Part I — Situation overview

On 5 September 2026, after the scientific congress of the chamber of nursing staff in Siófok, the health minister set out what the ministry will spend the nearly 500 billion forints of additional funding earmarked for the sector in this year’s reworked budget on. According to his statement the preparation of the pay settlement for nursing staff is complete, the inter-ministerial consultations with the Ministry of Finance have accelerated, and the largest share of the extra funding will go on recognising the career path of healthcare workers, and within that on creating a new pay scale for nursing staff. The minister outlined a long-term structure that deals equally with new entrants, the middle generation and experienced older colleagues, and signalled that the representation of the nursing staff will have a place at the negotiating table, and that they will be counted on in the fine-tuning of the pay scale as well. Training, emergency care, the state of the ambulance service, prevention and rehabilitation were also on the agenda at the congress. The announcement is part of the same week in which the government also decided to initiate the restoration of compulsory membership of the medical chamber; making membership compulsory is decided by Parliament in an amendment to the law. This is a related but separate regulatory question: strengthening professional self-government does not substitute for measuring the effect of the pay measure.

The prehistory runs along two strands. One is budgetary: the 500 billion forints a year of extra healthcare funding was an election commitment whose feasibility analysts disputed at the time of the announcement — not primarily for the first year, but for a lasting expansion repeated every year. The reworked 2026 budget now submitted revealed by how much state funding for the sector actually rises, and the present ministerial statement adds what part of this goes on pay. The other strand is professional: the bottleneck of Hungarian healthcare has for years been not the number of beds but the number of nursing staff. According to the OECD’s 2024 comparison, in the countries of the European Union there are on average 8.4 practising nurses per thousand inhabitants, and the indicator rose in most member states between 2010 and 2022 — in Hungary and Latvia, however, it fell, in two countries that were already below the average at the start of the period. In MIAK’s interpretation this is the single most important figure in the case: this is not a matter of a gap but of a widening distance.

MIAK’s reading: the pay settlement is the right instrument for the right problem, but the condition of success is not the size of the sum, it is whether it is tied to a measurable retention goal. A pay scale on its own is a grading system; it becomes a career model by containing a path of advancement, and it becomes policy by having an indicator attached to it. MIAK’s programme point E6 prescribes exactly this duality: alongside the pay, a fixed indicator (attrition rate, share of unfilled posts, leaving the profession within five years), and if it is not met the programme is to be reviewed. Without this, in two or three years’ time the only verifiable statement left will be that the money was spent.

Part II — Foundations in the literature

Three sources give the interpretive frame. The summary Policy Brief 66 — Strengthening Europe’s Nursing Workforce by Rachel Greenley, Linda H. Aiken, Walter Sermeus and Martin McKee (authors of the Magnet4Europe research consortium; Aiken is the most-cited researcher of the relationship between nurse numbers and patient outcomes) systematises the evidence on nurse retention. It gives an unambiguous answer to the key question of the present case: competitive pay is indispensable, but on its own it does not solve the wider causes of dissatisfaction and attrition. The OECD report Health at a Glance: Europe 2024 provides the numerical picture of the situation: at EU level some 1.2 million doctors, nurses and midwives are missing, a quarter of nurses are over 55, and Hungarian nurse density is not only below the average but also fell between 2010 and 2022. And the World Health Organization’s (WHO) report European Health Report 2024 systematises the causes of the crisis: ageing, internal movement from the countryside to the city and from the public to the private sector, international migration, and attrition due to poor working conditions and mental strain. The three sources together lead to the same place: money is an entry ticket, not a solution. The detailed treatment of the literature — source by source, with quotations — can be found in section 6.4 Literature in detail.

Part III — MIAK’s concrete proposal

MIAK proposes three measurable steps. The starting point is that the announced direction is supportable: nursing staff pay has for years been the weakest point of the system, and the asymmetry of earlier pay measures — settling the doctors’ side alongside the nursing staff’s — further increased the tension. The proposals therefore are not against the package but for measuring its effect and for its sustainability.

3.1 A quarterly public workforce report broken down by institution (with the first publication in the first quarter of 2027)

The health insurer and the care-organising authority should publish quarterly, broken down by institution, four data points: the number of filled and unfilled nursing posts, the number of leavers and entrants in the given quarter, the average number of patients cared for per nurse on inpatient wards, and the share of nursing staff over 55. The data should be machine-readable, downloadable as a time series, and the institutional breakdown should go down at least to hospital level. This is the same logic with which the ministry made ambulance response data and hospital infection data public — that is, it is not the introduction of a new principle but the extension of a practice already begun to the workforce. Without the report the effect of the pay settlement cannot be measured: today there is no public time series from which it could be decided in a year’s time whether the package has halted attrition. The proposal is the joint application of MIAK’s programme points E2 (Digital healthcare system) and G1 (Data-driven budget) to the sector’s workforce.

3.2 Non-pay retention elements alongside the pay scale, with measurable targets (simultaneously with the pay scale)

MIAK proposes that the new pay scale should enter into force not on its own but as a package, with four non-pay elements: (1) setting a maximum patient-to-nurse ratio on the highest-risk wards — intensive care, emergency care, geriatrics — as several EU member states have also done; (2) a non-managerial clinical advancement path, so that professional development is not available only in a ward-head position; (3) compulsory management training for head nurses, because according to the evidence the quality of the immediate manager is one of the strongest factors in retention; (4) a burnout prevention programme with compulsory supervision. The summary by Aiken and co-authors (see 6.4.1) counts all four among the interventions proved effective, and also states that they reinforce one another — separately they are weaker. The cost of these elements is small compared with the pay package, while their absence reduces the effect of the pay package. The proposal is the direct concretisation of programme point E6 (Nurse retention package).

3.3 A public phasing path for the multi-year funding, with annual review

A pay scale is a lasting commitment: the cost in the first year is the smallest, because the ramp-up of the grading system and the base effect of the pay increase raise expenditure in the following years. MIAK therefore asks the ministry to publish the cost path of the pay package for at least four years — broken down by year, showing the ramp-up of grading and the base effect — as well as on which budget line and under what revenue assumption the funding is available. This is needed not out of mistrust but because the characteristic risk of public service pay measures is not the introduction but the second and third year, when the base effect appears while political attention is already elsewhere. If the path is public, the profession and the public can hold it to account. The proposal connects to programme points G1 (Data-driven budget) and FO10 (Modernisation of wage bargaining — tripartite pay consultation forum); the latter because involving the representation of nursing staff in consultation becomes institutional only if it is not a one-off gesture but a recurring forum.

The three proposals are bound together by a single principle: the pay settlement becomes a career model if it has an indicator, accompanying measures and a multi-year funding path. Without these three even the largest sum becomes a one-off rise whose effect melts away in two or three years — exactly as has happened several times already in the past decade.

Part IV — Expected effects and risks

Dimension Expected effect Risk
Healthcare provision Stabilising nursing staff numbers directly improves patient safety; a lower patient-to-nurse ratio measurably reduces complications If only pay changes while the workload does not, the retention effect will be short-lived
Labour market A predictable pay scale and an advancement path make the career more attractive to young people, among whom interest has fallen at EU level too The private sector and the foreign labour market remain competitors; the pay advantage can quickly lose its value
Budget Targeted use of the sector’s additional funding gives a better return than spreading institutional operating support The base effect of the pay scale raises expenditure in the following years; without a funding path the second and third year are the risky ones
Proportions within the sector Settling the ratio between nursing staff and doctors’ pay reduces the “top-heaviness” of the system Relative pay compression may generate tension on the doctors’ side; this has to be communicated in advance

The main question of judgement is the sequencing of pay and working conditions. A pay rise is immediately perceptible, politically easy to communicate and quick to implement; improving staffing ratios, management training and burnout prevention are slower, less spectacular, but according to the evidence have a more lasting effect. The two are not alternatives, but in practice one tends to crowd out the other, because the budget debate is about pay. MIAK therefore proposes that the non-pay elements should enter into force simultaneously with the pay scale, not after it. The second point of judgement is the sensitivity of data publicity: workforce data broken down by institution may put some hospitals in an uncomfortable position, and in the short term it worsens patients’ confidence in the institutions concerned. In MIAK’s view this is acceptable — the same argument was heard before the publication of hospital infection data, and there too the decision fell in favour of publicity; distortion can be avoided if context (type of institution, care profile) is published alongside the data.

Part V — Measurability and summary

5.1 What is worth following? (suggested KPIs)

The performance indicators below (KPIs, Key Performance Indicators) are suggestions, not government decisions — MIAK considers them suitable for judging in 12 and 24 months’ time what the pay package has delivered:

  • The share of unfilled nursing posts: broken down by institution, quarterly. This is the most important indicator, because it directly signals whether the system is able to replace those who leave.
  • The annual leaving rate: how many nursing staff leave the institution, and the profession, in a year. MIAK’s programme point E6 proposes halving attrition by 2030.
  • The number of practising nurses per thousand inhabitants: the movement of the current value, which is below the EU average. This is the indicator that makes the result internationally comparable — the EU average in 2022 was 8.4.
  • The share of new entrants leaving the profession within five years: this shows whether the career model really is a career, or just a grading system.

5.2 Summary

MIAK’s request can be summed up in a single sentence: alongside the pay scale there should be a quarterly workforce report broken down by institution and a four-year funding path, and the non-pay retention elements should enter into force at the same time as the pay. The direction of the package is good, and the problem it answers is real: Hungarian nurse density not only falls short of the EU average, it has moved further from it over the past decade and more. That is precisely why it would be a pity if the effect of the measure could not be judged afterwards.

Two MIAK foundational values are at play here. Data-drivenness, because with a sectoral measure of 500 billion forints the greatest risk is not that it goes in the wrong direction but that we shall not find out whether it went in the right one; the absence of measurement turns every later debate into a political debate. And accountability, because without publicity for the multi-year funding path there is nothing against which to measure promise and delivery — and with public service pay measures credibility is decided precisely in the second and third year, not at the announcement.

Part VI — Reasoning and further sources

6.1 The framing of the press by spectrum

The daily coverage in every band took the ministerial statement as its basis, but the placement differed. The liberal-left and public affairs band treated the news as a stand-alone sectoral announcement: Telex gave the longest collection of quotations from the minister’s statement, highlighting the involvement of nursing staff representation in the consultations, and referred to its own summary of the first hundred days of the newly created ministry. HVG carried the same more concisely, but added as a separate angle the ministry’s earlier steps on data publicity — the publication of ambulance response statistics and hospital infection data — and thereby placed the pay measure in a wider transparency programme. This framing comes closest to what MIAK also proposes.

The economic band gave the most useful background, in two layers. Portfolio on the one hand reported the present announcement, and on the other — a few days earlier — set out in detail how much additional funding actually appears for healthcare in the reworked 2026 budget. It also recalled the prehistory of the commitment: the campaign spoke of 500 billion forints a year, and analysts signalled even then that the harder task is the lasting expansion repeated every year, not the first year. 444.hu’s budget podcast discussed the same question in the context of the whole reworked budget. This strand does not appear in the daily news, even though it is the greatest risk of the package — MIAK’s proposal 3.3 answers it.

The conservative band put on its front page not the pay settlement but the week’s other healthcare decision, the restoration of compulsory membership of the medical chamber; the materials of Mandiner and ATV carried this strand. That is a legitimate choice of news — chamber membership directly affects every practising doctor — but it has the consequence that the pay settlement for nursing staff, which is a substantially larger item in magnitude, received less attention in this band. According to the monitor’s source markings, Népszava’s material was available only at title level (title-level reference only).

6.2 Facts and data

Data Value Level of evidence
Additional funding for the healthcare sector in the reworked 2026 budget close to 500 billion forints ministerial statement, on the basis of the budget bill
The main direction of use of the additional funding pay settlement for nursing staff and a new pay scale ministerial statement (5 September 2026)
Practising nurses per thousand inhabitants, EU average 8.4 (2022), up from 7.3 (2010) OECD: Health at a Glance — Europe 2024
The direction of the Hungarian indicator between 2010 and 2022 fell, while it rose in the majority of member states OECD: Health at a Glance — Europe 2024
Estimated EU healthcare workforce shortage some 1.2 million doctors, nurses and midwives (2022) OECD: Health at a Glance — Europe 2024
The share of nurses over 55 in the EU about a quarter OECD: Health at a Glance — Europe 2024
The organisational cost of replacing one nursing post of the order of several months’ pay European Observatory: Policy Brief 66
The restoration of compulsory medical chamber membership government decision of September 2026 government information

One remark on the data: the “close to 500 billion forints” is the sectoral increment relating to the reworked 2026 budget now submitted, not the stand-alone cost of the pay settlement — according to the ministerial statement its “largest share” goes on pay, but the exact proportion is not yet public. The blog therefore gives no sum for pay. This distinction matters because the additional funding and the wage bill are not the same item, and the conflation of the two regularly causes misunderstanding in public debate.

6.3 Policy dimensions

  • Healthcare (programme points) — tying the nurse retention package to indicators, and reducing the administrative burden as a non-pay retention instrument (programme point ID: E6, E2, E3);
  • Employment policy (programme points) — the public service pay scale logic and the institutionalisation of tripartite pay consultation (programme point ID: FO1, FO10);
  • Economy (programme points) — a data-driven presentation of the multi-year funding of the pay measure and mandatory ex-post impact assessment (programme point ID: G1, G20).

A clarification of competences for the sake of public debate: the legal form of the nursing staff pay scale is a piece of legislation, whose making falls within the competence of the government and the ministry concerned, while the budgetary funding is decided by Parliament in adopting the budget act. The ministerial announcement therefore signals an intention and an inter-ministerial agreement, not regulation in force. Likewise: making professional chamber membership compulsory is a separate legislative question that is not part of the pay measure — the two came onto the agenda in the same week but are decided in different procedures.

6.4 Literature in detail

6.4.1 Greenley, Aiken, Sermeus, McKee: Policy Brief 66 — Strengthening Europe’s Nursing Workforce

The European Observatory’s 2024 summary builds on the results of the Magnet4Europe research programme, and its most important finding for the present case is that competitive pay is indispensable but on its own not sufficient:

“Competitive remuneration is vital. […] a systematic review in the United Kingdom found that poor pay significantly impacts job satisfaction and retention among NHS staff, but increasing wages, while often essential, is on its own insufficient to address the broader issues of dissatisfaction and turnover.”

The brief lists six priorities: ensuring adequate staffing, a supportive working environment, changing the organisation (not the individual), strengthening nursing leadership, supporting the ageing workforce, and measuring retention. This last is the most missing element in the Hungarian situation: “better data on who leaves nursing and why will give insights that support retention” — that is, for retention one first has to know who leaves and why. The brief brings the strongest evidence on staffing ratios: according to the European research every additional patient per nurse increases the likelihood of burnout, job dissatisfaction and the intention to leave within the following year — and the effect appears in patient safety as well. From this follows the first element of MIAK’s proposal 3.2, setting a maximum patient-to-nurse ratio on the highest-risk wards, as well as proposal 3.1: measurement is not an adjunct to the pay settlement but a condition of its effectiveness.

📖 Source: Greenley, Aiken, Sermeus, McKee: Policy Brief 66 — Strengthening Europe’s Nursing Workforce: Strategies for Retention (European Observatory on Health Systems and Policies, 2024)

6.4.2 OECD: Health at a Glance — Europe 2024

The OECD’s biennial European summary put two topics at the centre in 2024, one of them the healthcare workforce shortage. The report describes the situation as a crisis: twenty EU member states reported a shortage of doctors, fifteen a shortage of nurses, the estimated total shortfall is some 1.2 million doctors, nurses and midwives, while more than a third of doctors and a quarter of nurses are over 55. The finding relating to the Hungarian situation is the most important data point in the present case:

“Between 2010 and 2022, the number of nurses per capita has increased at least slightly in most EU countries. However, it has decreased in Latvia and Hungary, two countries that already had a low density in 2010, thereby widening the gap with the EU average.”

The report adds that the Hungarian government has raised nurses’ pay significantly in recent years in order to improve the attractiveness of the profession and retention — that is, the pay rise did happen on its own, and yet the staffing indicator worsened. This is the most important lesson of the Hungarian case, and it coincides exactly with the British research result quoted in the previous subsection: pay is a necessary but not a sufficient condition. The report itself proposes a multi-element approach — improving working conditions and remuneration in the short term, expanding training capacity in the medium term, and alongside these reshaping task allocation and making better use of digital tools. MIAK’s proposal 3.2 carries this multi-element logic over to the Hungarian package.

📖 Source: OECD: Health at a Glance: Europe 2024

6.4.3 WHO: European Health Report 2024

The World Health Organization’s (WHO) European regional report places the workforce shortage in a wider frame, and points out the apparent contradiction that also recurs in the Hungarian debate — the problem is not a fall in absolute numbers but the difference between the growth rates of demand and supply:

“Despite having more health and care workers than ever in history, almost all Member States of the Region are facing a health workforce crisis, with shortages and maldistribution across different healthcare sectors. The growing demand for health services is outpacing the supply of health workers.”

The report identifies five causes of the narrowing of the supply side: the ageing of healthcare workers, internal movement from the countryside to the city, the flow from the public to the private sector, international migration from lower-income to higher-income countries, and increasing attrition due to poor working conditions and worsening mental health. All five factors are present in the Hungarian situation, and of these the pay settlement acts directly on only the last two — and even on those only in part. The report therefore names, alongside improving retention, the improvement of workforce planning and investment as critical steps; and planning is not possible without data. This is the third, independent argument for MIAK’s proposal 3.1: a quarterly workforce report broken down by institution is a precondition not only for measuring the effect of the pay package but also for capacity planning in the coming years.

📖 Source: WHO: European Health Report 2024

6.5 International comparison (where relevant)

There are three proven intervention patterns for nurse retention in Europe, and none of them is purely pay-based. The first is the mandatory staffing ratio: in 2019 Germany introduced a minimum staffing requirement in the highest-risk hospital areas — intensive care, geriatrics, cardiology, traumatology — with different values for day and night shifts; in England the professional guidance body has issued recommendations on this since 2014. According to the research results, prescribed staffing ratios go together with lower levels of burnout. The second is the organisational model: the European trial of the originally American Magnet programme ran in 308 hospitals in six countries, and builds on professional autonomy, participation in ward-level decision-making and the quality of management — MIAK’s programme point E6 also refers to this pattern. The third is regular, public workforce data collection, which the European Observatory’s summary names as a priority in its own right: without it there is no knowing who leaves the profession and why, so the intervention cannot be targeted either. The Hungarian package currently rests on the first pillar — pay; MIAK’s proposals would add the other two alongside it, at significantly lower cost.

Healthcare

  • E2 — Digital healthcare system
  • E3 — Transparency of waiting lists
  • E6 — Nurse retention package

Employment policy

  • FO1 — Employment data platform
  • FO10 — Modernisation of wage bargaining — tripartite pay consultation forum

Economy

  • G1 — Data-driven budget
  • G20 — Economic policy impact assessment system

Suggested new programme point: A quarterly healthcare workforce report broken down by institution — unfilled posts, leavers and entrants, patient-to-nurse ratio — for the Healthcare area.

6.7 List of sources

Press sources (MIAK press monitor, 6 September 2026 — topic 3):

Knowledge base references (specialist books):

  • 📖 Greenley, Aiken, Sermeus, McKee: Policy Brief 66 — Strengthening Europe’s Nursing Workforce: Strategies for Retention (European Observatory, 2024)
  • 📖 OECD: Health at a Glance: Europe 2024
  • 📖 WHO: European Health Report 2024

MIAK internal materials:

  • MIAK policy area: Healthcare (programme points; programme point ID: E2, E3, E6)
  • MIAK policy area: Employment policy (programme points; programme point ID: FO1, FO10)
  • MIAK policy area: Economy (programme points; programme point ID: G1, G20)
  • MIAK press monitor, 6 September 2026 — topic 3, score: 89/100

Supplementary public data sources (where used):

  • OECD Health Statistics — nurse and doctor headcount data
  • Eurostat — health personnel database

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