Nov.
26
2018

HOW MANY DOCTORS ARE THERE REALLY?

The main conclusions of the article:

Even though there have not been so many doctors working in Hungary, the time they spend active in public healthcare is decreasing.

Currently, far fewer people use public healthcare services than in 2006. The reason is either the copayment or that the public health sector has been at full capacity since 2009 – it cannot take care of more patients.

The shortage of doctors has been a controversial topic lately. One side bases its view on experience and expects a collapse of the sector, while the other pulls up the numbers saying ‘there have not been so many doctors working in Hungary’. And indeed, at first glance, there seems to be no problem with the numbers.

According to the Hungarian Central Statistical Office (HCSO), since 2010, the number of doctors working in healthcare has started to grow after the earlier stagnancy. This is even more eye-catching if we look at the number of doctors per head, because, unfortunately, the country’s population is decreasing. Where is the problem then?

It is a complex problem, but let’s have a look at the most straightforward point. Even though the number of doctors has not decreased, how much they work in the public health sector has. The numbers from Szinapszis Market Research and Consulting are quite indicative: in 2014, 49% of patients in Budapest saw a private doctor, while this number rose to 60% in 2016 – and there is a similar tendency in the country too. This can only be done if doctors do this at the expense of their time spent in public healthcare.

Since I did not find any data on private practice, I asked doctors so that I get at least an estimate on how many working hours shifted from public to private practice – which is not reflected in the number of doctors.

The first conclusion is that it is not a coincidence that there is no data on the topic – even doctors find it challenging to separate their working hours to public and private they are so blended together.

The second one is that those who can give an estimate, they say that the time spent in public and private practice is around 70 to 30% respectively, while in 2000, it was minimal, around 5%. If we adjust the previous picture with this, then we can see that the number of doctors is effectively decreasing: based on this estimate, by 6% since 2000, and since the 2004-peak by more than 20%. Indeed, the estimates above might not be the most accurate, but they seem more realistic than what we saw at the beginning.

If we look at the first figure from a different point, the situation still does not look as rosy as it seemed from the data of the Hungarian Central Statistical Office. Though the population has dropped, the number of patients at general practitioners, which can be explained by that as the population is becoming older, the more people go to the doctor…

…or would go if there were any free appointments since not only demand but supply can be a limitation too. If public practice, the supply, decreases, then it cannot take care of more people even if the demand for it is high. There is another Hungarian Central Statistical Office data for this: measuring how many times people go to doctors – to private or public practitioners.

As the figure shows, despite the decreasing population, the number of visits to doctors has not dropped – except for 2007, when it declined by 20% for both private and public practitioners, breaking the earlier growing tendency, which I find rather odd: something has been holding back the number of visits ever since.
2007 was the year when the 300 HUF copayment was introduced, and 2008 was when it was revoked.

There is no ultimate explanation for this phenomenon, but based on the graphs, today’s healthcare owes a lot to that fall. What would the current public healthcare capacity do with 10 million extra patients every year – assuming that we were still at the 2006 level? An alternate explanation is that healthcare is at its maximum capacity since 2009, so even if more people wanted to go to the doctor, they simply cannot.

Original date of Hungarian publication: 11 September 2018