Abstract
The new Hungarian Labour Code allows informal payments to be accepted, subject only to the prior permission of the employer. In Hungary, the area most affected is Health Care, where informal payments to medical staff are common. The article assesses the practice on ethical terms, focusing on organisational justice. It includes an analysis of distributional injustice, that is, of non-equitable payments to professionals, on the distribution of payments depending on the specialisation and status of the doctor, on his or her rights to allocate Health Care resources and/or on how assertive he or she is. We show, by means of a content analysis of internet postings and of interviews with physicians, the feelings and attitudes of both patients and doctors—thus enabling us to trace interactional and procedural injustice and portray the main driving forces of informal payment with causal loops. We use a new approach (a system dynamics computer simulation) to demonstrate how informal payments influence therapy procedures. The example of treating the common skin disease of psoriasis examines the specific behaviour of doctors in their everyday practice and estimates the extent to which the prescription of unnecessary or more expensive therapy increases the costs. With this multi-method approach, we demonstrate that the legislation allowing informal payment represents bad ethics, since it enforces organisational injustice, creates mistrust between physicians and patients, decreases performance and increases the total costs paid both by society and the Health Insurance Fund. Informal payments distort the allocation of resources, enforce discrimination based solely on money, violate the concept of solidarity and limit Human Rights in terms of health.
Similar content being viewed by others
References
Ádám, Gy. (1993). Az orvosi hálapénz Magyarországon (Informal payments in Hungary). Budapest: Magvető kiadó.
Adams, J. S. (1965). Inequity in social exchange. In L. Berkowitz (Ed.), Advances in experimental social psychology (Vol. 2, pp. 267–299). New York: Academic Press.
Ajtay, A., & Felmérai, I. (1991). Piaci elemekre épülő egészségügyi ellátás (Health care based on market forces). In: Recept. 2. évf. 6. sz.
Akkermans, H. (1995). Quantifying the soft issues: A case study in the banking industry. http://www.systemdynamics.org/conferences/1995/proceed/papersvol2/akker313.pdf
Aksoy, S., & Elmai, A. (2002). The core concepts of the ‘four principles’ of bioethics as found in Islamic tradition. Journal of Medical Ethics, 21(2), 211–224.
Allin, S., Davaki, K., & Mossialos, E. (2005). Paying for ‘free’ health care: The conundrum of informal payments in post-communist Europe. http://www.bu.edu/actforhealth/actforhealth04/Part%201_4_informal_payments.pdf
Ashforth, B. E., & Anand, V. (2003). The normalization of corruption in organisations. Research in Organisational Behavior, 25, 1–52.
Bata, Zs. (2012). Psoriasis vulgaris. http://www.psorioderm.com/dload/psoriasis_vulgaris_dr_bata_zsuzsanna.pdf
Bognár, G., Gál, R. I., & Kornai, J. (2000). Hálapénz a magyar egészségügyben (Informal payment in the hungarian health care system). Közgazdasági Szemle, XLVII, 293–320.
Botes, A. (2000). A comparison between the ethics of justice and the ethics of care. Journal of Advanced Nursing, 32, 1071–1075.
Buda, J. (2002). A társadalombiztosítás rövid története (The short history of health care insurance) Egészségügyi Menedzsment, IV, 2.
Cohen-Charash, Y., & Spector, P. E. (2001). The role of justice in organisations: A meta-analysis. Organisational Behavior and Human Decision Processes, 86, 278–321.
Colquitt, J. A., Conlon, D. E., Wesson, M. J., Porter, C. O. L. H., & Ng, K. Y. (2001). Justice at the Millennium: A meta-analytic review of 25 years of organisational justice research. Journal of Applied Psychology, 86, 425–445.
Cropanzano, R., & Ambrose, M. L. (2001). Procedural and distributive justice are more similar than you think: A monistic perspective and a research agenda. In J. Greenberg & R. Cropanzano (Eds.), Advances in organisational justice (pp. 119–151). Stanford, CA: Stanford University Press.
Cropanzano, R., & Greenberg, J. (1997). Progress in organisational justice: Tunnelling through the maze. In C. L. Cooper & I. T. Robertson (Eds.), International review of industrial and organisational psychology (Vol. 12, pp. 317–372). New York: Wiley.
Dózsa, Cs. (2004). Agresszív HBCS politika Magyarországon (Aggressive DRG politics in Hungary). IME III(4), http://www.imeonline.hu/pdf/archivum/2004_05/14-20.pdf
EEKH. (2011). Szakorvosjelöltek Markusovszky Lajos ösztöndíja (Markusovszky scholarship of residents) http://www.eekh.hu/letoltesek/osztondij_palyazat_o.pdf
EEKH. (2011b). Tájékoztató a 2012-es évi hiányszakmák köréről. (Information about the shortage occupations list in health care) http://www.eekh.hu/letoltesek/hiany_keret.pdf
Eleftheriadis, P. (2012). The right to health care. Journal of Law, Medicine & Ethics, 40(2), 268–285.
Ensor, T., & Witter, S. (2001). Health economics in low income countries: Adapting to the reality of the unofficial economy. Health Policy, 57(1), 1–13.
Eris, M. (2012). Improving health outcomes and system in Hungary. ECO/WKP(2012)38.
EüM. (2009). 3/2009. (II. 25.) EüM rendelet az emberi felhasználásra kerülő gyógyszer, illetve gyógyászati segédeszköz ismertetésére, az ismertetői tevékenységet végző személyek nyilvántartására, és a gyógyszerrel, gyógyászati segédeszközzel kapcsolatos, fogyasztókkal szembeni kereskedelmi gyakorlatra vonatkozó részletes szabályokról (Regulation of the detailed Rules of Marketing in the Hungarian Health Care), http://www.complex.hu/jr/gen/hjegy_doc.cgi?docid=A0900003.EUM
Field, M. G. (1991). The hybrid profession: Soviet medicine. In A. Jones (Ed.), Professions and the state: Expertise and autonomy in the Soviet Union and Eastern Europe. Philadelphia: Temple University Press.
Forrester, J. W. (1980). System dynamics—future opportunities. TIMS Studies in the Management Sciences, 14, 7–21.
Gaál, P. (2005). Gift, fee or bribe? Informal payments in Hungary. http://www.bu.edu/actforhealth/actforhealth04/Part%201_4_informal_payments.pdf
Gaál, P. (2006). Hálapénz? (Informal payment?), www.behsci.sote.hu/eloadasok/szociologia/aok_szoc_4eload_2007_2008.ppt
Gaál, Cs. (2009). Gazdaságosság és orvosi etika (Economic viability and Ethics). Egészségügyi Gazdasági Szemle, 47(4), 26–31.
Gaal, P., Carlo Belli, P., McKee, M., & Szocska, M. (2006). Informal payments for health care: Definitions, distinctions, and dilemmas. Journal of Health Politics, Policy and Law, 31(2), 251–293.
Gaal, P., & McKee, M. (2004). Informal payment for health care and the theory of ‘inxit’. International Journal of Health Planning and Management, 19, 163–178.
Gaal, P., & McKee, M. (2005). Fee-for-service or donation? Hungarian perspectives on informal payment for health care. Social Science and Medicine, 60(7), 1445–1457.
Garcia-Prado, A., & Chawla, M. (2006). The impact of hospital management reforms on absenteeism in Costa Rica. In Health Policy Plan, 21(2), 91–100.
Greenberg, J. (1993). The social side of fairness: Interpersonal and informational classes of organisational justice. In R. Cropanzano (Ed.), Justice in the workplace: Approaching fairness in human resource management (pp. 79–103). Hillsdale, NJ: Erlbaum.
Horváth, F., Terebessy, A., & Balász, P. (2011). A hálapénzkérdés értékelése IV. éves orvostanhallgatók körében (Survey about the informal payment among IV. year medical students). LAM 21(8–9), 559–563.
Imre, L., & Szummer, C. S. (2002). A HBCS nevű csodaszerről és annak káros mellékhatásairól (About the magic thing named DRG and about its adverse side-effects). IME, 1(3), http://imeonline.hu/pdf/absztraktok/1/15.pdf
Joób, S. (2011). Hálapénzre mennek az önkéntes orvosok (Volunteer doctors and informal payment), http://index.hu/belfold/2011/12/13/halapenzre_mennek_az_onkentes_orvosok/
Joumard, I., André, C., & Nicq, C. (2010). Health care systems: Efficiency and institutions. OECD, Economics Department Working Paper, No. 769, http://search.oecd.org/officialdocuments/displaydocumentpdf/?doclanguage=en&cote=eco/wkp(2010)25
Kapocsi, E. (2004). Válság vagy megújulás? Válaszúton az orvosi hivatás (Crises or renewal? The crossroads of the medical profession). LAM, 14(1), 72–75.
Kaposvari, C., & Vitrai, J. (2008). Snapshot of health inequities in hungary: Small area–level and social inequities in health care needs. HealthMonitor Research and Consulting.
Kincses, Gy. (2004). A paraszolvencia kérdéséről (About the question of of parasolvencia). LAM, 14(3), 212–217.
Kornai, J. (2008). A puha költségvetési korlát szindrómája a kórházi szektorban (The soft budget constraint syndrome in the hospital sector). Közgazdasági Szemle, LV(12), 1037–1056.
Kovácsy, Zs. (2012). Hálapénz: nehéz versenyezni a csodaszerrel (Informal payment, difficult to compete with the magic thing), HVG, http://hvg.hu/gazdasag/20120524_kovacsy_zsombor_korrupcio
KSH. (2008). Statisztikai Tükör. II.176. (Statistics bulletin).
KSH. (2012). Statisztikai Tükör. VI.51. (Statistics bulletin).
LCH. (2012). A munka törvénykönyvéről (Labour code of Hungary). Magyar Közlöny, 2(6.01), 257–317.
Leventhal, G. S. (1976). The distribution of rewards and resources in groups and organisations. In L. Berkowitz & W. Walster (Eds.), Advances in experimental social psychology (Vol. 9, pp. 91–131). New York: Academic Press.
Leventhal, G. S. (1980). What should be done with equity theory? New approaches to the study of fairness in social relationships. In K. J. Gergen, M. S. Greenberg, & R. H. Willis (Eds.), Social exchange: Advances in theory and research (pp. 27–55). New York: Plenum.
Lewis, M. (2010). Informal payments and the financing of health care in developing and transition countries’, IPC working paper series number 98. http://ipc.umich.edu/working-papers/pdfs/ipc-98-lewis-informal-payments-financing-healt-care-developing-transition.pdf
Lippai, R. (2012). Még nem múlt el a robbanásveszély (The danger of explosion is not over), http://mno.hu/belfold/egeszsegugy-1041296
Losonczi, Á. (2009). Az ember ideje (The time of man) Holnap.
Lukács, M. (2009). Hálapénz. A Patika Egészségpénztár reprezentatív kutatása a betegek hálapénzadási szokásairól (Informal Payment. Representative Survey of the Patika Health Fund). Budapest: Euro Design Pont Kft.
Marsha, L., & Richins, M. L. (1983). Negative word-of-mouth by dissatisfied consumers: A pilot study. The Journal of Marketing, 47(1), 68–78.
MEDPONT. (2009). A hálapénz a jelenlegi egészségügy egyik mozgatórugója? (Is the informal payment one of the driving forces of health care?), http://www.medpont.hu/hirek/egeszsegugyi-hirek/4082-a-halapenz-a-jelenlegi-egeszseguegy-egyik-mozgatorugoja
Mihályi, P. (2004). A hálapénzről—talán utoljára (About the informal payment—perhaps for the last time). Egészségügyi gazdasági szemle, 42, 5–21.
Miles, M., & Hubermen, M. (1994). Qualitative data analysis. London: Sage.
MOK. (2010). Etikai kódex (Code of Ethics of the Hungarian Medical Chamber). Magyar Orvosi Kamara. http://www.mok.hu/upload/mok/document/MOK_etikai_kodex.pdf
NRC. (2012). Internetpenetráció riport 2011/Q3 (Internetpenetration report), http://nrc.hu/hirek/2012/01/13/Internetpenetracio.
OECD. (2011). OECD Progress report. http://www.transparency.hu/uploads/docs/Progress_Report_on_OECD_Convention_Enforcement_July2011.pdf
OECD Health Data. (2011). www.oecd.org/health/healthpoliciesanddata/oecdhealthdata2012.htm
OEP. (2010). A plakkos psoriasis diagnosztikájának és kezelésének finanszírozási protokollja (Financing protocol of psoriasis with plaques), OEP
Pathirana et al. (2009). Európai S3-irányelvek a psoriasis vulgaris szisztémás kezeléséről (European S-3 directives about the systemic treatment of psoriasis vulgaris). Jeadv, 23(Supplement 2).
Patika. (2009). A Patikapénztár reprezentatív kutatása a betegek hálapénzadási szokásairól (Representative survey on informal payment from the viewpoint of patients). Euro Design Pont Kft.
Praxis. (2012). Praxis blog. http://praxis.blog.hu/
Rácz-Kummer, K. (2009). A gyógyszerpiac szerkezeti sajátosságai (The structure of the medicine market). In MEB 2009—7th international conference on management, enterprise and benchmarking June 5–6, 2009 Budapest, Hungary, http://kgk.bmf.hu/system/files/28_RaczKummer.pdf
Richardson, G. P., & Anderson, D. F. (1980). Toward a pedagogy of system dynamics. TIMS Studies in the Management Sciences, 14(1980), 91–106.
Sajó, A. (2008). Az állam működési zavarainak társadalmi újratermelése (Social reproduction of state’s dysfunctions). Közgazdasági Szemle, LV. évf(7–8), 690–711.
Seres, L. (2012). Legalizáljuk a korrupciót (Legalizing corruption), HVG, http://hvg.hu/velemeny.publicisztika/20120713_halapenz_korrupcio_seres
Sinkó, E. (2006). Értékrendváltás az átalakuló egészségügyben avagy az átalakulófélben levő egészségügy (Change of value system in the changing Health Care or the Health Care System in Transition). Esély 16 http://www.esely.org/kiadvanyok/2006_6/SINKO.pdf
Sinkó, E. (2009). Diszfunkcionalitások a Magyar egészségügyben (Dysfunctionaliities in the Hungarian Health Care) IME VIII(7), 9–12.
Solymosi, T. (2005). Mai Magyar egészségügy: helyzetelemzés és kibontakozás (Contemporary Hungarian health care: situation analysis and future development), Védegylet, http://www.konzilium.hu/plafon/ve.pdf.
Stepurko, T., Pavlova, M., Gryga, I., & Groot, W. (2010). 2010 ‘Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments. BMC Health Services Research, 10, 273.
Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage.
Szebik, I. (2003). Masked ball ethics, laws and financial contradictions in hungarian health care. Science and Engineering Ethics, 9, 109–124.
Szeghalmi, B. (2012). Mennyit keresnek a diplomás pályakezdők? (How much do young graduates earn?), http://www.kisalfold.hu/gazdasag/mennyit_keresnek_a_diplomas_palyakezdok/2291505/.
Szende, A., & Culyer, A. J. (2006). The inequity of informal payments for health care: the case of Hungary. Health Policy, 75(3), 262–271.
Szíjjártó, L. (2004). A hálapénznek meg kell szűnnie! (The informal payment should be eliminated!) LAM, 14(8–9), pp. 638–639.
Szinapszis. (2009). Orvosaink a hálapénzről, (Our doctor’s opinion about informal payment), http://www.szinapszis.hu/uploads/Szinapszis_-_Orvosaink_a_halapenzrol_20100816.pdf.
Szirmai, I. (2002). Valami ideg. (Something neural) Lift Coeur.
TÁRKI, Omnibusz 1999/2, 2003/6, 2007/11, 2009/11. http://www.tarki.hu/hu/news/2009/kitekint/20091203.html.
Thibaut, J. W., & Walker, L. (1975). Procedural justice: A psychological analysis. Hillsdale, NJ: Erlbaum.
Transparency. (2012). Corruption risk in the Visegrád countries. Visegrad integrity system study. Transparency International. http://www.transparency.hu/uploads/docs/visegrad.898.pdf
Tyler, T. R. (2000). Social justice: Outcome and procedure. International Journal of Psychology, 35, 117–125.
Vian, T. (2007). Review of corruption in the health sector: Theory, methods and interventions. Health Policy and Planning, 23, 83–94.
Vian, T., & Burak, L. (2006). Beliefs about informal payments in Albania. Health Policy and Planning, 21(5), 392–401.
Worldbank. (2012). Standard antibribery code. http://siteresources.worldbank.org/antibriberycode.doc
Zivkovicz, N. (2010). A MEGOLDÁS: Zöldkeresztes mozgalom orvosaink itthon tartására! (The solution: green-cross movement in order the keep our doctors at home), http://rezidens.hu/index.php?option=com_content&view=article&id=20:a-megoldas-zoeld-keresztes-mozgalom-orvosaink-itthon-tartasara
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Somogyvári, M. The Costs of Organisational Injustice in the Hungarian Health Care System. J Bus Ethics 118, 543–560 (2013). https://doi.org/10.1007/s10551-012-1600-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10551-012-1600-3