Miklós Szócska

Informal Payments for Health Care: Definitions, Distinctions, and Dilemmas

There is increasing interest in the issue of informal payments for health care in low- and middle-income countries. Emerging evidence suggests that the phenomenon is both diverse, including many variants from cash payments to in-kind contributions and from gift giving to informal charging, and widespread, reported from countries in at least three continents. However, cross-national research is hampered by the lack of consensus among researchers on the definition of informal payments, and the definitions that have been proposed are unable to incorporate all forms of the phenomenon that have been described so far. This article aims to overcome this limitation by proposing a new definition based on the concept of entitlement for services. First, the various forms of informal payment observed in practice are reviewed briefly. Then, some of the proposed definitions are discussed, pointing out that none of the distinctive characteristics implied by these definitions, including illegality, informality, and corruption, is adequate to capture all varieties of the phenomenon. Next, an alternative definition is formulated, which identifies the distinctive feature common to all forms of informal payments as something that is contributed in addition to the terms of entitlement. Then, the boundaries implied by this definition are explored and, finally, the implications for research and policy making are discussed with reference to the lessons developed countries can learn from the experiences of transitional countries.

The medical career choice motivations — Results from a Hungarian study

Some decades ago being a medical doctor was characterized unambiguously as a profession that offers help and serves the patients’ needs during medical treatment. In today’s society, this image of the medical profession has been substantially changed. The present paper aims to examine medical career choice motivations and preferences of choosing speciality, in the light of current social and economic changes in Hungary. The study was carried out by using a voluntary, self-administrated, questionnaire among first-year medical students and resident doctors in four medical faculties in Hungary. The career choice motivations of the first-year medical students and resident doctors are similar and match to the traditional health profession career choice motivations. Nevertheless the first-year students consider high income as one of the most important factors. They appear more conscious and more ambitious regarding their future speciality choice. The Hungarian health care system and medical education must be prepared for the presence of students that are aware of the high market value of a medical diploma, have excellent language skills, and consider migration as one main factor in their motivation when choosing a medical profession.

Managing healthcare reform in Hungary: challenges and opportunities

The reform of healthcare services is a priority in transitional Hungary, but managing these changes is fraught with difficulties due to the political climate and managerial inexperience

Will you support a patient-centred R&D agreement?—Response from Miklós Szócska

In response to the open letter on patient-centred research and development (R&D), failures and imbalances that characterise the global pharmaceutical market have long been recognised and dealt with, although no breakthrough has been reached in finding real solutions to these problems. While accessibility and affordability challenges in lower income countries still persist and call for reinforced actions, developments of recent years have brought about or revealed further unfavourable phenomena, such as extremely high, unaff ordable prices, sometimes limited therapeutic advances brought about by innovative drugs or in certain cases lack of real innovation. These already represent global challenges in times when the socioeconomic relevance and importance of health and the health sector is being recognised and reflected in the Sustainable Development Goals, foreseeing to ensure global access to medicines and vaccines. These comprehensive developments underline the urgency of uniting forces in laying the foundations for a fairer pharmaceutical market. This is a complex task involving a large number of various players; however, it could never be questioned that the whole process should be driven by public health needs and serving patients. Ongoing WHO activities should continue and play an orienting role in both publicly and privately funded R&D activities in order to better channel R&D resources to the most relevant therapeutic areas. WHO should play a driving role by formulating questions and providing a framework for fi nding adequate responses. Discussions by member states on identifying and shaping proper frames for creating a balanced global pharma ceutical market, and correcting failures of the present system should be continued by all players concerned. Long-term solutions, serving patients needs and at the same time resolving the smooth operation of the pharmaceutical market, should be identifi ed and a sensitive balance established. This cannot be a simple process. WHO should play a leading role in these efforts to ensure that public health interests prevail and dominate. At the same time, the intersectoral character of the issue cannot be ignored and long-term, sustainable solutions can be the result of extensive multisectoral consultations.

WHOse agenda for WHOm? Analysing the manifestos of the candidates for Director-General of WHO

I have read the Correspondence by Kent Buse, Iwan Williams, and Sandra Hawkes with great interest. The authors provided a provocative analysis on WHO Director-General candidates’ manifestos alignment with the political priorities expressed in the United Nations Agenda 2030 for Sustainable Development health-related targets. In the supplement of the Correspondence, these targets are explicitly listed and each candidate’s commitment is noted with tick or cross symbols. In my view, a more thorough analysis of the available resources might have allowed a richer insight to the candidates’ positions on the Sustainable Development Goals (SDGs). I would restrain myself to highlight three topics where I feel that I have made strong, direct, and public commitments noted by the observers of this extensive campaign. My commitment to fight tobacco by all means could not be better refl ected by the “Tobacco Agenda”, which is a series of public health regulatory interventions that resulted in the complete ban of smoking in enclosed public and commercial spaces. This agenda also supported tobacco distribution via designated shops, and topping the process with continuous increases in the price of tobacco products. This agenda sits, in part, at the intersection of what I see as my next firm commitment, which is increasing health financing. This commitment is manifested in piloting new business models during my time as the Hungarian Minister of State for Health. Specifi cally, innovative fi nancing techniques were linked to the consumption of unhealthy snacks and soft drinks, not only resulting in extra revenue for health fi nancing, but also promoting a healthier, self-conscious behaviour for the whole population. To leverage the suppliers of health technologies, I think I made a clear and strong commitment when I deemed the WHO in my public appearances as an umbrella organisation for research and development, acting to mobilise the creativity of the global health policy community in order to be ready to enhance 21st century governance, resource generation, business models, and procurement for the entire disease area. Regardless of the outcome of the election process to fi nd the new WHO Director-General, my actions are the purest evidence of my commitment towards achieving the SDGs. I also hope that I can keep proving this to the wider public.

Managing intra-EU mobility—do WHO principles of ethical recruitment have relevance?

BackgroundThe WHO Global Code of Practice on the International Recruitment of Health Personnel provides for guidance in health workforce management and cooperation in the international context. This article aims to examine whether the principles of the voluntary WHO Global Code of Practice can be applied to trigger health policy decisions within the EU zone of free movement of persons.MethodsIn the framework of the Joint Action on European Health Workforce Planning and Forecasting project (Grant Agreement: JA EUHWF 20122201 (see healthworkforce.eu)), focus group discussions were organised with over 30 experts representing ministries, universities and professional and international organisations. Ideas were collected about the applicability of the principles and with the aim to find EU law compatible, relevant solutions using a qualitative approach based on a standardised, semi-structured interview guide and pre-defined statements.ResultsBased on implementation practices summarised, focus group experts concluded that positive effects of adhering to the Code can be identified and useful ideas—compatible with EU law—exist to manage intra-EU mobility. The most relevant areas for intervention include bilateral cooperations, better use of EU financial resources, improved retention and integration policies and better data flow and monitoring.Improving retention is of key importance; however, ethical considerations should also apply within the EU. Compensation of source countries can be a solution to further elaborate on when developing EU financial mechanisms. Intra-EU circular mobility might be feasible and made more transparent if directed by tailor-made, institutional-level bilateral cooperations adjusted to different groups and profiles of health professionals. Integration policies should be improved as discrimination still exists when offering jobs despite the legal environment facilitating the recognition of professional qualifications. A system of feedback on registration/licencing data should be promoted providing for more evidence on intra-EU mobility and support its management.ConclusionsWorkforce planning in EU Member States can be supported, and more equitable distribution of the workforce can be provided by building policy decisions on the principles of the WHO Code. Political commitment has to be strengthened in EU countries to adopt implementation solutions for intra-EU problems. Long-term benefits of respecting global principles of the Code should be better demonstrated in order to incentivise all parties to follow such long-term objectives.

The role of controllable lifestyle in the choice of specialisation among Hungarian medical doctors

BackgroundHungary has been serious facing human resources crisis in health care, as a result of a massive emigration of health workers. The resulting shortage is unevenly distributed among medical specialisations. The findings of research studies are consistent in that the most important motivating factor of the choice of the medical career and of medical specialisations is professional interest. Beyond this, it is important to examine other reasons of why students do or do not choose certain specialisations. The lifestyle determined by the chosen speciality is one such factor described in the literature.MethodsUsing convenient sampling, first year resident medical doctors from each of the four Hungarian universities with a medical faculty were asked to participate in the study in 2008. In total 391 first year resident medical doctors completed the self-administered questionnaire indicating a 57.3% response rate. On the basis of the work of Schwartz et al. (Acad Med 65(3):207–210, 1990), the specialisation fields were divided into the two main categories of non-controllable (NCL) or controllable lifestyles (CL). We carried out a factor analysis on motivating factors and set up an explanatory model regarding the choice of CL and NCL specialisations.ResultsTwo maximum likelihood factors were extracted from the motivational questions: “lifestyle and income” and “professional interest and consciousness”. The explanatory model on specialisation choice shows that the “professional interest and consciousness” factor increases the likelihood of choosing NCL specialisations. In contrast the “lifestyle and income” factor has no significant impact on the choice of CL/NCL specialisations in the model.ConclusionsOur results confirm the important role of professional interest in the choice of medical specializations in Hungary. On the other hand, it seems surprising that we found no significant difference in the “lifestyle and income” related motivation among those medical residents, who opted for CL as opposed to those, who opted for NCL specialisations. This does not necessarily mean that lifestyle is not an important motivating factor, but that it is equally important for both groups of medical residents.