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Hungarian Medical Chamber Proposes Criminalization of Tipping Doctors

Péter Cseresnyés 2020.01.21.

The Hungarian Medical Chamber (MOK) has come up with a proposal urging for a significant salary raise of healthcare workers, and the criminalization for accepting and receiving tips for treatments. According to the government, the proposal is not clear enough and doctors should have a “broad consensus” on the subject before negotiating the suggestions further.

“Parasolvency [gratuity to the healthcare worker for the treatment] is a seriously damaging phenomenon in Hungarian society. It poisons the trust between doctor and patient, makes patient relationships unpredictable, and raises unrealistic expectations, undermines professional principles, impairs a significant portion of government health policy intent, distorts medical education, and impedes knowledge transfer,” the Medical Chamber writes in their proposal.


Parasolvency is an under-the-table payment in Hungarian healthcare. The widespread practice has a centuries-old tradition. As doctors and nurses are grossly underpaid and overwhelmed in the public health system, many accept money offered by patients as a ‘gratuity.’ In other cases, people are willing to pay their doctors huge sums to get ahead on waiting lists. So far, there were many failed attempts to eliminate the practice, as it costs a tremendous amount of money to the Hungarian people.

The document states that both offering and accepting tips should be considered criminal offences.

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According to the proposal, after the government increases the wages of Hungarian doctors to the level of the Visegrad countries, criminalizing gratuity payments will be in “the patient’s and the doctor’s core interest.”

Gyula Kincses, the newly elected president of MOK, said in an interview with economic daily Világgazdaság that “we want to solve this problem because giving and accepting gratuities for doctors is unethical and it causes unbelievable distortions and damages.”

“The black income lining the doctor’s pocket and the fact that it is a huge financial burden for the public are the smallest [problems] out of these. However, it also seems to have a significant impact on the structure of the healthcare system, for example on waiting lists,” he said.

According to Kincses, it is possible to create fair medical treatment without the gratuity process, but only after raising the wages of state health employees.

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A multi-step wage increase is not what we need, because it doesn’t have the desired social impact, so we can say that healthcare has finally become a priority sector, he added.

“If there’s no D-day feeling then it won’t work, but it also requires a government campaign and intent,” Kincses said.

Since its release, many members of the health sector reacted to the proposal.

Ágnes Cser, president of the Democratic Trade Union of Workers in the Hungarian Social and Health Sector (MSZ EDDSZ), called the Medical Chamber’s criminalization proposal ‘unethical and unfair.’

In a tv interview on Saturday, the trade union leader explained that the punishment would damage the trust between the patient and doctor, which is essential in therapy work.

A gradual salary increase in the healthcare sector is needed to eliminate this type of gratuity “system”, she added, but she cannot agree with a huge one step raise because Hungary would then “collapse.”

Most Hungarians See Tipping Doctors after Treatment as a Crime

In a radio interview, Ildikó Horváth, the state secretary in charge of health care said that doctors themselves should define “what criminalization should involve.” The chamber failed to specify “whether it would mean fining doctors and patients or jailing them,” she added.

Once doctors have “a clear stance based on a broad consensus,” the ministry will be ready to negotiate, Horváth said.

Concerning the raise of doctors’ salaries, Horváth urged the chamber to join the ongoing talks on hiking wages across the sector.

As we have previously reported, a study last year found that most Hungarians disapprove of tipping doctors and want the practice to be classed as a crime.

Featured photo via Pixabay/marionbrun