Part I — Situation overview

On 26 September, during his country tour stop in Szolnok, Prime Minister Péter Magyar announced that the government had adopted a HUF 10 billion waiting list reduction programme. The programme will start this year and must produce visible results from 1 January at the latest. Waiting would be reduced first where the lists are longest: hip and knee replacement operations and cataract operations. The envelope will be used to expand capacity and set up new medical teams, and procedures will be performed at night too if necessary. If the programme is successful, it will be extended to other areas. The Prime Minister also recalled the government’s commitment: a maximum wait of two months in outpatient specialist care and six months in inpatient care. “We are still far from that today,” he added. He also stated that in 2027 healthcare will receive HUF 500 billion more than in 2026. Telex quoted from the website of the National Health Insurance Fund (NEAK) that at the beginning of April 9,602 people had been waiting more than sixty days for hip replacement surgery, while by mid-September 10,607 patients were on the list.

The programme is thus responding to a worsening trend. MIAK has written about waiting lists several times in recent months. In August it proposed a system-level baseline assessment (against what will we measure its success?), and on 20 September a ban on paid queue-jumping, public waiting list data and a rule governing movement between public and private care (banning it is not enough). This analysis does not repeat these. This time the subject is a concrete programme with money and a deadline attached. The question is how to design it so that in January it can be decided whether it worked. Two days earlier, on 24 September, HVG reported that the Directorate of Human Reproduction (HRI) had for the first time published the success rates of the 13 state IVF centres institution by institution.

MIAK’s reading: HUF 10 billion is in itself neither a lot nor a little. What matters is how many additional operations it buys, and whether this is genuinely more than the hospitals would have performed without the programme. It also matters what remains of it after January. The data of the IVF centres, in turn, show that institution-level public outcome reporting is feasible in Hungarian healthcare too.

Part II — Foundations in the literature

Three sources provide the interpretative framework. The volume Health Systems Governance in Europe by Elias Mossialos (professor of health policy at the London School of Economics) and co-authors discusses the health effects of the EU Working Time Directive. It cites a study according to which surgeons deprived of one night’s sleep made more errors and worked more slowly in a simulated operation. Hans Okkels Birk and co-authors, in the 2024 country report on Danish healthcare, describe how the waiting time guarantee works and why waiting times began to rise again. If there are not enough staff, the guarantee also becomes unsustainable. The volume Improving Healthcare Quality in Europe by Reinhard Busse (professor of health care management at the Technical University of Berlin) and co-authors presents two mechanisms of effect of public, institution-level outcome reporting. Patients can choose the better provider, and weaker institutions improve on seeing how far behind they are. The detailed discussion of the literature — by author, with quotations — can be found in section 6.4 Literature in detail.

Part III — MIAK’s concrete proposal

MIAK proposes three measurable measures. Their common aim is that the “visible result” of 1 January should be a verifiable fact rather than a mood, and that the programme should leave lasting capacity behind.

3.1 Public programme plan with a baseline and unit cost per procedure (publication by 31 October 2026)

MIAK proposes that the Ministry of Health and NEAK publish a short, public programme plan when the programme is launched. For three procedures (hip replacement, knee replacement, cataract surgery), it should include the September baseline: the number of people on the list, the number of those among them who have been waiting more than sixty days, and the median patient’s waiting time. The plan must also lay down the precise definition of the measurement. From the public reports it is currently unclear whether the September figure of 10,607 refers only to those waiting more than sixty days, or to the whole list. If this is not fixed in advance, any result can be produced in January. The plan should also state how many additional procedures the programme buys by procedure type and by institution, and what the resulting additional cost per procedure is. By way of illustration: if the full HUF 10 billion went only to hip replacement patients waiting more than sixty days, that would be roughly HUF 940,000 per patient. The programme must state whether this is a supplement to regular financing or the full price of the operation. Finally, the plan should define what it considers success on 1 January, for example a specified percentage reduction in the number of those waiting more than sixty days. The proposal applies the E3 waiting list transparency and the G1 data-driven budget programme points to a concrete programme with a deadline. The technical basis of the data is the E2 digital health system.

3.2 Additional-output rule and conditions for night-time surgery (from the start of the programme)

MIAK proposes that the programme finance only genuine additional output. For every participating institution, the monthly average number of operations in the three procedures over the previous twelve months must be recorded. Programme funding should be paid only for operations above this level. In the same hospitals, the waiting lists for other elective operations must also be monitored monthly. If operating theatres, anaesthetists and theatre nurses are reallocated from other care, the hip list shortens, but other patients wait longer. That is not waiting list reduction, merely a rearrangement of the queue. Night-time operations require three conditions. First: the night team cannot come off on-call duty or after a day shift; the rest periods under the Working Time Directive must be respected. Mossialos and co-authors show precisely (see 6.4.1) that a sleep-deprived surgeon makes more errors. They also document that in Hungary it used to be common practice to work a regular shift after 24 hours on call. Second: the extra work should be voluntary and separately remunerated. This includes the anaesthetists and the theatre and ward nurses who care for the patient during the night and the following day. Third: the complications, thirty-day readmissions and reoperations of operations performed in the programme must be measured separately. Procedures performed outside working hours must also be compared with those performed during the day. The proposal is linked to the E6 nurse retention package: an exhausted nursing workforce cannot sustain a programme built permanently on night shifts.

3.3 After 1 January: lasting capacity and extension of the IVF model (public evaluation by 28 February 2027, first institutional outcome report by the end of 2027)

MIAK proposes that the January evaluation of the programme be public, and that it decide on continuation according to criteria laid down in advance. The criteria: was the target value met, was the output genuinely additional, did no other waiting list deteriorate, and did the complication rate not rise. The condition for extension must also be written down now, not in January. If the programme works, the Government should specify in the 2027 budget bill how much of the HUF 500 billion extra goes to lasting surgical capacity: operating theatres, staff and post-operative care. According to the Danish experience described by Birk and co-authors (see 6.4.2), waiting times began to rise again after a decade and a half of decline, when staff ran out. Without capacity, the guarantee is also unsustainable. The second element is the extension of the IVF model. HRI published the results by institution and with a comparable reference group, and HVG also drew attention to the distorting effect of small case numbers. The same method can be applied to hip and knee replacement and to cataract operations. The complication, reoperation and readmission rates must be published annually for each institution, with risk adjustment. In the longer term, patient-reported outcome measures (PROMs — patient-reported outcome measures, for example walking ability and pain after the operation) must also be reported. According to the analysis by Busse and co-authors (see 6.4.3), such reporting has the greatest effect where baseline performance is weak. The IVF centres’ data also provide a basis for the DM2 family support impact assessment programme point. The effectiveness of the IVF programme as a family policy instrument can now be measured at institutional level for the first time. Outcome reporting for elective operations transfers the logic of the G20 impact assessment system (Drucker audit — an ex-post review of whether a measure actually delivered the expected result) to healthcare.

The common principle of the three proposals is that a programme with a deadline must know in advance what it measures itself against, what it buys and what remains afterwards. According to the Danish experience, waiting times fall durably when capacity and staff stand behind them. Mossialos and colleagues warn of the risk of a tired team. And according to Busse and colleagues, the publicity of institutional results in itself sets improvement in motion. This is already visible at the IVF centres.

Part IV — Expected effects and risks

Dimension Expected effect Risk
Patients The number of those waiting more than sixty days for the three procedures falls measurably; surgical outcomes become visible by institution If capacity is reallocated from other care, other patient groups wait longer
Patient safety Complications of night-time operations are measured separately, so it becomes apparent in time if out-of-hours surgery is riskier The pressure of the January deadline may encourage breaches of rest periods and looser patient selection
Healthcare workers Voluntary, separately remunerated extra work; lasting capacity from 2027 provides more predictable work schedules A campaign-style programme built on night shifts accelerates burnout and emigration
Budget The unit cost per procedure is public; part of the extra funding in 2027 goes to lasting capacity After the one-off money, the previous state returns and the waiting list grows again
Institutions The outcome list encourages weaker hospitals to improve, as the exchange of experience has already started among the IVF centres Without risk adjustment, institutions treating more severe patients receive unfairly poor rankings and may avoid difficult cases

The main trade-off is between speed and durability. The 1 January deadline is politically understandable, and it is also good for patients to get their turn soon. Three months, however, is little time to build new capacity. The cheapest route to a quick result is for existing doctors and nurses to work more, or to reallocate from other lists. The first carries the risk of exhaustion and to patient safety. The second merely shifts the problem. This is why the additional-output rule of point 3.2 and the separate measurement of complications are needed.

The second question is the fairness of outcome reporting. For the IVF centres’ data, HRI itself indicated that differences in patient mix may distort the picture, and HVG warned of the effect of small case numbers. HRI therefore applied a reference group that includes only patients aged 25–36, with specified clinical conditions. The same is necessary for replacement and eye operations: without adjustment for age, comorbidities and case numbers, the outcome list is misleading. The third question is continuation. If the January evaluation is not public, the success of the programme can be interpreted in any way after the fact. If the conditions for continuation are not written down in advance, the decision will depend on the political mood of the moment, not on the data.

Part V — Measurability and summary

5.1 What is worth following? (suggested KPIs)

MIAK suggests following the performance indicators (KPIs — Key Performance Indicators) below:

  • Number of those waiting more than sixty days: for hip replacement, knee replacement and cataract surgery, on 1 January 2027 compared with the pre-defined baseline of September 2026, broken down by institution. Suggested target: achievement of the reduction laid down in the programme plan, and reversal of the trend in all three procedures.
  • Share of genuine additional output: what percentage of operations financed in the programme exceed the institution’s average for the previous twelve months. Suggested target: 100%. In the same institutions, the waiting lists for other elective operations must not grow.
  • Patient safety: the thirty-day readmission and reoperation rates of operations performed in the programme, separately for operations performed outside working hours and during the day. Suggested target: the rates for out-of-hours operations are no worse than those for daytime ones.
  • Lasting capacity: the amount earmarked for lasting surgical capacity in the 2027 budget, and the additional operating theatre capacity still operating at the end of 2027. Suggested target: waiting times do not rise back to the September level during 2027 either.
  • Institutional outcome report: for how many types of elective operation a risk-adjusted institutional outcome list similar to that of the IVF centres is published. Suggested target: at least for the three programme procedures by the end of 2027.

5.2 Summary

MIAK welcomes the fact that the government has launched a programme tied to a target figure and a deadline. This is a rare and good starting point for accountability. The programme will be verifiable if, by the end of October, the baseline, the precise measurement definition, and the number and unit cost of the additional operations purchased are made public. The money may be given only for genuine additional output, and night-time operations may be performed only by rested teams who volunteer, with separately measured complications. In January, a public evaluation must decide on continuation. The extra funding in 2027 must create lasting capacity, and the institutional outcome reporting introduced for the IVF centres must be extended to replacement and eye operations.

Two MIAK foundational values are at stake here. Data-drivenness, because the result of a programme with a deadline can only be measured against a baseline and definition fixed in advance. Without this, in January both success and failure could be claimed. And accountability, because the example of the IVF centres has shown that when institutional results are public, weaker institutions start improving on their own. The same principle can be applied to the use of the waiting list programme’s money and to the quality of operations.

Part VI — Reasoning and further sources

6.1 Press framing by spectrum

In the left-liberal band, Telex published a stand-alone, factual article on the programme. Alongside the elements of the government announcement, it added the trend in the number of people waiting for hip replacement from the NEAK website. In doing so, it placed the news in the context of a measurable, worsening trend. 444.hu mentioned the programme in only a few sentences in its long report on the Szolnok event. The outlet wrote about a programme worth “several tens of billions of forints”, which differs from the ten billion reported by Telex. The focus of the report was the overhaul of KATA, the wealth tax and the accountability process. Népszava put the egg-throwing in its headline. From healthcare, it highlighted that the Prime Minister had told Health Minister Zsolt Hegedűs that as head of government he too would make unannounced hospital visits. The downloaded article did not mention the waiting list programme. HVG’s article of 24 September gave a detailed, data-rich analysis of the institutional comparison of IVF centres. Besides the improving national results, it also presented the methodological limitations and the shortage of egg donation.

Articles from the public-affairs band (24.hu, Index, ATV) and the economic band (Portfolio) were not among the sources for the topic. The pro-government conservative band (Magyar Nemzet, Mandiner) did not put the topic at the centre on the monitored day. A common feature across the whole spectrum is that none of the outlets published more about the details of the programme than the announcement. It is not clear how many operations will be bought, in which hospitals, at what unit price, and against what the result will be measured in January. This gap is itself an argument for the public programme plan proposed in point 3.1.

6.2 Facts and data

Data Value Source
Envelope of the waiting list reduction programme HUF 10 billion (according to the 444.hu report, “several tens of billions”) Telex, 444.hu, 26 September 2026
First target areas hip and knee replacement, cataract operations Telex, 444.hu, 26 September 2026
Deadline the programme starts this year, visible results from 1 January at the latest Telex, 26 September 2026
Government commitment on maximum waiting outpatient specialist care: 2 months; inpatient care: 6 months Telex, 26 September 2026
Extra funding for healthcare in 2027 +HUF 500 billion compared with 2026 Telex, 26 September 2026
Those waiting more than sixty days for hip replacement, early April 2026 9,602 people Telex, based on NEAK data
Those waiting for hip replacement, mid-September 2026 10,607 people (the report does not make clear whether this refers only to those waiting more than sixty days) Telex, based on NEAK data
Number of state IVF centres 13 (the state took over the centres in 2022) HVG, 24 September 2026
Estimated cumulative live birth rate, 2024 Hungary 26.4%; European average (ESHRE, 2020) 32.3% HVG, 24 September 2026
Clinical pregnancy rate for fresh embryo transfer, reference group, 2025 nationally 35.03%; between 23.4% and 50.4% by institution HVG, based on HRI data
Clinical pregnancy rate for frozen embryo transfer, 2025 nationally 31.5%; between 13.2% and 53.6% by institution HVG, based on HRI data
IVF centres performing better than the national average 8 out of 13 HVG, based on HRI data

Two remarks belong to the figures. First, for the hip replacement data, according to Telex’s text, the number of those waiting more than sixty days in April was 9,602. Based on the wording, the September figure of 10,607 may also refer to the whole list. This difference is precisely the definitional question that the programme plan proposed in point 3.1 must fix in advance. Second, the reference group of the IVF centres consists of patients aged 25–36 with at least six retrieved eggs, treated without surgical sperm retrieval. For low-volume centres, HVG specifically noted that a single case can shift the annual rate by several percentage points. The Hungarian average is lower than the European one, but according to HVG this is partly explained by the fact that in Hungary state treatment with one’s own eggs is permitted up to the age of 45, whereas in most countries only up to 40.

6.3 Policy dimensions

  • Healthcare (programme points) — the baseline of the waiting list programme, its additional nature and the staffing conditions of night-time operations, institutional outcome reporting for elective operations (programme point ID: E3, E2, E6);
  • Demography (programme points) — measuring the effectiveness of the IVF programme as a family policy instrument on the basis of institutional data (programme point ID: DM2);
  • Economy (programme points) — the unit cost of the HUF 10 billion envelope, the share of the HUF 500 billion extra funding in 2027 devoted to lasting capacity, and the ex-post evaluation of the programme (programme point ID: G1, G20).

6.4 Literature in detail

6.4.1 Elias Mossialos et al.: Health Systems Governance in Europe

The volume’s chapter on health professionals discusses the EU Working Time Directive. The directive lays down minimum daily and weekly rest periods, maximum weekly working time, and certain rules on night work and shift work, and it applies to all workers in healthcare. According to the authors, a generation earlier doctors worked extremely long shifts, which endangered both their own health and that of their patients. From a study they cite:

“surgeons who missed a night’s sleep made 20% more errors and took 14% longer to perform a simulated operation than those at the start of a shift.”

In other words, surgeons deprived of one night’s sleep made 20 per cent more errors in a simulated operation and worked 14 per cent more slowly than those at the start of their shift. The volume presents the Hungarian situation in the mid-2000s in a separate box. At that time it was common for a doctor to start a regular eight-hour shift after twenty-four hours on call. According to an estimate by the Hungarian Medical Chamber, the disputed on-call regulation affected some 25,000 doctors. An English case study also shows that compliance with working time rules ultimately required the reorganisation of care, because rostering senior doctors at night was not sustainable in the long run.

Another chapter of the volume reviews cross-border care programmes set up to deal with waiting lists. Between 2001 and 2003 England sent waiting list patients to Germany, France and Belgium with two short-lived programmes. Norway operated a similar “patient placement bridge” for three years. Ireland, by contrast, has operated a permanent fund since 2002 to purchase care for waiting list patients. Translated to the Hungarian programme: night-time surgery is safe only if the team is rested and volunteers, and acceleration programmes either remain short campaigns or become lasting institutions. Points 3.2 and 3.3 build in these two lessons.

📖 Source: Elias Mossialos, Govin Permanand, Rita Baeten, Tamara Hervey (eds.): Health Systems Governance in Europe — The Role of European Union Law and Policy

6.4.2 Hans Okkels Birk et al.: Denmark: Health System Review (2024)

According to the Danish country report, in Denmark the patient has the right to a diagnosis within thirty days and to treatment within a further thirty days. If the region cannot provide this in its own hospitals, it is obliged to inform the patient that they may be treated in another public or private hospital at the region’s expense. Private hospitals operate as reserve capacity for the waiting time guarantee on the basis of contracts concluded with the regions. They usually performed 5 per cent of elective operations, but in 2022, because of the pandemic and the nurses’ strike, already 10 per cent. According to the report, the average waiting time for elective operations fell between 2005 and 2019, but has been rising since. Besides the backlog accumulated during the pandemic, the reason is staff shortages: in 2022 some 4,700 nursing posts were vacant, and operations had to be cancelled because of the shortage. The authors draw a clear conclusion:

“If capacity cannot be increased, patient rights regarding waiting time guarantees etc. may need to be revised.”

In other words, if capacity cannot be expanded, the patient rights tied to the waiting time guarantee may also have to be reviewed. The report also warns that activity-based financing encouraged the mere increase of activity, not care that creates value for the patient. Therefore, from 2017 the Danish regions largely replaced it with a model built on broader performance indicators. Part of this is the development of patient-reported outcome measures, among others for hip and knee replacement operations. Translated to the Hungarian programme: the government’s two- and six-month commitment is a goal similar to the Danish guarantee, but it can only be maintained with lasting capacity and staff. And a programme that rewards only the number of procedures increases volume, not necessarily outcomes. This is why point 3.3 ties continuation to lasting capacity and institutional outcome measurement.

📖 Source: Hans Okkels Birk et al.: Denmark: Health System Review (Health Systems in Transition, 2024)

6.4.3 Reinhard Busse et al.: Improving Healthcare Quality in Europe

The volume’s chapter on public reporting gives three defining features. Reporting is addressed to the general public, concerns identifiable institutions or professionals, and is based on regularly collected, comparative data. It distinguishes two mechanisms of effect. Through the selection pathway, patients choose the better provider. Through the change pathway, weaker institutions improve on seeing how far behind their peers they are, which is also encouraged by the threat of reputational loss. According to the authors’ summary, public reporting is associated with a small reduction in mortality, although the quality of the evidence is moderate or weak:

“Public reporting has been found to be more effective if baseline performance is low.”

In other words, public reporting is more effective where baseline performance is low. The chapter also mentions unintended effects, for example changes in coding and readmission practices, and the fact that patients, especially older and more disadvantaged ones, rarely use such data. Effective reporting requires easily accessible information and valid, reliable indicators. Mandatory regulation helps ensure that all providers are included and that the data are of good quality. At the Hungarian IVF centres the change pathway already seems to be working: according to HVG, after learning of the data the institutes began to share their experience with one another. For replacement and eye operations, where there are currently no public data at all on differences between institutions, reporting under point 3.3 would start precisely from a weak baseline. Because of the risk of coding distortion, the indicators must come from NEAK’s financing data and the Electronic Health Service Space (EESZT), not from institutions’ self-reporting.

📖 Source: Reinhard Busse, Niek Klazinga, Dimitra Panteli, Wilm Quentin (eds.): Improving Healthcare Quality in Europe — Characteristics, effectiveness and implementation of different strategies

6.5 International comparison

The waiting time guarantee and public outcome reporting operate together in several European countries. In Denmark, alongside the thirty-plus-thirty-day guarantee, the public health portal also provides information on waiting times and quality indicators, so patients can exercise their right to a free choice of hospital on the basis of real data. According to Busse and co-authors, well-developed public reporting systems operate in the United Kingdom (nhs.uk), the Netherlands (kiesbeter.nl), Germany (weisse-liste.de) and Denmark (sundhed.dk). Among the member states that joined after 2004, however, few such initiatives are known, mainly in the Baltic states. Estonia’s quality bonus system links public reporting with a financial incentive. The Hungarian comparison of IVF centres is a step forward in this field. For international comparisons, HRI reports the estimated cumulative live birth rate, an indicator also used by the European Society of Human Reproduction and Embryology (ESHRE).

There is also international experience on the durability of acceleration programmes. According to Mossialos and colleagues, England and Norway tried to shorten waiting lists in the early 2000s with programmes that ran for a few years. Ireland’s fund, established in 2002, by contrast became a lasting institution. The Danish example shows that even a well-functioning guarantee becomes hollow if staff run out. The Hungarian programme should therefore measure not only how much the list shortens by 1 January, but also whether it is still shorter at the end of 2027.

Healthcare

  • E3 — Waiting list transparency
  • E2 — Digital health system
  • E6 — Nurse retention package

Demography

  • DM2 — Impact assessment of family support

Economy

  • G1 — Data-driven budget
  • G20 — Economic policy impact assessment system (Drucker audit)

Proposed new programme point: Institutional outcome report for elective operations — following the model of the IVF centres, complication, reoperation and readmission rates for the highest-volume elective operations published annually, by institution, with risk adjustment and case-number flagging, supplemented in the longer term with patient-reported outcome measures, from NEAK and EESZT data — for the Healthcare area.

6.7 List of sources

Press sources (MIAK press monitor, 27 September 2026 — topic 2):

Knowledge base references (books):

  • 📖 Elias Mossialos, Govin Permanand, Rita Baeten, Tamara Hervey (eds.): Health Systems Governance in Europe — The Role of European Union Law and Policy
  • 📖 Hans Okkels Birk et al.: Denmark: Health System Review (Health Systems in Transition, 2024)
  • 📖 Reinhard Busse, Niek Klazinga, Dimitra Panteli, Wilm Quentin (eds.): Improving Healthcare Quality in Europe

MIAK internal materials:

  • MIAK policy area: Healthcare (programme points; programme point ID: E2, E3, E6)
  • MIAK policy area: Demography (programme points; programme point ID: DM2)
  • MIAK policy area: Economy (programme points; programme point ID: G1, G20)
  • MIAK press monitor, 27 September 2026 — topic 2, score: 82/100

Supplementary public data sources:

  • National Health Insurance Fund (NEAK) — waiting list register and financing data
  • Directorate of Human Reproduction — institutional success rate comparison for 2024–2025
  • Electronic Health Service Space (EESZT)

Generation metadata