Part I — Situation overview

On 24 June 2026 several events, only partly connected to one another, sketched out the direction of the new government’s healthcare policy. Zsolt Hegedűs, the minister for health, announced on social media the healthcare extension of ‘Purgatory’ — the government’s operation uncovering abuses. A few hours later the National Investigation Bureau of the Rapid Response Police carried out on-site investigative acts in the central building of Semmelweis University, as part of an ongoing criminal procedure; the press emphasised that there is no officially confirmed connection between the ministerial post and the police action. A rule-of-law principle should be recorded at the outset: a police investigative act is not a verdict and does not establish guilt — the presumption of innocence applies to everyone until a final court decision.

On the same day the minister submitted an amendment to the compulsory health insurance act, which moves the assessment of equity (individual) drug claims back to the state health insurer, the NEAK (National Health Insurance Fund Manager) — phasing out the foundation-based system that drew much criticism for the slowness of its administration and the opacity of its decisions. Meanwhile the press presented the undignified conditions of the psychiatric ward of the Szent János Hospital: deteriorating infrastructure, a severe shortage of professionals, gaps in the social safety net — care taking place, in one worker’s words, “in undignified conditions”. This thread is sharply distinct from the others: it is not a corruption case, but a symptom of underfunding and workforce shortage.

MIAK’s reading is twofold. On the one hand, making healthcare public money transparent and the rule-of-law uncovering of genuine abuses is a legitimate and necessary goal. On the other hand, one must guard against the rhetoric of “accountability” masking the real, structural disease of the system: the trouble of hospitals is typically caused not by fraud, but by chronic professional shortage and the failure to raise pay. The two problems need two different answers — transparency for one, retention reform for the other — and the role of the branches of power (police, prosecution, court) must be kept clear.

Part II — Literature foundation

Before turning to MIAK’s concrete proposals, it is worth fixing the professional frame. The report Health at a Glance: Europe 2024 by the OECD and the European Commission quantifies that in 2022 the EU countries collectively faced a shortage of around 1.2 million doctors, nurses and midwives, and that the recruitment of foreign-trained workers is a fast but unsustainable solution, because it pushes the shortage onto the — often poorer — source countries. The literature on nurse retention is summarised by the analysis Policy Brief 66 by Linda Aiken and her co-authors (the Magnet4Europe research programme): the key to retention is a supportive work environment, a clinical career path and adequate headcount, and this requires a system-level, organisational — not individual — intervention. The interpretive frame of structural corruption is provided by Robert Klitgaard (American economist, a leading author of corruption research) in his work Controlling Corruption (1988): corruption flourishes where a monopoly position and broad discretion meet an absence of accountability — that is, the lasting solution is the narrowing of discretion and the increase of transparency, not the individual “raid”. The detailed literature treatment — by author, with quotations — can be found in section 6.4 Literature in detail.

Part III — MIAK’s concrete proposal

MIAK proposes two complementary packages of measures that separate the two different problems: it treats accountability with structural transparency, and the hospital crisis with retention reform.

3.1 Structural transparency instead of the individual “raid” (immediately)

According to MIAK, the lasting answer to healthcare abuses is not the spectacular police action carried out at individual institutions, but the system-level transparency of the path of public money. MIAK proposes the display of healthcare public procurement and institutional finances on a real-time, public public-money platform, as well as the use of an artificial-intelligence-based procurement anomaly detector on the data — which automatically flags suspicious patterns (single-bid tenders, price distortion, recurring winners). In Klitgaard’s frame (see 6.4.3) this is exactly the narrowing of discretion and the increase of accountability: the treatment of the structural cause, not the symptom. This is complemented by the transparency safeguard of the just-announced drug-equity reform — public decision criteria and deadlines. This is the content of programme points A1 (public-money dashboard) and A2 (public-procurement transparency). An important rule-of-law condition: actual holding to account is the competence of the prosecution and the independent court — the prosecution is not identical with the judiciary, and government communication does not replace a final decision.

3.2 Nurse-retention package and the structural treatment of the hospital crisis (within 12 months)

According to MIAK, the root of the crisis seen at the János hospital is the workforce shortage, so the answer must be given in retention. MIAK proposes a comprehensive nurse-retention package: competitive, properly arranged pay for nurses and allied health professionals, a clinical career and progression model, and the prescription of a minimum headcount guaranteeing patient safety. International research is unambiguous: the nursing shortage cannot be solved by import — that only displaces the problem — only by improving the work-environment and pay conditions of retention. This is complemented by the real-time, public disclosure of waiting lists, which makes access transparent and accountable, as well as digital development built on the EESZT (Electronic Health Service Space — the country’s shared health data system). This is the content of programme points E6 (nurse-retention package), E3 (waiting-list transparency) and E2 (digital healthcare system).

The common principle of the two packages is to match the solution to the problem: accountability calls for structural transparency, while the hospital crisis calls for structural pay and retention reform. Conflating the two — when the workforce shortage is treated as an “accountability” question — draws attention away precisely from the real solution.

Part IV — Expected impacts and risks

Dimension Expected impact Risk
Healthcare / care The retention package reduces the nursing shortage, improves patient safety and access Without pay reform and a career path, the outflow continues and care deteriorates (especially in psychiatry)
Transparency / public money The public public-money platform and anomaly detector structurally reduce the space for abuse The individual “raid” logic is spectacular but does not treat the structural cause; it may erode trust
Rule of law / institutions The clear separation of the branches of power strengthens the legitimacy of the procedures Blurring the police/communication and judicial roles can undermine legal certainty and the presumption of innocence

The main consideration is that the rhetoric of accountability not suppress structural reform. The proposal tips to the risk side if politics concentrates on the spectacular action against institutions, while pay reform and the retention package are left undone — then the real disease of the system (the workforce shortage) worsens further, while the public may believe that the problem has been “solved”. The other risk is the blurring of the roles of the branches of power: the establishment of actual responsibility is a question of independent judicial procedure, not of a government announcement.

Part V — Measurability and summary

5.1 What is worth tracking? (suggested KPIs)

MIAK proposes tracking the following performance indicators (KPIs) — these are recommendations, not government decisions:

  • Nursing headcount and turnover: it is worth tracking whether the nursing shortage falls (whether the domestic ~64/10,000 inhabitants indicator approaches the EU average of ~85) and the rate of leaving the profession.
  • Length and publicity of waiting lists: whether the real-time, public waiting-list interface is completed, and whether throughput times shorten.
  • Drug-equity decisions: whether the assessment becomes faster and more transparent after the return to the state insurer.
  • Public-money transparency in healthcare: whether the public public-money platform and the procurement anomaly detector work on healthcare data.

5.2 Summary

MIAK’s request in a single sentence: healthcare accountability must be achieved through structural transparency — with a public public-money platform and a procurement anomaly detector — and the hospital crisis must be answered with nurse-retention and pay reform, while keeping the roles of the branches of power (police, prosecution, court) clear.

This position follows from two MIAK foundational values. Accountability here is twofold: on the one hand it means making the path of public money public (this restrains abuse at its source), on the other hand the respect for the rule-of-law guarantee that the establishment of responsibility is the business of an independent court — not of the executive power or of communication. Data-drivenness, in turn, means that the cause of the hospital crisis must be identified on the basis of data: the numbers point unambiguously to the workforce shortage, so the answer too must be directed there, not into the symptomatic action against institutions.

Part VI — Justifications and further sources

6.1 Press framing by spectrum

The framing of the topic clearly showed the differing viewpoints of the spectrum. In the liberal-left and public-affairs band, 444.hu foregrounded the temporal coincidence of the police act at Semmelweis and the ministerial ‘Purgatory’ post (stressing that the connection between the two is unconfirmed), while 24.hu brought, on the one hand, a factual presentation of the drug-equity reform, and on the other, the crisis of the psychiatric ward of the János hospital — the latter in a human, reportage form. In the economic band, Portfolio processed the shutdown and restart of the operating theatres of the Oncology Institute due to a heatwave, that is, infrastructure-operation crisis management. In the pro-government/conservative band, Magyar Nemzet framed the minister’s forum critically as “a series of PR announcements”, objecting that essentially only the HUF 500 billion of extra funds known from the campaign was voiced as a concrete commitment. The spectrum thus read the same sequence of events with different emphases: investigative-accountability versus care-structural versus communication-critical frame — and it is precisely for this reason that MIAK considers the clear separation of the two different problems (abuse and workforce shortage) important.

6.2 Facts and data

  • The assessment of equity drug claims returns to the state insurer (NEAK); under the transitional provision, earlier claims are still assessed by the phased-out foundation system until 31 July 2026.
  • The National Investigation Bureau of the Rapid Response Police carried out an investigative act at Semmelweis University; its connection with the ministerial post is officially unconfirmed (investigative act ≠ verdict).
  • The planned surgeries of the National Oncology Institute, suspended due to the heatwave, restarted after the repair of the cooling system; the non-deferrable interventions were carried out throughout.
  • Nurses/10,000 inhabitants: about 64 (Hungary) against the EU average of ~85 — a “critical shortage”.
  • The EU countries collectively faced a shortage of around 1.2 million health workers in 2022 (OECD estimate).

6.3 Policy aspects

  • Healthcare (programme points) — the nurse-retention package, waiting-list transparency and the digital healthcare system form the core of the structural answer;
  • Transparency and anti-corruption policy (programme points) — the public-money dashboard and the procurement anomaly detector provide the structural accountability;
  • Justice (background material) — the establishment of responsibility is the competence of the independent court; the clear separation of the roles of the prosecution and the court is a condition of the legitimacy of the procedures.

6.4 Literature in detail

6.4.1 OECD / European Commission: Health at a Glance: Europe 2024

The report quantifies the total healthcare workforce shortage and its migration dimension, and warns that overreliance on foreign-trained workers aggravates the shortage:

“an overreliance on foreign-trained health workers risks exacerbating workforce shortages and overall fragility in source countries”

The report identifies three main strategies: training more workers (which takes years), retaining the existing ones by improving working conditions, and innovation in service delivery. For the Hungarian situation — where the nurse/inhabitant ratio is critically below the EU average — this means that the hospital crisis cannot be solved either by police action or by nurse import; the work-environment and pay conditions of retention must be improved.

📖 Source: OECD / European Commission: Health at a Glance: Europe 2024

6.4.2 Policy Brief 66 — Strengthening Europe’s Nursing Workforce (European Observatory)

According to the analysis of the Magnet4Europe programme, international recruitment is a “quick fix”, but it may exhaust the workforce of resource-poor countries, and retention requires system-level, mutually reinforcing interventions:

“Prioritizing retention keeps nurses in their jobs is good for patient outcomes, reduces the costs of high turnover and can break the cycle of overload and burnout that sees nurses leave the profession early.”

According to the brief, a supportive work environment, a clinical career path and adequate headcount together reduce burnout and turnover. This is the direct conceptual basis of MIAK’s nurse-retention package (E6): the crisis seen on the psychiatric ward of the János hospital is not a disciplinary but a work-environment and headcount question.

📖 Source: Greenley, Aiken, Sermeus, McKee: Policy Brief 66 — Strengthening Europe’s Nursing Workforce: strategies for retention (European Observatory, 2024)

6.4.3 Robert Klitgaard: Controlling Corruption

Klitgaard describes the structural conditions of corruption: it is a question not of individual morality but of institutional design where it proliferates:

“corruption flourishes: monopoly plus discretion, and an absence of accountability.”

According to Klitgaard, rules in themselves are neither good nor bad — they either create rent and widen the space for discretion, or narrow discretion and ease accountability. Applied to healthcare public procurement, this means that the lasting solution is the narrowing of discretion and the increase of transparency (public public-money platform, A1; anomaly detector, A2) — not the individual, institution-targeting action, which treats the symptom and not the cause.

📖 Source: Robert Klitgaard: Controlling Corruption (1988)

6.5 International comparison

In tackling the nursing shortage, the retention-centred model has proven itself in several European countries: the Magnet hospital certification system (adapted by the Magnet4Europe programme) demonstrably reduces turnover and improves patient outcomes through supportive leadership, an adequate nurse-to-patient ratio and clinical autonomy. By contrast, systems that tried to fill the shortage primarily through foreign recruitment (for example the drawing of Romanian nurses to Germany) only displaced the problem and weakened the care of the source country. The Hungarian lesson is unambiguous: the sustainable answer is domestic retention, not import — and certainly not symptomatic, institution-targeting action.

Healthcare

  • E2 — Digital healthcare system (EESZT)
  • E3 — Waiting-list transparency
  • E6 — Nurse-retention package

Transparency and anti-corruption policy

  • A1 — Public-money dashboard
  • A2 — Public-procurement transparency

6.7 Source register

Press sources (MIAK press monitor, 25 June 2026 — topic 7):

Knowledge-base references (literature):

  • 📖 OECD / European Commission: Health at a Glance: Europe 2024
  • 📖 Greenley, Aiken, Sermeus, McKee: Policy Brief 66 — Strengthening Europe’s Nursing Workforce (European Observatory, 2024)
  • 📖 Robert Klitgaard: Controlling Corruption (1988)

Note: the local file path of the books does not appear in the blog’s visible text — only the author and the title.

MIAK internal materials:

  • MIAK policy area: Healthcare (programme points; programme point ID: E6, E3)
  • MIAK policy area: Transparency and anti-corruption policy (programme points; programme point ID: A1, A2)
  • MIAK press monitor, 25 June 2026 — topic 7, score: 80/100

Additional public data sources:

  • NEAK waiting-list and financing data; EESZT statistics
  • OECD health indicators

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