Professional Turmoil in Hungary Taxing Tips. Interwoven in the health care system of most socialist countries is the practice of tipping, a phenomenon in which patients or their relatives give money, gifts, or various favors to physicians either before, after, or during treatment. When tips are given in advance, they clearly represent a bribe; in other cases they are genuinely motivated by gratitude. However, tipping can create uneasiness, mistrust, and embarrassment in patient-physician relationships, and tension and envy among specialists. In Hungary, the extremely low salary of physicians, the level of which was established after the Second World War, seems to have justified the acceptance of tips and other forms of benefits. In the 1970s however, state health administrators launched a campaign against tipping, one that was doomed to fail. They publicly condemned physicians for taking envelopes from patients, but failed to enforce their rhetoric against those in prestigious positions. Although ethics committees were established in every county, primarily for the purpose of eliminating tipping, they have proven too weak even to dare criticizing the biggest recipients of tips. The health adminstrators appear to have concluded that it is better and cheaper to let consumers subsidize physicians than to raise salaries. The issue took a new turn in January 1988, when for the first time ever, the state began to tax every form of personal income and included physicians' tips as taxable income. Physicians are outraged: A practice that has been for several years a subject of criticism is now to be tolerated and to become a source of state revenue. The profession defends its practice by pointing out that tipping has so infiltrated every dimension of life in the society that it is malicious to single out the medical profession. Of course, no recipient of tipping is about to declare the actual amount of the tips regardless of the threats of tax offices. Moreover, the taxing of tips requires revision of a basic ideological tenet. Socialism is held to be superior to capitalism on the grounds that it ensures both full employment and free medical care to all. Yet this view becomes untenable once the reality of the practice of tipping is acknowledged. What is clear is that either the idea of a free, equal, and high level of health care to all has to be given up, or physicians have to be paid adequately. Currently, Hungarians are content to wait-and-see, but the stake is not small: It is a matter of having a tolerable or utterly malfunctioning health care system. A Rejected Medical Ethical Code. A subject of discussion in the Hungarian medical profession for several years has been the need to create moral guidelines for physicians. …
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