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ABSTRACT
The relationship between the Horthy era (1920–44) and the communist era shows continuities from a social historical perspective. The paper contributes to the reinterpretation of these relations by examining Hungarian health care in the 1930s and 1940s with a focus on the relationship between international transfers and path dependency in forging health care reforms. The author argues that the achievements communists regarded as inventions of socialism in health care and the welfare state had already been developed in the 1930s and 1940s. It was only because of the strict wartime budget of the early 1940s that these welfare reforms had not been realized. With the help of internal affairs documents, essays on health care, official statistics records in the National Archives of Hungary and the Semmelweis Library and Archives of Medical History as well as press material, Cora demonstrates that, even if communists depicted the interwar period as ‘fascist and imperialist’, the health care system of the so-called ‘productive social policy’ showed continuities. Moreover, social policy makers of the 1930s and early 1940s, such as Béla Johan, Ferenc Keresztes-Fischer and Béla Kovrig also designed welfare and health care reforms for the post-war period by both developing already existing Hungarian programmes and selectively adapting foreign welfare models (American management principles, the Alsace scheme and the Beveridge Plan). The study investigates Hungarian health care in view of the theory of path dependency and the macrohistorical convergence thesis developed by Tomka (on East–West convergence). It is within this framework that the paper addresses the issue of health care transfers to better understand the development of twentieth-century European health care systems by identifying similarities and differences in their development as well as to speculate on the trajectory of various political solutions to social challenges, including health care.
Acknowledgements
I am thankful to Professor Barry Doyle for his valuable pieces of advice when revising this paper, to my anonymous readers who contributed to improving the article, and to Dr Thomas Williams, who provided professional proofreading.
Disclosure statement
No potential conflict of interest was reported by the author.
Notes
1. Cf. Cora, “Kovrig Béla és a produktív szociálpolitika Magyarországon,” 193–207.
2. Ambrosio, Irredentism, 112–13.
3. Papházi, Egyesületek, társadalom, egészségügy, 97–125.
4. For example, in 1937 only 18.6% of all factories in Budapest had bathrooms, while only 1.1% of them had regular medical consulting hours. According to an aptitude test carried out by the National Institution of Social Security (Országos Társadalombiztosító Intézet) in 1935, 25–30% of workers’ children suffered from some kind of illness. The legal regulation on child and women’s labour had not been realized by 1936, either. The P100 poverty threshold could be applied to both the agrarian and urban poor. Also, social work was still in its infancy in Hungary in the 1930s. In 1938 cities spent 7.7% of their annual budgets on social work on average (P17.25 million in total). Moreover, only 15–20 Hungarian cities had regular day care centres, school charities and soup kitchens. See Pik, A szociális munka története Magyarországon, 1817–1990, 224–5; Lukács, “A mai magyar város élete,” 74–5.
5. Bikkal, Magyar szociálpolitika, 69–70.
6. Pik, A szociális munka története, 227–31.
7. Gyáni, Gábor, and Kövér, György, Magyarország társadalomtörténete a reformkortól a második világháborúig, 321.
8. See also Grombir et al., “Hospital Provision.”
9. Ferge, Fejezetek a magyarországi szegénypolitika történetéből, 135.
10. Doros, Családvédelem. Küzdelem a születéscsökkenés ellen, 5–65.
11. Doros, “Az egészséges magyar népszaporodás feltételeinek biztosítása,” 77; Johan, Az egészségügyi és szociális gyermekvédelmünk bírálata, 1–3; Meskó, “A magyar orvosi rend célkitűzései,” 38–9.
12. Tomka,Családfejlődés a 20. századi Magyarországon és Nyugat-Európában: konvergencia vagy divergencia?, 17–29, 111; Tomka, A Social History of Twentieth-Century Europe, 13–21.
13. Turda, Modernism and Eugenics, 110–17.
14. Csík, “A teljes magyar nemzeti állam egészségügyi rendszere a MONE megvilágításában,” 53–4.
15. Cf. Bryant, Franco’s Internationalists.
16. Csík, “A teljes magyar nemzeti állam egészségügyi rendszere a MONE megvilágításában,” 55; Doros, “Az egészséges magyar népszaporodás feltételeinek biztosítása,” 79–80; Meskó, “A magyar orvosi rend célkitűzései,” 39–40.
17. Meskó, “A magyar orvosi rend célkitűzései,” 38; Teleki, “A ‘vezetés’,” 1–13; Johan, “Mit várhatunk a mai magyar közegészségügyi munkától,” 84–5.
18. Documents of the Ministry of Internal Affairs. June 1940. National Archives of Hungary (Magyar Nemzeti Levéltár) MNL-OL K-153/4.
19. The National Stefánia Institution was nationalized in 1940. See Botos, Fejezetek a Belügyminisztérium történetéből 1848–1938, 42.
20. Gyáni and Kövér, Magyarország társadalomtörténete, 373–4.
21. Johan, “A Zöld Kereszt és a társadalom,” 25–9.
22. Systematic comparisons would form the topic of another article. For the application of modern management principles in twentieth-century hospitals, see Fernández Pérez, The Emergence of Modern Hospital Management and Organization in the World 1880s–1930s; and Fernández Pérez, “How to Evaluate the Capacity of Hospital Systems in a Very Long-Term International Comparative Perspective?,” 182–226.
23. Bikkal, Magyar szociálpolitika, 70; Nagy, “A társadalompolitika új elemei az 1930-as évek Magyarországán,” 99–103.
24. Botos, Fejezetek a Belügyminisztérium történetéből 1848–1938, 41–3.
25. Csík, “A teljes magyar nemzeti állam egészségügyi rendszere a MONE megvilágításában,” 57.
26. Ibid.
27. Kontra, “A zöldkeresztes egészségvédelmi munka,” 435–6.
28. The NHPA united all Hungarian organizations and activities related to health protection from 1 January 1941 (Ministry of Internal Affairs Decrees 888/1940 and 1000/1940), and became one of the fundamental institutions of health care during the war. The NHPA made it compulsory to establish tuberculosis and STD treatment centres in every town and district in the country, which were subsidized by national, municipal and social security institutions. The main tasks of the NHPA were health-related and preventive counselling, education, maternity and childcare and protection, maternity assistance and aids, the so-called ‘baby linen’ (a package of health care goods for infants), health protection of schoolchildren, food relief, treating tuberculosis and sexually transmitted diseases, taking care of bed-ridden people, and so on. The doctors and nurses working in these health centres were employed by the state. Bikkal, Magyar szociálpolitika, 71–4; Johan, Az egészségügyi és szociális gyermekvédelmünk bírálata, 5–6; Kontra, “A zöldkeresztes egészségvédelmi munka,” 436–9.
29. A magyar társadalombiztosítás ötven éve: 1892–1942, 126–132.
30. Vilar‐Rodríguez, “Competition and Collaboration between Public and Private Sector,” 1384–1408.
31. Keresztes-Fischer, “Közegészségügyi politikánk irányelvei,” 18.
32. “Vitéz Endre László és a falu egészségügye,” 22–3.
33. Many new and well-known health institutions were established in this period, for instance, the Lipótmező Hospital and the Mátra Hungarian Royal Horthy Miklós Sanatorium (Mátraháza). In 1926 the Ambulance Association of Cities and Counties was founded, which established 70 ambulance stations by 1938. See Kiss, “Az ispotálytól a modern kórházig,” 49–67.
34. Johan, “Mit várhatunk a mai magyar közegészségügyi munkától?,” 88–90; Kiss, “Az ispotálytól a modern kórházig,” 69–74.
35. See Grombir et al., “Hospital Provision” and Doyle et al., “The Development of Hospital Systems.”
36. On the post-Treaty of Trianon territory of Hungary (the territory of the country after the Paris Peace Conference), there were 52,752 available hospital beds in 1942. These data have been reconstructed with the use of the following statistics: Csík, “A teljes magyar nemzeti állam egészségügyi rendszere a MONE megvilágításában,” 57; Keresztes-Fischer, “Közegészségügyi politikánk irányelvei,” 18; Lukács, “A mai magyar város élete,” 70; Mészáros, “Kórházügy,” 212–22.
37. Northwest Hungary: 261.6; Western Hungary: 346.5; Southern Hungary: 343.2; Northeastern Hungary: 380.2; Transylvania (250 on average). Kiss, “Az ispotálytól a modern kórházig,” 75.
38. Kiss, “Az ispotálytól a modern kórházig,” 78.
39. Documents of the Ministry of Internal Affairs. Johan, Béla: A közegészségügyi szolgálatunk krízisének okai, különös tekintettel az orvoskérdésre. Javaslatok ennek megoldására vonatkozólag. 1941. május 11. [The causes of the crisis of the health care service, with a view to the question of the medical profession. Recommendations to solve the problem]. SOL Box 119.
40. Johan, A közegészségügyi szolgálatunk krízisének okai, SOL Box 119.
41. Internal Affairs Documents, April 1941. National Archives of Hungary, MNL-OL K-28/61.
42. Kiss, “Az ispotálytól a modern kórházig,” 78.
43. Johan, A közegészségügyi szolgálatunk krízisének okai, 119.
44. Kiss, “Az ispotálytól a modern kórházig,” 75, 78.
45. For these, see his correspondence with his wife and posthumous documents: Social Political Essays of Géza Mihályhegyi, SOL Box 308.
46. Mihályhegyi, “Szervezzük meg a katolikus beteggondozást”; Social Political Essays of Géza Mihályhegyi, SOL Box 308.
47. Social Political Essays of Géza Mihályhegyi, SOL Box 308.
48. The original text in Hungarian: “Eddig is már sokat írtak ezekről a kérdésekről, de inkább csak általános impressziók alapján, esetleg bizonyos célok szolgálatában. Így például a zsidó érdekeltségek állandóan cikkeznek az orvoshiányról, mert így remélik, hogy a zsidó orvosok munkához, esetleg álláshoz juthatnak, viszont a keresztény sajtóban a cikkek – éppen ellentétes céllal – azt törekedtek bizonyítani, hogy elég az orvos.” Johan, A közegészségügyi szolgálatunk krízisének okai, SOL Box 119.
49. Gyáni and Kövér, Magyarország társadalomtörténete, 374.
50. Egresi, Szociálpolitika Magyarországon, 302; Tomka, A Social History of Twentieth-Century Europe, 154–71.
51. For an example of its treatment, see Petres, “A zsidó kérdés orvosi és társadalmi szempontból,” 1–3.
52. Ormos ranks the world of homesteads and the counties of Southern Transylvania among these regions. See Ormos, Magyarország a két világháború korában, 1914–1945, 158.
53. For further details, see Don, A magyarországi zsidóság társadalom- és gazdaságtörténete a 19–20. században, 29–34; Ungváry, A Horthy-rendszer mérlege, 20–38.
54. Kovács, A csonkamagyarországi zsidóság a statisztika tükrében, 64–5.
55. In 1941 Johan registered 7243 Christian doctors in Hungary, 3055 of whom practised in Budapest. Outside the capital, 4188 worked in the country, and this number was used to calculate the rate of 52. See in detail. Also, see Johan, A közegészségügyi szolgálatunk krízisének okai, SOL Box 119.
56. Johan, A közegészségügyi szolgálatunk krízisének okai, 119.
57. Keresztes-Fischer, “Közegészségügyi politikánk irányelvei,” 119.
58. According to contemporary law, a doctor could only fill the post of medical officer after 34 years of age, and because of the retrieved territories, which necessitated greater investment rates from the national budget, he could only reach salary level VIII. Therefore, Johan wanted to raise the salaries for medical officers by first increasing the salary level to VII, as a school headmaster or a notary was also on level VII. The salary increase was supplemented by additional allowances enabled by Health Ministry Decree 7.000/1925. Johan, A közegészségügyi szolgálatunk krízisének okai, SOL Box 119.
59. Johan, A közegészségügyi szolgálatunk krízisének okai, 119.
60. For the Hungarian reception of the Beveridge Plan, see Cora, “A Beveridge-terv recepciója a magyarországi szociálpolitikában a második világháború idején,” 106–26.
61. Due to the limits of this paper, I cannot discuss this question in detail. See Cora, “A Beveridge-terv recepciója a magyarországi szociálpolitikában a második világháború idején,” 106–26.
62. For example, see Kovrig, “A Beveridge-javaslat. Az angliai szociális átalakulás története”; Tóth, “A Beveridge-terv,” 7; Bornemissza, “Ungarische Sozialpolitik und Beveridge-Plan;” Pulay, “A Beveridge-terv,” 218–24; Szociálpolitikus: Munkásság és munkásvédelem. A Beveridge-terv.
63. Metz, “Az orvos, a tisztviselő, meg a biztosított,” 191–2.
64. For the modernization and valorization process, see the following decree: 220/302. No. VII. 1943; Országos Orvoskamarai Közlöny 8 (March 5, 1944): 120–122.
65. For the decrees, see 236.600/1944. B.M. sz.; 80.346/1944. FM. sz.; Országos Orvoskamarai Közlöny 8 (March 5, 1944): 123.
66. Decree: 237.000/1944. B.M. sz.
67. Act XVI of 1900 had already obliged GPs to treat agricultural workers with voluntary social security for accidents if their treatment was not covered by any other doctor. See Országos Orvoskamarai Közlöny 8 (May 6, 1944): 58.
68. Keleti, “Egészségvédő és gyógyító alap,” 29.
69. Gyáni and Kövér, Magyarország társadalomtörténete, 374.
70. Johan, “Mit várhatunk a mai magyar közegészségügyi munkától?,” 92.
71. Bikkal, Magyar szociálpolitika, 73–4.
72. Bogdán, “Mi lesz azután?,” 256.
73. Sickness insurance involved the following: medical examination and free treatment (for a maximum of one year in hospitals and sanatoriums and for a maximum of half a year in the case of the family members of insured persons; sickness benefits for one year; half sum sickness benefit for the family of insured persons; and free medication).
74. Keleti, “Egészségvédő és gyógyító alap,” 30.
75. Laczkó, A magyar munkás- és társadalombiztosítás története, 149.
76. These claimants had been entitled to the very low-level services of the National Nursing Fund earlier.
77. Preventive services included free pregnancy health care services after the fourth month (nursing, obstetric counselling and so on), as well as free maternity clothes, milk and free baby linen. Keleti, “A biztosítottak egészségvédelme,” 68–9.
78. Kerék, Milliók a milliókért, 58–61.
79. Bikkal, Magyar szociálpolitika, 28.
80. Hungary’s participation in the war obviously played a part in the realization of this programme. Bikkal, Magyar szociálpolitika, 28–9; Karvázy, “A házassági kölcsön,” 41–4.
81. The greater increase of working hours meant that a doctor could devote more time to his patients. In this period, however, patient flow increased by only 11%, the number of social insurance doctors by 38%, and the number of hours they worked by 82%. Patient flow amounted to 1.1 million people. Thus, in 1942 15–20 minutes could be spent on one patient per day. Keleti, “Javul a betegellátás,” 3–4.
82. Johan, “Mi várható a szervezett közegészségügyi munkától?,” 41.
83. Keresztes-Fischer, “Közegészségügyi politikánk irányelvei,” 19.
84. Hindy, “Mit akarunk?,” 2.
85. These committee materials can be found among the documents prepared for the parliamentary debate on the budget for the 1944 financial year. They were compiled in December 1943, which can be inferred from the fact that the document refers to the ‘public reconciliation’ in parliament between Béla Imrédy and Prime Minister Miklós Kállay on December 16, 1943. See “Zoltán Meskó’s Speech in Parliament,” 16; “Health Care Parliamentary Fact Sheet,” 216; Documents of the Upper House of Parliament, The Budgetary Debate of 1944, The Report of the Budgetary Committee, SOL Box 338.
86. Documents of the Upper House of Parliament, The Budgetary Debate of 1944. The Report of the Budgetary Committee, SOL Box 338.
87. Johan, “Mi várható a szervezett közegészségügyi munkától?” 42.
88. “Health Care Parliamentary Fact Sheet,” 216.
89. Botos, Fejezetek a Belügyminisztérium történetéből 1848–1938, 47; Johan, “Mi várható a szervezett közegészségügyi munkától?,” 43.
90. Documents of the Upper House of Parliament. The Budgetary Debate of 1944. The Report of the Budgetary Committee, SOL Box 338.
91. Documents of the Upper House of Parliament. The Budgetary Debate of 1944. The Report of the Budgetary Committee, SOL Box 338.
92. Documents of the Upper House of Parliament. The Budgetary Debate of 1944. The Report of the Budgetary Committee, SOL Box 338.
93. “Health Care Parliamentary Fact Sheet,” 216.
94. Johan, “Mi várható a szervezett közegészségügyi munkától?,” 44.
95. Documents of the Upper House of Parliament. The Budgetary Debate of 1944. The Report of the Budgetary Committee, SOL Box 338.
96. Health centres were maintained by the doctor and the locality; therefore, many doctors in the chamber addressed the minister of internal affairs and asked that half of the health centres be paid for by social insurance institutions. This was also accompanied by a request: doctors should have the same rights to housing as civil servants. The petition was sent with the signatures of doctors György Bakács and Vitéz László Csík, “Health Care Parliamentary Fact Sheet,” 216.
97. Zoltán Meskó reported on the modernized health care conditions in Hungarian heavy industry in detail. See “Zoltán Meskó’s Speech in Parliament,” 16.
98. See Turda, Modernism and Eugenics.
99. Petres, “Társadalombiztosítás és közegészségügy,” 398–406.
100. Tomka, A Social History of Europe in the Twentieth Century, 155–9.
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Zoltán Cora
Zoltán Cora is a Senior Assistant Professor at the Faculty of Arts, University of Szeged, Hungary. His main areas of research are nineteenth–twentieth-century European history, international relations, and British and Hungarian political and social history, especially in the interwar period (1918–39), as well as classical and modern aesthetics with a focus on the sublime. His publications include edited volumes, book chapters on these topics and articles published in Comparativ: Zeitschrift für Globalgeschichte und vergleichende Gesellschaftsforschung, Aetas, Múltunk, Századok, Social History, Korall and other journals. He participates in the Comparative History Project organized by the Central European University, Pasts Inc., and has received several research grants (BKVGE Berlin, ESSE Bursary London British Library, Erdős Pál Junior Research Fellowship, Magyary István Board of Trustees). In 2011 he defended his PhD dissertation entitled ‘A szociálpolitika válaszútjai Magyarországon: A mintakövetés lehetőségei és kényszerei (1938–1950)’ [Hungarian social policy at crossroads: possibilities and necessities of pattern finding (1938–1950)]. He is currently working on the publication of a monograph on Hungarian social policy.