By Gergely Szakacs
BUDAPEST (Reuters) - A year after COVID-19 arrived in Hungary, public hospitals have spent most of their resources fighting the virus and are currently battling its deadliest outbreak yet, unable to treat the growing numbers of people awaiting non-emergency procedures.
So with public hospitals closed to elective surgery, a quiet revolution in private health care is unfolding, led by a wave of investment in private hospitals and growth in health insurance.
Traditionally public hospitals provide the overwhelming majority of in-patient care, looking after everything from tonsillectomies to heart bypass surgery, but the pandemic has created an opportunity for existing private healthcare providers to expand and new competitors to enter the market.
Private hospital executives interviewed by Reuters have pledged or invested 85 million euros ($100 million) in the sector: a new hospital due in the capital Budapest, taking the lion's share of that spending, alongside a surgical ward planned in an existing facility and additional beds and upgraded equipment completed in another.
There is no publicly available data on such investments, but in the past two years only two new private hospitals were opened. Total investment is dwarfed by annual public health spending worth 4% to 5% of economic output, based on OECD figures.
Private health insurance grew by 23% last year, with some of that large increase due to relatively low market penetration according to Hungarian insurance association figures.
The average waiting time for common procedures, such as orthopaedic surgeries, has rocketed to more than a year from just 22 days based on public data from the government's National Health Insurance Fund.
For example, the wait for a hip replacement has grown from 59 days to 406 days, for a hernia 25 days to 410 days, it said.
Emergency surgery has continued throughout the pandemic.
For Rozalia, a 41-year-old sales manager at a Hungarian company, the revolution cannot come soon enough. She had life-saving surgery to remove a tumour from her breast last summer and has since lived with a tissue expander, a temporary fix until an operation to change it to a permanent implant.
"All my doctor could say that once the halted operations restart, they will discuss when I may get mine it is not likely before the end of the summer," she said, adding however that she cannot afford the procedure in the private sector.
Hungary's health authorities have given no indication as to when waiting times could fall back to normal. Neither the public health fund nor the health ministry responded to requests for comment.
Antal Kovacs, chief executive at the Da Vinci private clinic in southern Hungary, is sceptical the backlog could be wrestled down in just a year once the coronavirus crisis abates.
"Those who cannot or do not want to wait any longer, will look for private care, unless they require a procedure that cannot be performed in the private sector," he said.
Aron Kovaloczy, managing director at DLA Piper Business Advisory, said the quality, access, infrastructure of Hungary's public health system "has been steadily declining for years".
"In tandem with that, effective demand by people whose needs cannot be met by the public health system has been increasing," he said.
Of the $100 million investment under way and in the pipeline, the Buda Health Centre plans to start construction of a new hospital in Budapest this year at a cost of up to 30 billion forints ($97 million), adding 131 beds and eight operating rooms, Director Peter Pal Varga said.
"As private health insurance expands and we also grow organically, our patient numbers will increase," he said. "We need to meet the demand in the market."
Vienna Insurance Group's Union unit said while the number of Hungarians who could afford private in-patient care was still low and currently available in-patient care limited, private sector offerings were set to expand in the coming years.
"As the role of the private sector increases, so does demand for private health insurance," business unit leader Gabor Zsolnai said, adding that Union expected another 15-20% increase in private health insurance sales this year.
Anita Gurney, chief executive of the Duna Medical Centre private clinic that opened a new hospital in Budapest this year, said while in-patient private care could be pricey, it is no longer just the privilege of the elite.
"It all depends on when people's pain or their patience reaches a limit pushing them towards private care," she said.
(Reporting by Gergely Szakacs; Editing by Alison Williams)