian people over the past 20 years. More than 19,000 people died thanks to inadequate medical care in 2008 alone, Gyenes said.44
AUTHOR’S NOTE: Fidesz did not respond to an invitation to contribute information to this report.
1 Országos Egészségbiztosítási Pénztár, Összefoglaló adatok 2009, http://www.oep.hu/pls/portal/docs/PAGE/LAKOSSAG/OEPHULAK_UVEGZSEB/KOLTSEGVETESEK/2009N4.PDF
3 Weborvos, 235 milliárd várólistán, June 2, 2010, http://www.weborvos.hu/lapszemle/235_milliard_varolistan/156364/. Orginally appeared in Somogyi Hírlap.
5 Anita Neizer, “Ígéret szép szó: 100 milliárd forint kellene az emelt orvosbérekre,” Hírszerző, Feb. 26, 2010, http://www.hirszerzo.hu/cikk.igeret_szep_szo_100_milliard_forint_kellene_az_emelt_orvosberekre.141551.html Hírszerző is formerly owned by Political Capital’s parent company, Communications First Consulting Ltd.
6 Erzsebet Nógrádi Tóth, “Havi 150 ezer bruttó - Nem csoda, ha elhagynák az országot a fiatal orvosok,” Világgazdaság, March 26, 2010, http://vilaggazdasag.hu/velemeny/jegyzet/havi-150-ezer-brutto-nem-csoda-ha-elhagynak-az-orszagot-a-fiatal-orvosok-310706#p2
8 Anna Danó, “Ki fog minket gyógyítani tíz év múlva?” Népszabadság, March 18, 2010, http://www.nol.hu/archivum/20100318-2020-tol_nagy_lehet_az_orvoshiany-2
10 OEP, Összefoglaló adatok 2008http://www.oep.hu/pls/portal/docs/PAGE/LAKOSSAG/OEPHULAK_UVEGZSEB/KOLTSEGVETESEK/EVK08SUM.PDF
12 Calculated from 2008 data, available for 18 of the 31 OECD member states.
13 Hungarian Central Statistics Office, “A KSH Jelenti: Gazdaság és Társadalom,” 2010/2, pp. 15-16, http://portal.ksh.hu/pls/ksh/docs/hun/xftp/gyor/jel/jel21002.pdf
14 MTI, “Kövér: Lenullázódott az új kormány mozgástere, Magyar Nemzet, March 27, 2010 http://mno.hu/portal/703615?searchtext=Lenull%C3%A1z%C3%B3dott
15 Erzsebet Nógrádi Tóth, “Ismét nő a kórházi adósság,” Világgazdaság, April 16, 2010 http://vg.hu/vallalatok/egeszsegugy/ismet-no-a-korhazi-adossag-312860
16 OEP, 2010. évi OEP kincstári költségvetés http://www.oep.hu/pls/portal/docs/PAGE/LAKOSSAG/OEPHULAK_UVEGZSEB/KOLTSEGVETESEK/OEP%20KINCST%C3%81RI%20K%C3%96LTS%C3%89GVET%C3%89S%202010.PDF
17 László Skultéty, Tamás Tompa, Gyógyszerkiadások alakulását befolyásoló tényezők, GKI-EKI Egészségügykutató Intézet Kft http://www.allamreform.hu/letoltheto/egeszsegugy/hazai/Gyogyszerkiadasok_alakulasat_befolyasolo_tenyezok_GKI-EKI.pdf
19 Mihályi argued that the public-private scheme made sense: For example, Hungary had used “mixed ownership” as a first step when selling off other state companies, such as telephone monopoly Matáv, before privatizing majority stakes at a later date. Péter Mihalyi, ed., Health Insurance Reform in Hungary, Vol. 2, Budapest, Europe Ltd., 2008; Péter Mihalyi, “The Rise and Fall of the New Health Insurance Act,” p. 11
20 Ágnes Dreissiger, “’Elhittem, hogy lesz egészségügyi reform’ – Interjú a HospInvest elnökével,” Hirszerző, July 17, 2009 http://www.hirszerzo.hu/cikk.elhittem_hogy_lesz_egeszsegugyi_reform_interju_a_hospinvest_elnokevel.116038.html
21 Sándor Joób, “A Hospinvest nem tudja kifizetni tartozásait,” Index.hu, January 25, 2010 http://index.hu/belfold/2010/01/25/nem_tudja_kifizetni_tartozasait_a_hospinvest/. HospInvest is a former client of Flow Public Relations, owned by Political Capital’s parent company, Flow Corporation.
23 Judit Horváth, “A bukás oka: torz egészségpolitika,” Medical Tribune, June 17, 2010, http://www.medicalonline.hu/cikk/a_bukas_oka__kormanyzati_egeszsegpolitika/index.php
26 Országos Egészségügyi Pénztár, “Vezetői tájékoztató az Egészségbiztosítási Alap költségvetésének 2009. évi teljesítéséről” http://www.oep.hu/pls/portal/docs/PAGE/LAKOSSAG/OEPHULAK_UVEGZSEB/KOLTSEGVETESEK/2009%20DECEMBER%20HAVI%20TELJES%C3%8DT%C3%89S1%20_0.PDF
27 The percentage calculation uses a 2009 GDP estimate of HUF 26.1 trillion and estimated hospital debts of HUF 80 billion. Source: Health Strategy Research Instiute (ESKI), Health Ministry.
28 Erzsebet Nógradi Tóth, “Szócska: Nincs napirenden az önkormányzati kórházak államosítása,” Világgazdaság, June 21, 2010, p. 2 http://www.vg.hu/velemeny/interju/szocska-nincs-napirenden-az-onkormanyzati-korhazak-allamositasa-319420
30 Judit Sándor, “Vége a kimutyizott döntéseknek?” Weborvos, June 10, 2010, http://www.weborvos.hu/egeszsegpolitika/vege_kimutyizott_donteseknek/156907/
32 MTI, “Szócska Miklós az első egészségügyi lépésekről,” June 10, 2010 http://hetivalasz.hu/itthon/szocska-miklos-kotelezo-kamarai-tagsag-patikaalapitas-felfuggesztese-ebf-megszuntetese-30001
33 Miklós K. Szócska, János M. Réthelyi, Charles Normand, “Managing healthcare reform in Hungary: challenges and opportunities,” British Medical Journal, July 23, 2005 http://www.bmj.com/cgi/content/extract/331/7510/231
36 Neizer, “Ígéret szép szó,” http://www.hirszerzo.hu/cikk.igeret_szep_szo_100_milliard_forint_kellene_az_emelt_orvosberekre.141551.html
37 Neizer, “Ígéret szép szó,” http://www.hirszerzo.hu/cikk.igeret_szep_szo_100_milliard_forint_kellene_az_emelt_orvosberekre.141551.html
41 Anita Neizer, “Botrányosak a pedagógusi fizetések! - interjú Réthelyi Miklóssal,” Hírszerző, June 23, 2010, http://www.hirszerzo.hu/cikk.botranyosak_a_pedagogusi_fizetesek_-_interju_rethelyi_miklossal.155819.html
42 Nógradi Tóth, “Szócska: Nincs napirenden…” http://www.vg.hu/velemeny/interju/szocska-nincs-napirenden-az-onkormanyzati-korhazak-allamositasa-319420
43 Radikális változás: A Jobbik országgyűlési választási programja a nemzeti önrendelkezésért és a társadalmi igazságosságért, p. 42 http://jobbik.hu/sites/jobbik.hu/down/Jobbik-program2010OGY.pdf