Chronic underfinancing is a common pitfall for many former socialist states and Hungary is no exception.
Total health spending ultimately accounted for 8.0 percent of GDP in Hungary in 2014, which is below the average of 9.3 percent across OECD countries. Moreover, only 63 percent was funded through public sources. Furthermore, fresh data from the National Health Insurance Fund (OEP) demonstrates that although a total of HUF 310.6 billion (USD 1.13 bn) was spent to subsidize medicines sold at pharmacies in 2015, compared to the planned budget of HUF 219 billion (USD 796.45 m) in 2012, a considerable 20 percent, equating to HUF 65 billion (USD 236.73 m), was covered by payments from pharmaceutical companies themselves.
“This indicates that healthcare is not a top priority for the government, and that really constitutes a problem,” argues Dr. Csaba Szokodi, Chair of AmCham’s Healthy Nation Policy Task Force. “We really need to focus on rendering healthcare a major topic in the political arena. We see the government eager to invest in research and development and clinical trials in the biotech and pharmaceutical industries, but not in the healthcare system as a whole. If you speak to a government official and ask if healthcare is good for the country, they will say yes to attracting investment, but when you talk about creating a sustainable healthcare system there is no clear and promising response. I strongly believe, that these two dimensions should be connected,” he reasons.
Ultimately, “You require healthy workers to have a healthy economy,” as general manager of GSK Hungary Claire Roger puts it. She does note, however, that “very recently, the government has belatedly started to place a greater emphasis on improving the conditions in healthcare.” “The new fiscal budget has announced a potential increase in not only salaries for healthcare workers, but also the pharmaceutical budget—the first time in several years—which is very much a step in the right direction,” she analyses.
When health priorities do not align with the tone at the top, it’s ultimately the patients who inherit the short end of the stick. “More affluent people in Budapest enjoy a life expectancy similar to that of the Swiss. However, some districts in the city have life expectancies up to 10 years less,” observes Dr. István Vályi-Nagy, director general of one of the largest hospital networks in Hungary, Szent Laszlo. “One of the reasons for this is that a certain strata of citizens don’t seem to take any responsibility for managing their illnesses: some can be quite ignorant, while others fail to undertake the normal prevention techniques. There are, for example, a lot of elderly people who lived most of their active lives under the paternalism of the communist system, many of whom are not in good condition health-wise. Most smoke and drink too much, eat fatty foods and don’t exercise and thus end up suffering from a variety of lifestyle diseases, often concurrently.”
Country director of Swiss pharmaceutical company IBSA, Anna Wienner believes that the onus must be on the industry itself to mitigate this state of affairs through promotion of health education initiatives. “Because of the historically passive and subservient relationship between doctors and patients in Hungary, levels of patient participation remain extremely low. This habit is difficult to break, but patients must, at some point, start taking the initiative to improve and manage their own health. If you analyze the statistics on Hungarian life expectancy, we rank towards the bottom in Europe. I believe that the pharmaceutical companies themselves thus have an obligation to work to increase health literacy rates,” she argues.
“Today we are working with patient groups, for specific therapeutic areas such as rheumatology and also in rural areas to raise and increase awareness. Supporting a patient association is actually very easy, but the power of patient associations in Hungary remains very weak, especially when compared to Western Europe. In the future this simply has to change and I believe it will so long as we take steps to properly empower them,” declares Wienner.
The idea of pharmaceutical actors stretching beyond their traditional role as purveyors of pills to concern themselves more with patient centricity and the realization of positive health outcomes certainly does seem to be gaining traction within the local market. “In terms of unlocking savings or reallocating resources, I don’t think the industry has anything left to really offer… instead I believe we’ve now gotten to a point where it’s time to think about investing in the health of our patients and improving the overall welfare of our fellow citizens,” agrees the general manager of Novo Nordisk Hungary, Zsolt Jozsa.