Money talks, dogs bark, goes a Hungarian saying, and nowhere is this more true than in the health business. Yes, indeed, business. Because in Hungary, despite a national health insurance program which guarantees its citizen almost free health care, reality looks a little more grimy. If you can afford to pay your doctor under the table, you have more of a chance to survive. That’s if the post-apocalyptic conditions in hospitals don’t kill you first through one infection or another.
In most cases, the world over, if you’re sick and can’t manage, you go see a doctor. If you’re really sick, you go to the hospital. In Hungary the procedure is no different, except you shouldn’t forget to bring money. Because in Hungary you don’t only tip the cab driver, server, hairdresser, and beautician, you also tip the doctor. It’s called gratitude money (hálapénz), and is as natural and widely accepted as taking an umbrella with you when it rains.
The initial idea behind it was to say thank you to your doctor for dealing with you. With a little present, some homemade Pálinka perhaps, or homemade bacon. During communism, when these things were scarce, this evolved into hard cash. Dollars and Deutschmarks were preferred, but Hungarian Forints were not exactly frowned upon either. This being Hungary, where presentation is everything, the money was never handed over hand-to-hand, but was placed in an envelope, to make the whole thing more palatable.
What started as a way of saying thank you, has gradually evolved into a full blown extortion racket. Naturally, no one is standing at your bedside – or even by the door – with a knife at your throat, but really they don’t have to. A shrug of the shoulders, a dismissive attitude, followed by a “there’s nothing we can do,” until the money shows up, and the message is clear: if you want to get healthy, pony up. Defenders of the practice say it’s because doctors earn very little money, and deserve to make a living. Rationally thinking people look to the government and demand doctors be paid more.
“My cousin was in a car accident and jammed up his leg pretty badly,” says Sára, a student from Budapest. “The doctors said there was nothing they could do, they’d have to amputate. We raised 3 million forints (10,000€), and they said they could operate. My cousin can walk now, and you’d never be able to tell, but imagine if we hadn’t been able to raise that kind of cash.”
Sára isn’t the only example. An anecdote is making the rounds in Budapest, which may or may not be true, but illustrates the issue of gratitude money perfectly. The story has always been told to the narrator by “my friend’s mother, who works in the hospital.” It runs something like this: a patient wanted to thank the doctor for everything, and brought in a large chocolate egg with the words, “we just wanted to thank you, Doctor, for your service.”
The doctor looks at the beautifully wrapped present, and states drily – not without an all too audible note of disdain – “we normally expect money.”
“I see,” replies the patient, before enquiring, “what would be an appropriate sum?”
“Around 20,000 is usually expected,” replies the good doctor.< To put this in perspective, an income of 200,000HUF (roughly 667€) is considered “pretty decent.” Most people will make 20-40% less than that. Consider that in Hungarian hospitals patients not only bring their own bed clothes but also cutlery, toilet paper, plates, cups, and any medication not associated with their current affliction, and things quickly add up. Despite all that, the hero in our story is undaunted. “I see,” he states, then opens the egg, inside of which we find a wad of money, neatly folded (as befits a man of the doctor's position), a total of 100,000HUF. Our hero calmly peels off 20,000, hands it to the doctor, with the words, “then this will be appropriate,” thanks him again and leaves. Whether true or not, when on top of dealing with being hospitalized for whatever reason - or merely seeing the doctor - can bring out added levels of stress because of not meeting a potential target, it's easy to see how the story can be gratifying. In Hungarian healthcare the question isn't just whether the doctor is competent or not, but whether or not the gratitude you can afford to pay will be enough. The money always has to be given in cold, hard cash, as opposed to say a bank transfer. After all, the tax authorities will never get wind of it. And even though everyone and their mother is painfully aware of this practice, no one speaks up against it. Yet, all is not lost. In arguably the richest district of Budapest, up in the hills of Buda, Dr. F. wouldn't dream of accepting gratitude money. An expert in his field - to hear one patient put it, “I'm only alive because of him” - his gift (other than keeping patients alive, according to another patient, is that “he knows exactly how to talk to each and every person in his care.” And still, patients give him money, or try to, out of habit, because that's just how it's done. Fatima, who ended up in Dr. F.’s care, describes her experience. “A lady left the day after I came in. She had a final consultation with Doctor F., and when she came back she told her husband that the doctor just wouldn't accept any gratitude money. She and her husband consulted for five straight minutes on how to give him the money. When he discharged me, he did so by the reception desk, in plain view of everyone. He took excellent care of me, took time out to explain everything, really cared. But I never saw a person leave so fast as that day. He clearly didn't want any gratitude money.” As it turns out, Dr. F. is not alone. A closed group on Facebook, calling itself 1001 Doctors Without Gratitude Money, and doctors openly speaking out against this practice might be but a drop in the proverbial ocean, but as more and drops gather, what has been termed a “corrupt practice having nothing to do with any form of gratitude” by one doctor might be slowly on its way out. Eventually. Photo: Matt Madd