Discussion Papers 1986/1.
Centre for Regional Studies
of Hungarian Academy of Sciences
DISCUSSION PAPERS
No. 1
Critical Issues in the Deyelopment of Hungarisr
Public Health with Special Regard
to Spatial Differences
by
OROSZ. Eva
Series editor: HRUBI, Laszlo
Pecs
1986

Discussion Papers 1986/1.
CONTENTS
Page
INTRODUCTION
3
/a/ Universal Provision of Medical Care
5
/b/ Some Characteristics of Financing
Public Health
6
/c/ Unified Oiganizational Structure
7
PART ONE
MAJOR TENSIONS IN EXTERNAL /SOCIO-ECONOMIC/
AND INTERNAL CONDITIONS OF HUNGARIAN PUBLIC
HEALTH
lo
Unfavourable Trends in the Population's
State of Health
11
Inadequacy of Developmental Resources; the
Steadily Subordinated Role of Public Health
in the Distribution of Resources 12
Inner Disproportions in!the Development of
Public Health
11+
The Retardation of Hungarian Medical
Technology
16
The Financing Mechanism for Public Health
in the Framework of Budgetary Accounts
17

Discussion Papers 1986/1.
Page
State Inclusion of "Bribes" /Gratitude-
Money/ in Doctor's Earnings
18
DifferencesBetween Public Health Neods
and the Traditional System of Doctor's
Values
18
The Low Level of the Social Integration
of Public Health
19
PART TWO
MAJOR PROCESSES OF REGIONAL INKUALITIES IN
PUBLIC HEALTH INFRASTRUCTURE.
2o
Uneven Moderation of Regional Differences
in Practitioner and Hospital Provisions
2o
Adverse Development Paths in the Regions
with Unfavourable Facilities
24
Effects of Regional Development Polir
26
Public Health PolioN and Regional
Differvu-es
29
in s So i ri
Re.I ;1,t i ohs W i I h.i n I hr
P cart i I i on, 1. 7 s wit tlum
SI'MMAPY
REFERENCES
17
APPENDTX
;:0

Discussion Papers 1986. No. 1.
Critical Issues in the Development of Hungarian
Public Health with Special Regard to Spatial Differences 3-47. p.
NTRODUCTION
his study examines some important problems facing the
ungarian health system, particularly with regard to
dentifying spatial differences in the provision of health
are. The study consists of two parts: the first presents
summary of the relevant literature;while the second dis-
c sses the research findings. The remainder of the intro-
uction provides an overview of the post-WWII Hungarian
iealth system to help better acquaint readers who may not
e familiar with the situation here.
t the close of World War II,  Hunga•y inherited  a dispropor-
ioned health care facility network  resulting both from
ormer development patterns and  from cosidevable war damage.
arge  areas and wide social strata had  to do without medical
care.
n the course of the  post-war decades. however ouistanding
results have been reached: mass diseases have been liqui-
dated;  and  objective, subjective and organizational precon-
ditions  for public health care covering the whole area of
the country, along will (he expansion of social insurance
have been established. /14/
A major achievement of socialist public health has been ra-
pid suceesS in the prevention and cure of "morons hungaricus",
i.e. tuberculosis. For example, our of lo thousand inhabi-

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 4-
tants, there were 9.61 deaths due to tubercolosis in 1949,
but only 2.51 in 1965.
Infant mortality has also decreased remarkably. Out of one
thousand new-born children /under the age of one year/ 156.
died in 1930-31. However, this rate averaged 98.3 between
1945 and 195o, while data for 1961-65, 1969-7o and 1983 wer
respectively  42.7;  35.8; and 19. This latest figure though
is admittedly  rather unfavourable by  international comparis
In 1938,  10,590 - or 11.7 per lo,000 - practicing doctors
were in Hungary,  whereas today 2o,358 - or 26.6  per  lo,000
provide medical  care, a rise of 2.3 times.
This increas
in the doctor-population ratio is outstanding even with
respect to international standards; with Hungary holding
fourth or
fifth place in Europe during the late seventies.
Furthermore the number of hospital beds amounted to only
48,898 in 1938 /a rate of 54.0 per ton thousanu inhabitants,
while in 1983 96,398 beds wore serving the recovery of the
sick population, y3ilding a bed-population rate of 9o.3.
Three features of the Hungarian public health system are
notable:
/a/ medical care /treatment/ is offered to every Hungarian
citizen free of charge /as a social right/;
/b/ financing this system relies both on State budget and
the budgets of councils;

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 5
/c/ the system has a  unified organizational structure
operated by  the state.
/a/ Universal  Provision of Medical Care
Health insurance covered hardly more than one third of the
Hungarian population before 1945. Peasant and agricultural
workers, who represented the majority of the population al-
most stood completely outside the social insurance system.
The organizational system of health insurance was extraor-
dinarily scattered, with more than 3o health insurance insti-
tutions operating in the country.
Unification of the organizational system was carried out
at the end of the forties. Nevertheless, a decisive turn in
the expansion of health insurance took place in the early
sixties. It was motivated by the socialist reorganization
of agriculture; that is, the free medical care /treatment/
wasnlso extended to the co-operative peasantry. While so-
cial insurance covered only 62 per cent of the Hungarian
population in 19'17, this figure rose to  97  per cent by
1965.
The Public Health Act passed in 1972 is regarded as a new
stage of development, inasmuch as it was declared that
every citizen has the right to free medical treatment.
However, each person must pay a modest fee for medicines.

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 6-
/b/  Some Characteristics of Financing Public Health
On the one hand the system of financing public health inst:
tutions is separate from the institutional system of socia:
insurance. However, on the other hand,both systems of final
cing  are closely connected with the State budget. Einployeel
pay old-age pension-contribution on the basis of their wage
and salaries, while employers pay social insurance contribi
tion on  the basin of  wage costs. These sums represent a pax
of the  State budget incomes. Social  insurance expenditures
-/for pensions, sickness benefit, etc./, in turn, represent
an element of the State budget expenditures. Nevertheless,
there is not a direct relation between the two money funds
/i.e. between the incomes and expenditures of the social
insurance/.  An overwhelminfT majority of public health insti
tutions is under  the management of local /city  or village/
or county councils. Accordingly, those institutions are
financed from the budget of the councils. /A considorible
part of  the budgetary funds of councils derives from State
subsidies./
The management and financing of medical universities and
other national medical institutions are performed directly
by the Ministry of Health.

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 7-
/c/ Unified Organizational Structure
The public health system, established in the last third of
the past century, represented historical precedents of the
present public health organizational system. Act 1876/XIV
concerning the organization of public health in Hungary was
a remarkable composition even on the international scene.
In addition to hygienic and epidemic directions, this law also
provided for a comprehensive regulation of the institutional
system of public health. For example, the law stipulated that
every town as well as every village with a population over
six thousand people, hid to have a public practitioner. Mi-
nor settlements jointly employed a rural district doctor.
The law also declared that the management of public health
was the task of the State, and that the management system
of public health was formed on the basis of public administ-
ration. However, due to the social-economic backwardness of
the country, only a fraction of the progressive spirit and
aims of the law on public health were realized by 1945.
Before 1945, in addition to public health services opera-
ted by local authorities, medical care /treatment/ was also
provided by different social insurance institutions, as
well as charitable and private institutes. This scattered
organizational system of public health was unified in the
early fifties. At the same time, the system was put under
the twofold management and control of the Ministry of Health

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 8 -
and the councils. The operation of the unified public heal
organization became based on the principle of regional res
ponsibility. The essence of this principle manifests itsel
in the fact, that every public health service unit /distri
doctor, welfare centre, hospital etc./ looks after the po-
pulation of a pre-determined /prescribed/ area /district/.
As in other countries, public health is an extraordinarly
complex system also in Hungary. Within the framework of th
study only the major branches can be outlined.
Today, primary health care is performed by district gene-
ral practitioner's service, plant /factory/ practitioners,
district pediatricians, dental surgeons, as well as the ch
mist network. In 1983, one district general practitioner t
care of 2526 inhabitants. Out of the 3121 settlements of t
country 1589 /50.9  per cent/, were served loyalTy by a d
* riot general practitioner.
Out-patient care  is performed by  ambulatory clinics and
chronic care facilities. In-patient care is offered - on
thd basis of the progressive care /regionalized health sys
tem/ principle - by city and county hospitals, four univer
sity clinics, and national special institutions. Universit
clinics and three county hospitals also perform regional
level  tasks. /In cities with hospitals the ambulatory elin
and the hospital constitute one organizational
unit./ In

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
9
198o there were 196 hospitalizations per one lhonsand inha-
bitants. One of the main tasks of preventive-therapeolie (-ace
is the protection of women, children, family and youth.
The main forms of social care  are: social normin homes /for
the  aged, as well as physienify and  mentally handicappee
p  ople/ day-home for the elderly.  visiiinp; sociol
allowances.
Sanitation  and - epidemic sel-cieos  ;WC  svp:Ir;liod rvom  proven-
tive-therapeotic ones in loth or:7oniz3):lo31 and implementation.
The tasks of the rormor se•vircs cover amon others: modera-
:
Iion or drI•imcnial envirmum , inal condil ions. occupational
ond oolritional  ho;111h inquiries.  nrrycniion and overcomin
ir r c I i
i
cic. Their orani/alionoi mulls are
Mc so c:111cd
-s
epidemic  slalions/  on
the coonl\-lovel. as
scr‘i , cs  0 Pelniin in
and the disfricis  ur  111;-•

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
lo -
PART OYE
MAJOR TENSIONS IN EXTERNAL /SOCIO-ECONOMIC/ AND INTERNAL
CONDITIONS OF HUNGARIAN PUBLIC HEALTH
Disadvantageous processes have emerged in the population's
health conditions during the past lo-15 years. Accordingly,
the role played by the population's demographic state and
level of health in Hungarian socio-economic development has
changed dramatically. This limiting impact on economic deve-
lopment will increase in future decades.
Public health infrastructure today represents one of the
critical issues ooneerning Living condi tions. Its develop-
meat  lagged  behind both the lovilL  of economic progress and
the  r0 0 0loomonis or sooioiv.  This backwardness ran he attri-
buted  1p
the  [imited resort ryes  available for development.  flu
inner  di  sp rope c l ions iu  1,11 ,,  dove 1 oilmen
or pub
heal Lb.
and the incompletely built-up institutional  systcm  or  sookil
At
this developmental
sl - ac.  ”r  public health, the problems
ialed tc i l It re How,  1 differenees become manif , - I
in
waNs di•re•ent from those or more dynamicatlx develo1,in7
Iligh  level  public  health infrastructures.
The position of
more haelosard arras is noncrallv  more or;tival, the diffe-
relives uere estabtishcd  long  ago. Iho material conditions

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 11 -
for their moderation are more limited, etc./
Unfavourable Trends in the Population's State of Health
Hungary is among the worst European countries in terms of
its  general health and mortality characteristics. The extent
and the  steadiness of deterioration of the mortality rate
differ from the trends in countries with a similar level of
development, as well as in  the more advanced ones. /15/
Mortality trends are fundamentally influenced by cardio-
vascular and tumourous diseases. If]. Hungary, these two groups
of illnesses caused 72.7 per cent of total mortality in 1983
/or, to put it more precisely,  53.3  percent vas represented
by cardiovascular diseases, while 19.4 per cent by tumours/. x/

Mortality per ten thousand Hungarian male population due to
cardiovaseular diseases is the highest among the countries
of Europe. In 1982, out of ten thousand Hungarian men twiee
as many /72.1/ died of cardiovascular diseases  RN  in France.
x/
Mortality investigatio:0 indicate, thatc Ihe aging of the
population has been only one factor in the deteriorating
mortality rate. Since 19Wi. the mortality indices-by age
and sex-of age groups over 3o years have been increasing
steadily. /3/

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 12 -
Greece, Spain or Japan. Our position is even worse in compa-
rison with other countries, if we regard only mortality data
of age groups between 45 and 65 years. x/

Life expectancy at birth has increased or at least stagna-
ted in most European countries in the seventies. Hungary,
however, belongs to those  few countries where life expec-
tancy  has decreased. Life expectancy  of the male population
is lower today than in 196o. The improvement of life expec-
tancy at birth of the male population stopped in the mid-
sixties. Since then it has stagnated or declined. Life
expectancy at birth of our male population is one of the
lowest in Europe.
Inadequacy of Developmental Resources; the Steadily
Subordinated Role of Public Realth'in the Distribution
of Resources
The functioning of the public health  sphere is characte-
rized by  shortages.
x/ Investigations  of causes of death suggest that "Higher
domestic mortality is not a consequence of  the larger weight
of  a particular cause, but there is a  proportionally higher
mortality in every group of diseases in our country, than in
the majority of 4he European countries /only the share of
suicides differs remarkably from that in the countries in
Europe/." /2/

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 1 3 -
h e  basic cause of this shortage is that the extention
f social insurance rights to the whole population during
he sixties was not followed by the creation of the materi-
1 /financial/ conditions necessary for the realization of
hese rights. /17/
e trend in development resources of Hungarian public health
iffers remarkably from those in the western European states.
ublic health expenditures in these countries expanded con-
iderably between 196o and 1975, gaining increased shares
in their gross domestic prodUct as well. However, an abrupt
alt to these increased expenditures has occurcd seince the
id-seventies. /19/ The share of expenditures :' , or Hungarian
ublic health as a percentage of the national income did
of change remarkably between 196o and  1980. /Expenditures
On maintainance and operation of public health and social
institutions represented 3.52 per cent of the national
income in 1965. This figure was 3.2 per cent in 197o, thon
p.52  per cent in 1975 and finally 3.87 per cent in 1980./
his means that the development of public health had been
Overshadowed in the sixties and the seventies, lagging
behind both the economic development of the country and the
requirements of public health.
Development of public health has priority among the infra-
structural goals of national economic plans in the first
half of the eighties. Nevertheless, economic difficulties

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 1 4-
in Hungary led to the narrowing of the developmental sources
for the national economy as a whole. The restriction
in domestic consumption also affects the development of
the so-called public services. However, limitations influ-
enced public health to a lesser extent than for other fields.
This is shown by the fact that the share of public health
from the national income has slightly increased after 1980.
Despite this, developmental resources are hardly sufficient
even to maintain the present level of public health care.
Inner Disproportions in the Development of Public Health
The developmental path of Hungarian public health in the
post 1945 period can be described by successive dispropor-
tions. An initial stage which accentuated manpower and neg-
lected tho development of hospitals, was followed by a
trend of "concentrdting" on hospitals in the seventies.
The former developmental direction, "concentrating" on
manpower between 1945 and 197o, means - to put it simply -
that the public health government tried to satisfy the in -
creasing needs of the population first of alL through in -
crease in the number of physicians and the development of
out-patient care. This was a less capital intensive way
of public health development than a policy, aimed at
proportional development of care offered by hospitals and
physicians.

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
15
-
-
velopmental goals in the seventies meant not only that
U e development of hospital care - overshadowed for de-
des - obtained an proper position in the organization
public health, but in a certain interpretation it al-
meant the replacement of the "manpower-centered" deve-
lc pmental direction by a new disproportion of development,
melt' a "hospital-centered" trend. However, this latter
e ent did not entail that sufficient resources for hospi-
t 1 development were at disposal. In essence, du•inr: the
d stribution of insufficient overall resources, the dc-
velopmental needs of primary and social care were oversha-
dewed.
1M faot, primary health care  does liol manirest iiselV a.
a  "basis" of  Cho orr;anizalion  or  public health. Prevention.
I i  1:t 1  j
and "heal tIt ethical I , ./1"
onI i nt,,.
PLI\
tiII hordinuled vole to therapeutic activit\.
I.
lily dc\e-
r.
lopmont  or  an institotional noluork and ncl i i oc. ,r
cial care /Fo• handicapped and ited people: also lacd
I  tiernal disproportions in dovelopment:dse appear in the
fart that the transfOrmi.cn and
or  lho  a y.
tixttls
steueture  of public health are rather  slow as corn=
p4red with eltanes in the  structure of needs. New avtivi-
Oes and organizational elements emerge with a delay and .

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 16 -
are spred slowly.  This is especially the case in the field
of mental health care.
Disproportions  in the development of public health can be
attributed first of  all to the insufficiency of resources,
the inadequate distribution mechanisms of resources, prob-
lems  in the management  of public health and the problems
concerning the inner hierarchy  and traditional value syster,
of doctors.
The Retardation of Hungarian Medical Technology•
Diagnose, prevention, and treatment of different diseases
lag remarkably behind the world-wide possibilities offered
by the general level or technology. The  scarcit7 of  resour/
has been ()Lily a partial reason for this. An exaggerate(
quantitative view and methodelegicat deficiencies of public
health planning also. contributed to the backwardness.
"Oct hospit:,1-huilding normatives are eatastrophical from
the peil.  .r view of  instrument-requirements  .r  the upto-
date public hoaith  and  admissien rapacities. until reeentl)
the hospital-building policy  was  characterized by one-sidec
rush to increase the number  0P  beds on  every level."
/5;  p.49/

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
17
-
-
T  e Financing Mechanism for Public Health in the Framework
o
Budgetary Accounts
In fie present system of State budget and the financing ac-
: 4vities of councils public health may constantly be over-
' shadowed against the other sectors in the council budget. 14(
reol.rer, some subsectors may lastingly be in'h dispreferred
pas:Alen within public health as a whole. The p2esent mecha,
n'sm has greatly influenced the conservation of the regiona!
differences.
'There is no adequate relation either between the doctors'
' aCtivities and their earnings, or between the hospitals'
ativitics and their receipts.
"lin Hungary there is practically no relation between the
plerformance and the receipt:; of the hospital at all. Coun-
( ,i1 /or Ministry/ financing the hospitals allots for the
hospital considerable sums even if the hospital's perfor-
Mance is not adequate.  /To  put it more precisely, as there
is no measure to qualify, which institution has a better /or
lorso/ performance, hence thO inter-personal ties come ne-
Ocssarily to the fore."  /8;  p. 43/

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
-  1 8 -
State Inclusion of "Bribes" /Gratitude-Money/  in Doctor's
Earnings
"Official" earnings of doctors are extraordinarily low,
if we regard the social utility of their work and the "ca-
pital" spent on their training, etc. In the course of the
past decades, the so-called "gratitude-money" given by pa-
tients-tacitly tolerated by the  State and  regulated only
by the "actual habits%-has become a main element  in the
income /earnings/ of a considerable strata of doctors. This
condition provided to the State an opportunity to postpone
doctor's salary-increases. However, "corrigation" of doc-
tor's earnings by gratitude-money represents  waste  both
on the part of the State and on the part of the patients-
This situation also leads to tensions within the doctors'
society. /1/ In addition, gratitude-money-through the In-
terests of the doctors-hinders the transformation of the
activity-structure of public health.
Differences Between Public Health Needs and the Traditional
System of Doctor's Values
The prestige of district or workshop practitioners' acti-
vities and that of prevention and chronic care is low within
the doctor's society. The present "popular diseases" would
require psychosomalical or social therapeutic care. Never -
theless, the prevailing view and education both prefer the

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 1 9 -
ideal of medical science and the natural scientific cha-
racter of medical activities.  /6, 11/
,  The Low Level of Social Integration of Public Health
The Hungarian government liquidated the Social Welfare
Ministry /responsible both for social policy and public
health care/ at the end of the forties. At the same time
the Ministry of Health /with decreased authority/ was set
up. The political ideas of the period in uuestion stood in
the background of the transformation. It was thought that
the social political problems would be solved parallel
to economic development under socialism.
Accordingly,  the  solution of numerous social problems
/e.g. alcoholism, suicide etc./ has remained without an
adequate system of institutions in the  last decades, Ell-
though  ihey have their own publie health  aspects.  Finally,
the solution was left to public health; tliat is, the unsol-
ved problems were fed back to public health in a nmedicini-
zed',  form inereasing the tensions in this sphere. In the
lack of financial resources, public ,  health was stimulated
to decline /set aside/ the social political problems. /13/
The political view of social and social political prob-
lems were radically transformed in the seventies. However,
the effect of this turn on actual social processes still
manifests itself only in a rather  limited manner.

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 2o -
PART TWO
MAJOR PROCESSES OF REGIONAL INEQUALITIES IN PUBLIC HEALTH
INFRASTRUCTURE
So far we have reviewed - in outlines - the main problems
characterizing the development of Hungarian public health.
The problems treated on the one hand, reflect considerable
regional differences /e.g. remarkable regional differences
in the health of the population, the technical state and
equipment of hospitals, etc./ and, on the other, they pro-
vide wider frames - in part - for the trend of regional
differences in public health intrastructuro. The major
issues concerning these regional differences are discussed
below.
Uneven Moderation of 11.040.onal Differences in Practitioner
and Hospital Provisions
In the past few decades the number of practitioners has
increased at a faster rate, than that of hospital beds.
Between 196o and 1982 the number of doctors per ten thousand
inhabitants increased by 72 per cent, while the number of
hospital beds per ten thousand inhabitants grew by 28 per
cent.
This trend, however, did not result in the best possible,
or even necessary, moderation of the legional differences
in the supply of physicians.

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
Moreover,  the trend of regional differentiation, as op_
posed to  simple growth, has been in an adverse direction.
Regional differences in the supply of physicians decrease
to a lesser  extent than the  supply of hospital beds.
The  relative position of most counties changed only to a
small  extent. The moderation of the immense inequalities
the provision of physicians between Budapest and the count
side slowed down after 197o, and regional differences in 1
supply of physicians in villages increased during the same
period. Regional differences in the supply of physicians t
between Budapest and the countryside and among the individ
al counties - first of all in the fields of special care -
were remarkable in the early eighties. Differences within
individual public health branches were even more critical
and  pronounced. The above characterized processes are iliu
rated by Tables 1 and 2. /The  former illustrates the trend
in differences among the counties, while the latter shows
the differences between Budapest and the countryside./
While investigating the differences in the supply of hospi-
tal bed, we notice a considerably greater moderation than
in the supply of physicians. Out of the lowland counties, x/

x/ Their number amounts to  7,  including the largest county
/Pest/. The counties in  question are located /from the Danul
in the eastern part of Hungary,  while the western part is
called Transdanubia.;

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
Table  1
Relative Values of Major  Indicators of Regional Differences
in Public Health  Infrastructure
/the value for  the county with the best position  equals loo/
Number of Physicians
Numher of  Specialist
.
Counties
per lo,000 Inhabitants  per lo,000 Inhabitar
196 o
197o
1982
196o
197o
1982
County in the  best
position
loo
loo
loo
luo
Lou
loo
Average of the
counties
56.
5 8

61
!I()
52
'it)
Count;  in the
worst position
35
37
43
22
26
Standard deviation
/per cent/
24.8
22.5
2o.8
37.9
34.o
3o.5
Number  or rospiLai  Hod per loom°
tani:s \/
I 97 I
I 9 S 2
County in the hesi
position
T , )o
Average of the
counties
Count -s in the worst
position
Standard deytation
/pe• cent/
3 -).1
L 7. I
x/ without hods in central sanatflria
Source:
the author's own oom1,uiati0 - on  the  basis  of  data
issued by the Ministr\ 0 ,
,1111 and the Central
Statistical O1'1' is

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
-
2 3 -'
"ruble 2
Trend in Inequality of Public Health Provision Between
Budapest and the Country side
/Budapest = loo/
196o
197o
1982
(County average number of
physicians per 10,00o
inhabitants
30.0
39.9
45.4
!County average number of
(specialists per lo,000
inhabitants
2o.7
lo.3
34.9
'County average number of
hospital beds per lo,000
V
!inhabitants
55.3
49.)
54.8
x/ Data of 1961 and 1971
Source: see Table 1
those not possessing it flied -lent nniversity are si i I I
it
disadvantageous position, so we cannot speak of a complete
equalization of regional differences.
Nevertheless, n eritical point or hospital incrastrneture is
,represented first of all not by the differences in numbers
!of beds, but by the regional differences in the professional
/public health branch/ distribution of beds, as well as in
technical conditions and equipment of the hospitals. The latter
differences, for instance, became wider between 1965 and
1980.

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 24-
Furthermore, considerable differences can be found  in
the spatial structure of hospital provision, i.e. the re-
gional location of hospitals.
The regional location of hospitals - considering  the  main
regions of the country - shows remarkable  differences. Thy
differences - deriving mostly from  inadequate transpor
and communication facilities - greatly affect  access to
hospitals. A  dense network of medium and small  hospitals -
. besides the large ones -  was established in Transdanubia,
especially in its  nothern part. For instance, there  are 1 1
settlements with hospitals
in three Transdanubian counties
/of 9600  square kilometres/.
Quite another hospital  structure can be found on the low-
land areas  of Hungary.  Here, small hospitals are rarely
found. Moreover, there are only five settlements that poss
a hospital in two lowland counties /of 11,844 square kilo-
metres/. In the lowland region the average area per one hospi
is  8o  per cent  larger, than in Transdanubia, while the ave
population per hospital is 6o per cent greater than in Tra
danubia.
Adverse Development Paths in Pe rTi
with rnfavourable
Facilities
In 196o, there were two regions in unfavourable position cl
sidering supply of physicians, hospital beds and per capiti

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 25 -
public health expenditures of the individual counties.
They were: /a/ three south-western counties /Zala, Somogy
and Tolna/; /b/ five counties in the middle and eastern
region of the country /Bics-Kiskun, B4k4s, Pest, Szabolca-
Szatmar and Szolnok/.
The counties of the former region
closed the gap by
198o, thereby ameliorating their unfavourable position.
Nevertheless, the relative position of counties in unfa-
vourable conditions in the eastern region improved only
to a smaller extent. This has remained the region with
the worst provision of the country. Stabilization of the
detrimental position can be observed here. We have to  empha-
size,  however, that the extent of lagging behind both the
country average and the counties in the best position de
creased between 196o and 198o /especially as to the number
of hospital beds per ten thousand inhabitants/.
The "leveling" in question, however, is largely of a  guano-
titative character. Namely, the structure of social needs
for public health care has considerably altered in  the past
decades. The counties with lower provision were in  a worse
position to adjust the structure of their public  health
infrastructure•to changing, needs than counties with above
average provision. Or put another way: "close-up-processes"
of the past decades moderating the backwardness of the pre-
ceding period have not promoted - to a sufficient extent -
a parallel "adjustment" to the newly emerging needs.

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 26 -
In three of the counties with most unfavourable public
health care /BAcs-Kiskun, Pest and Szabolcs-Szatmar/ life
expectancy was lower than the country's average in the
early eighties. Male life expectancy at birth was the lowest
here in Hungary in 1981. As far as female life expectancy
is concerned the values for counties Szabolcs-Szatmar and
Pest were the lowest.
Mortality is also affected by numerous /non public health/
socio-economic factors. Hence, we do not presuppose a direct
cause-effect relations between the provision of public health
institutions and mortality. However, we have to mention as
a "neuralgic point" of public health care that in counties
with the worst mortality and life expectancy the conditions
for health care are also the most unfavourable.
Effects of Regional Development Policy
Regional inequalities in publiC health infrastructure  have
also been influenced by numerous processes outside  or  publie
health, among others by regional development,policy and  Hie
distribution mechanisms of council's financing  activities.
The past decade, i.e. the seventies brought n , •w de\eIopments
both in regional policy and public health.  The c.Atecaled
attention paid to hospitals in public health  development
has already been discussed. Settlement development in It

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
seventies was characterized by strong concentration of
both population and development capital in towns. "One
of the causes of the intensifying population concentra-
tion has been the increasing concentration in towns of
the so-called communal developments meant to improve the
settlement environment and the living conditions. Towns
utilized  88  per cent of the total communal developmental
fund of the country in 1979,  while this figure was only
78  per cent in 197o. /In 1979 the capital s share alone
was 42 per cent./" /7; p•729/
The effects of these processes — i.e. emphasis on towns
in settlement development and on hospitals in public
health policy - were mutually reinforcing. Developmental
resources of public health were concentrated in towns
to a greater extent than those for the development of
infrastructure as a whole. The other side of the process
is that regional differences became even larger in nume-
rous components of health care in villages.
Along with the "synchronic trends" of on the town-centero
regional development and hospital-centered public health
development was an "asynch .ronic" relation of regional
processes concerning primary health care. Rapid population
growth - mainly in the Transdanubian and northern towns -
was not followed by the development of primary health car(

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
For instance, population growth rate of over lo per cent
was accompanied by the deterioration in the district prac-
titioner's care in 54 per cent of towns of Transdanubian
and northern counties, as well as in the agglomeration
around Budapest between 197o and 1980.
A further essential feature of regional development is the
steadily worsening position of public health in the finan-
cing activities of councils.
A minor part of the developmental funds for public health
is controlled by the Ministry of Health. These resources
are distributed among the institutions /universities of
medicine, national institutes, etc./ under the supervision
of this ministry. During the Fifth Fivo-Year Plan period
/1976-8o/, centralized public health investments had a
share of 25.2 per cent of total public health investments,
or, in another words, the central budgetary expenditures
on public health represented 23.6 per cent of total public
health and social expenditures in 1980. /The former figure
was 2o.5 per cent for the period 1981-83 and the latter
one was 23.6 per cent in 1983./
The larger proportion of funds for public health comes
from the resources available for the financing activities
of councils. In the past decades, one of the main features
of the distribution mechanism of councils was the fact that

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
29
-
-
some activities or some regions of the country were cons-
tantly overshadowed. /2o/
The continued low position of public health in the dis-
tribution is also illustrated - among others - by the fact
that - according to our own calculations - its share of
budgetary expenditures in every county council has decreased.
Public Health Policy and Regional Differences
Here we emphasize the most important and general features
of public health policy in the past decades, i.e. those
ones that we regard as being of basic importance from the
point of 'view of regional differences.
Adjustment of public health policy to changes in social
needs was characterized not by continuous, organic altera-
tion /in planning, management, financial regulation, opera-
tion of institutions, etc./, but rather by lags, considerable
delays, i.e. lone years between "recognition" and "decision".
Ultimately, decisions aiming at the acceleration of adjustment
were "coaxed out" mainly by the speedy increase in the
number of heart diseases and the alarming deterioration of
the mortality rate.
One of the essential issues of this investigation has been
the relation between adjustment to social needs and regio-

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
-
3 o -
nal differences. According to the analyses a hypothesis on
the relation of "adjustment" and regional differences can
be formulated in the following way: in the case of several
components - which are of great importance from the point
of view of adjustment - the process of adjustment is accom-
panied by stabilizing and deepening regional differences
not only among the counties and between the towns and the
villages, but also within the group of villages.
In the field of hospital care, certain treatments, for ins-
tance casualty surgery and intensive therapeutic care were
established with great regional discrepancies. /9,18/ Simi-
larly, manifold differences can be observed in psychiatric
care, too.
Villages were not only "avoided" by the aspirations aiming
at the modernization of the organization and functioning
of public health care, but they had a smaller share in
opportunities offered by the rapid development of medical
technology. One case study reveals the extreme differences
in the equipment of village consultation-rooms. A conside-
rable part of districts lacks material conditions for mee-
ting increased primary care need. /16/ Nevertheless, public
health management tries to solve this problem first of all
by organizational means, rather than through stronger in-
crease of the resources for primary care.

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 31-
Components of public health policy are primarily represen-
ted by professional targets, such as development of preven-
tion and treatment of cardiovascular diseases, as well as
strengthening the role of chronic care, etc. Targets concer-
ning the development of some elements of the institutional
network /medical districts, hospital beds, places in homes
for the aged, etc./ represent a similarly important public
health policy conception. These latter targets serve as a
basis for the distribution of resources within the indi-
vidual five-year,
plan periods. There is no synchronism bet-
ween these two spheres of public health policy. The
established methods and mechanisms of planning are not able
to serve efficiently enough the targets promoting the ad-
justment of public health policy to needs.
Or, to put it
in another way: at present adequate means for adjustment
do not exist in planning, the operation of institutions
/financial regulation/, the information system of public
health, etc.
"Plans for the development of public health were restric-
tedonly to the money outlays of the development and the
maintainance of public health institutions and equipment
almost until now. Accordingly, ideas of planners began and
ended in terms of means, establishments, money ... Methodo-
logical ordering principles to measure the needs for care

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 32 -
on the basis of the state of health of the population were
almost completely absent from the practice of planning..."
/lo; p.213/
Naturally, central efforts aiming at reducing regional dif-
ferences are - primarily - directed to the "planned" proces-
ses. Consequently, the formation of new regional differences
•
in numerous essential /not planned/ components of public
health care took. place as a spontaneous process, reaching
immense extents in several cases also at present. For instance,
in psychiatric care there were 6.9 times more inhabitants
per one specialist workin7 in a dispensary in Somogy county
in 1082 than in Baranya county. /At the same time, this value
was '1.6 times •rcater than the country-side average./ Or,
considering the number of casualty surgery hods per ten
thousand inhabitants, there was a /1.1.-fold difference Lot-
ween Fej6r county /in the hest position/ and it .1(6s eounty
/in the worst/ in 1980.
Peculiar Social Relations Within the Practitioner's Stratum
Social conditions of doctors represent one of the most im-
portant factors affecting the supply of physicians to in-
dividual settlements and counties. One of the essential com-
ponents in this respect has been the place of .individual ins-
titutions, fields of specialization, and the settlements in
the system of doctor's values. A particularly unfavourable

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 33-
place in this system of values is to be engaged by a village
or as a district practitioner. This situation has deep his-
torical roots. Its economic basis was manifested in the  bad
living conditions for village doctors in the past /i,e.before
1945/. At present, this  basis  can be characterized by the
lower level of the urbanization of the settlements in ques-
tion and the essentially harder working conditions for the
rural practitioners than for doctors working in towns.
One of the major problems embodied in the moderation of
regional differences in public health is the fact that in
the past decades there were no efficient central incentives
operating against the spontancousprocesses increasing
inequalities in the supply of settlements with physicians.
A  survey  on the social conditions of doctors made by a
group of sociologists suggests that the physician's professio-
nal career and their choice  or  settlement  is  basically influ-
°need by social stratum and settlement they originally comp
from. "According to our data we can conclude: tho hi;Ther
the proportion  or  those  in a  settlement-typo attending the
university of  medicine, then working in public health, the
more probable is the supply of physicians to the given sot7.-
lemont." /4; p.71/
Accordingly, processes outside the sphere of public health
- among others the prospect of equality in the choice of
future profession, the quicker urbanization of rural settle-
ments, etc. - also play a basic role in the moderation of
regional differences in the supply of physicians.

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
_ 314 -
SUMMARY
In Part One we outlined those tensions and contradictions
whose solution is today in progress in Ilungarian public
health.
The study basically aimed at describing the main tendencies
in regional differences of public health infrastructure and
of the underlying factors.
The. joint effect of the following major processes were
;
primarily responsible for the regional differences in pub-
lic health infrastructure: /a/ changes in the stat.•  of
health o1' the population; /b/ demographic  pcurcsscs  and
their regional ciutracteristics; /r/ goals n
(lov-
lopment policy and  the  exaggerated emphasis on tohlts in
the real pro .cesses in the seventies; /d/ regional charac_
teristics of the development of infrastructu•0  branches
/e.g. transport, communication, etc./ representing the con-
ditions for  the  functioning of public health;  /e/ targets
of public health policy; /f/ intended or spontaneous  regio-
nal effects of the main targets of  this polic.; /g/ volume
and distribution mechanism of resources  dovotod t()
development of public health; /h/ chan  ing
uir;Ition
public health influenced by the compromises b•theen the
State administration and public heal th;
peculiar s,r
relations within the stratum of physicians.

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 35 -
Among the processes in the regional differences were em-
phasized: /a/ moderation of regional differences in the supply
of physicians and the supply of hospital beds at different
rates; /b/ cumulative and stabilizing disadvantageous provi-
sion in a group of counties and - partially - a parallel,
unfavourable change in mortality; /c/ peculiar relation
between the regional differences and adjustment to the so-
cial needs.
Our study also illustrates - among others - that numerous
problems in the development of public health are summa-
rized in the trend of regional differences. Therefore, only
the establishment of central programs is not sufficient to
moderate the differences in question /though such programs
also would be desirable/.
Changes of vital importance could be realized through the
increase of resources devoted to public health, the empha-
sized development of primary care and reform of planning,
management and financing of public health.
Finally, we stre s s again, that our study - in a one-sided
way - is concerned with the problems and conflicts of
Hungarian public health and their regional differences.
We are convinced that this approach is more adequate in
the present "path-searching" stage of the development of
Hungarian public health than the summarization of results.

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 36-
Moreover, scientific research can primarily contribute to
the improvement of public health care also by adopting
such an approach.

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
- 37  -
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/9/  GREFF, Lajos /1981/ A fekv5beteg gyOgyintezeti 6gyak
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Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
Table 1
Mortality

Infant mortality
Age-standardized
Counties
rates/per l000
mortality rates
live births/
/ 0 /oo /
198o-1983
1983
1. Baranya
19.8
14.8
2. Fejer
18.8
14.6
3. Gyor-Sopron
18.2
13.7
4. Kom6rom
18.o
15.7
5. Somogy
21.6
15.o
6. Tolna
21.6
14.3
7. Vas
17.3
13.4
8. Veszprem
2o.1
14.0
9. Zala
22.1
13.6
lo. Bacs-Kiskun
19.5
14.6
11. Bekes
20.2
13.2
12. Csongr6d
16.6
13.2
13. Hajdu-Bihar
17.6
13.6
14. Pest
'
25.9
14.6
15. Szabolcs-Szatmar
21.5
14.7
16. Szolnok •
2o.1
14.2
17. Borsod-A.-Z.
18.6
14.2
18. Heves
23.6
13.9
119. NOgrad
21.9
13.5
2o. Budapest
22.9
12.9
National average
2o.8
13.9

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to
Table) 2
Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
Physicians - per lo,000 population
196o
197o
198o
1984
Counties
MX=loo
M=loo
M=loo
M=loo
Baranya
18.2
95
27.1
loo
33.1
99
35.6  99
Fej6r
9.9
52
14.5
54  18.6
56
19.8  55
GyOr-Sopron
11.2
58
14.5
54  19.8
59
22.3
62
KomArom
12.4
65
15.9
59
19.7
59
21.2
65
Somogv
9.1
47
14.2
52  19.3
58
21.o  58
Tolna
8.9
46
16.6
61
2o.9
63
22.3  62
Vas
11.7
61
16.5
61
2o.2
61
22.6
63
Veszpr4m
11.o
57
14.9
55
2o.o
6o
22.3  62
Zala
8.7
45
14.5
54  21.8
65
23.7  66
Bacs-Kiskun
8.9
46
13.3
49  18.5
56
2o.6  57
B4k6s
8.5
44
12.8
47  16.2
49
18.4  51
Csongrad
19.2  loo
25.5
94
33.3
loo
35.9  loo
Hajdu-Bihar
14.8
77
2o.5
76  26.3
79
28.9
81
Pest
7.4
39
11.6
43  15.5
47  17.2  48
Szabolcs-Sz.
6.8
35
lo.o
37
13.8
41  15.9  44
Szolnok
9.o
47
14.0
52  17.5
53
2o.2  56
Borsod-A.-Z.
1o.4
54
15.1
56  18.1
54
19.9-  55
Hoves
lo.3
54
15.8
58
2o.3
61
21.8
61
NOgrad
10.4
54
15.o
55
18.5
56
21.3  59
County
average
lo.7
56
15.6
58
2o.2
61
22.3
62
Budapest
35.7  186
39.1
144  45.8
138  47;5  132
National
average
15.3
8o
2o.2
75
25.1
75
27.2  76
X  the value of the county with the best position equals loo

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
Table  3
Specialists
per lo,000 population
-
196o
197o
198o
1984
Counties
Mx =loo
M=loo
M=loo
M=loo
1. Baranya
lo.5
90
17.4
loo
24.3  loo
27.1  99
2. Fej6r
5.6
48
8.7
5o
12.7
52  14.1
52
3. Gy6r-Sopron
8.1
69
8.8
51
13.9
57  16.6
61
4. KomArom
6.5
56
9.7
56
12.o
49
14.6
53
5. Somogy
4.6
39
8.3
48
13.1
54
15.7
58
6. Tolna
4.7
4o
9.2
53
13.7
56
16.4
6o
7. Vas
6.2
53
9.1
52
14.1
58
16.3
6o
8. Veszpr4m
6.5
56
lo.1
58
14.1
58
16.o
59
9. Zala
3.7
32
6.9
4o
14.4
59
17.6
64
10. BAcs-Kiskun
4.8
41
7.6
44
11.9
49
14.7
54
1. Bekes
4.5
38
7.o
4o
10.4
43
11.8  43
12. Csongrad
11,7  loo
16.5
95
23.6
97
27.3  loo
13. Hajdu-Bihar
8.5
73
12.8
74
17.o
7o
2o.1  74
14. Pest
4.4
38
6.4
37
lo.9
45
12.6
46
15. Szabolcs-Sz.  2.8
22
4.5
26
7.o
29
9.5
35
16. Szolnok
4.9
42
7.8
45
11.1
46
13.3  49
17. Borsod A.
Z.
5.4
46
8.4
48
11.6
48
13.3
49
-
-
18.  Heves
5.3
45
8.6
49
13.o
53
15.5
57
19. /Therad
5.5
47
8.3
48
11.0
45
13.6
5o
County average
5.8
9.1
52
13.4
55
15.8
58
2o. Budapest
28.o
239
3o.o
172
37.1  153
39.1  143
National average
9.8
84
13.1
75
18.o
74
2o.3
74
•
x the value of the county with the best position equals loo

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
Table  4
Regional differences of the supply
of specialist X

Standard  deviation /%/  Relative value xx
Specialities
of the county with
the worst position
1970
1981
1970
1981
Internal medicine
44.2
31.3
15
3o
Surgery
30.6
33.2
28
29
Obstetrics and
gynaecology
31.1
26.6
32
37
Neonatology and
Paediatrics
32.8
31.4
28
31
Psychiatry and
neurology
50.1
35.7
16
25
Radiology
46.7
43.2
22
25
Urology
68.8
43.2
9
23
All the specialitie
34.0
30.5
26
29
Number of specialists per lo,000 population -
data of the counties without tha capital /Budapest/
xx  the value of the county with  the  best position equals lo

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
Table  5
Hospital beds x
- per lo,000 population
Counties
1961
1971
1980
1984
_xx =,
'
m
ioo
M=loa
M=loo
M=loo
1. Baranya
62.7
61
74.2
81  89.2  94
94.o  89
2. Fejer
44.8
44
54.4
59
59.5  63
68.8
65
3. Gy6r-Sopron
63.6
62
68.5
74  78.4  82
82.2  78
4. KomArom
62.2
6o
7o.1  76  77.5  81
83.8  79
5. Somogy
46.4
45
63.8
69  78.9
83
80.1  76
6. Tolna
45.5
44
74.8
81
78.9
83
81.2
77
7. Vas
1o2.9
loo  90.8
99
94.3  99
97.4  92
8. Veszprem
52.4
51
55.7
61  73.5  77
79.3  75
9. Zala
35.1
34
62.7
68  76.4  8o
79.3  75
lo.  B6cs-K.
39.9
39
54.3
59
73.7  77
74.o  7o
11.  136kes
'49.6
48
55.7  61  63.4  67
7o.6  67
12.  Cson ,7rAd
186.5
R4
87.6
95
89.8  94
91.9
87
13.  Hajdu B.
-
55.5
54
62.9
68
64.7  68
7o.5
67
14.  Pest
2o.8
2o
26.8
29
42.1  44
46.4  44
11.  Szabolcs-Sz.
35.3
34
55. 0

61  69.o  72
70.4
67
16.  Szolnok
.
4o.2
39
57.6
63  69.8  73
80.5  76
17.  Borsod A.Z:
52.7
51
73.7
-
8o
77.4  -81
80.1
76
18. Heves
71.1
69
92.o  loo
95.2  loo
Lol.;  loo
19. NOgrad
66.6
65
82.8
90
87.5
92
89.6
85
County  average
50.7
49
62.8
68
75.7
8o
76.0
73
2o. Budapest
143.5
139  129.5  141  137.2  .144
136.6  120
National average
67.8
66  75.8  82
87.5
92
88.4,
WI
actual beds, without beds in national sanatoria
xx  the value of - the county with the best position equal

Orosz, Éva: Critical Issues in the Development of Hungarian Public Health with Special Regard
to Spatial Differences. Pécs: Centre for Regional Studies, 1986. 3-47. p. Discussion Papers, No. 1.
Table 6
x
Relative scores
of health expenditures
per person/
Total
Hospital
Counties
expenditures
expenditures
1972
198o
1972
198o
1. Baranya
loo
loo
95
97
2. Fej4r
65
63
54
57
3.  Gy6r- Sopron
73
71
67
67
4. Kometrom
83
78
72
68
5. Somogy
77
8o
.. 68
76
6. Tolna
90
81
90
74
7.  Vas
94
87
93
83
8. Veszpr4m
7o
73
62
64'
9.  Zala.
74
71
67
65
lo. BAes-Kiskun
67
7o
54
62
11. B4k4s
66
67
59
55
12.  Csongretd
9 8

96
loo
loo
13.  Hajdu-Bihar
85
77
77
7o
14. Post
74
80
76
85
15.  Szaboles-Sz.
65
66
57
6o
16. Szolnok
67
66
52
57
17. Borscid-A.Z.
79
77
75
76
1B. Heves
82
76
74
73
19. NOgrAd
93
91
91
88
County average
75
77
68
73
2o. Budapest
log
95
98
89
National. average
83
8o
74
76
the  score  of the county with the best position is loo

Discussion Papers 1986. No. 1.
Critical Issues in the Development of Hungarian
Public Health with Special Regard to Spatial Differences
The Discussion Papers series of the Centre for Regional
Studies of the Hungarian Academy of Sciences was launches
in 1986 to publish summaries of research findings on reg
nal and urban development.
The series has  3  or  4  issues a year. It will be of inte-
rest to geographers, economists, sociologists, experts o:
law and political sciences, historians and everybody els
who is, in one way or another, engaged in the research o:
spatial aspects of socio-economic development and planni:
The series is published by the Centre for Regional Studi
Individual copies are available on request at the Centre
Postal address:
MTA Regionalis KutatAsok
Centre for Regional Studies
Kozpontja .
Hungarian Academy of
H-76o1 PtCS
Sciences
pf.199
P.O. Box 199
76o1 PiCS
Phone: /72/ 12  755
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Director general: GyOrgy ENYEDI
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X
x x
Forthcoming in  the Discussion Papers series:
Environmental Policy in Hungary
by
G;tirgy Enyedi and ViOla Zentai