The modern social welfare system was largely a product of the 1970s and 1980s, although setting of goals, initial planning, and more modest coverage for citizens began in previous decades. Amendments to the Constitution in 1972 guaranteed universal assistance for the ill, the aged, and the disabled. The Public Health Act of 1972 specifically guaranteed that beginning in 1975 all persons would have free medical care as a right of citizenship. The Social Insurance Act of 1975 provided that insurance conditions and benefits, which had been different for various occupational groups, become uniformly applied to all citizens. In 1982 even those persons involved in private economic activity became eligible for full social insurance coverage (including generous sickness and disability pay), instead of being limited to pension and accident coverage.

The social welfare system expanded steadily. According to official statistics, the percentage of the population's income represented by social benefits in cash (including social insurance payments) and kind (including free health care) was 17.4 percent in 1960, 22.8 percent in 1970, 27.3 percent in 1975, and 32 percent in 1980.

The state health care system was highly centralized. Increasingly specialized and sophisticated services were available at the level of the district (the country had 4,374 districts in 1984), municipality, county, region, and nation. Each district had a designated physician to whom its inhabitants first turned for care under the public health system. If an ailing person required a specialist, the district physician made the appropriate referral. In the 1980s, the availability of physicians, nurses, and hospital beds was high by international standards. In 1986 the country had 31,154 physicians, or about one physician per 299 inhabitants (up from one physician per 909 inhabitants in 1950, one per 637 inhabitants in 1960, one per 439 inhabitants in 1970, and one per 398 inhabitants in 1974). The country had 100 hospital beds per 10,000 inhabitants (up from 55.8 beds per 10,000 inhabitants in 1950, 71.1 in 1960, and 85.5 in 1974). The country had 3,801 dentists and dental surgeons, 43,579 nurses, 57,277 other health personnel, and 4,506 pharmacists.

Although by the 1980s about 99 percent of the population participated in the social insurance system and could receive free medical services and hospital care, much private practice was allowed. In 1984 more than 3,600 health service doctors engaged in private practice, treating private patients during their free time. Many of them had very lucrative private practices. Many persons in upper-income groups, who could afford the high price of private medical care, chose to use the services of a private physician rather than one assigned to them by the health service. Public opinion considered the care given by private physicians to be of higher quality than that provided by the health service.

In the 1980s, the public engaged in much frank and apparently uncensored discussion about serious shortcomings in health care. Complaints concerned the aging of hospital facilities, the disrepai 1000 ir of their equipment, the shortages of basic medications, and the inadequate training of low-paid medical personnel. Western analysts estimated that Hungary spent only 3.3 percent of its gross national product specifically on health service (the 6 percent figure listed in most statistical data actually included some social services). This percentage was the lowest of any East European country except Romania (in comparison, the United States spent 11 percent of GNP on health care). Critics judged the health system to be substandard, unreliable, and increasingly tainted by the practice of offering gratuities to medical personnel to ensure quality care. They warned that the achievements of past years were jeopardized by the current neglect.

Certain trends in the general health of the population indeed gave health authorities reason for concern in the 1980s. Life expectancy at birth was the lowest among thirty-three developed countries rated by the World Health Organization. In 1986 the infant mortality rate was 19 per 1,000 live births (see table 4, Appendix). This figure showed an improvement over the 1970 rate of 35.9 per 1,000. However, the infant mortality rate remained among the highest for industrialized countries with developed health systems. In 1985, according to Minister of Defense Ferenc Karpati, 10 to 11 percent of young males were unfit for military service, and another 4 to 5 percent could not undergo strenuous physical training. Among conscripts accepted for service, 3 to 4 percent were discharged before the end of their training for health reasons, primarily because of physical or nervous disorders.

Health authorities had other special concerns less directly related to the health care system. One such problem was the country's high suicide rate. In the mid-1980s, the suicide rate was 44 per 100,000 inhabitants, the highest suicide rate in the world. (The country with the second highest suicide rate, Austria, reported 26.9 suicides per 100,000 inhabitants in 1984.) The very high suicide rate had a lengthy history, confirmed by statistics dating back more than a century. Since the late 1960s, however, the rate had risen noticeably. Hungarian experts cited as factors contributing to the troubling situation alcoholism, mental illness, the growing number of elderly people, the disorienting effect of urban life, stress, and the weakening of family and community bonds as a result of rapid modernization. The high suicide rate among people over age sixty was thought to result from the economic stagnation and inflation of the 1980s, which made it difficult for people to subsist on small pensions.

In the mid-1980s, the authorities were also discussing the growing incidence of substance abuse. The incidence of alcoholism had increased during the previous generation, and a high percentage of suicide victims were alcoholics. As of 1986, consumption of alcohol per person per year was 11.7 liters consumption of hard liquor (4.8 liters per person) was the second highest in the world. Authorities had increased the price of hard liquor five times between 1973 and 1986, but despite these measures, excessive alcohol consumption remained a problem. Although less salient than alcoholism, drug addiction was also becoming a source of some concern and was discussed in the press. Acquired immune deficiency syndrome (AIDS), a serious health threat associated with drug use in many countries, was not a major health concern in Hungary in the late 1980s. According to government statistics released in early 1989, the first AIDS patient entered a Budapest hospital in 1985. During the following four years, the country had twelve AIDS-related deaths.

In the 1980s, another source of anxiety for both health authorities and the general public was the downward trend projected for the country's population (see Structure , this ch.). As early as 1973, concern about the slowdown in population growth had led to the introduc 79ction of f a comprehensive population policy. Supplemental provisions had broadened the coverage in subsequent years. The policy mandated generous pregnancy and maternity allowances. Working mothers enjoyed a twenty-week maternity leave with full pay. After the twenty weeks had elapsed, the mother could receive an allowance to enable her to raise the child at home until it reached the age of three the amount of the allowance varied according to the number of children and amounted to about 25 to 40 percent of national average earnings per month. In addition, working mothers had access to unpaid days off (prorated according to the number and ages of the children involved) or other benefits to enable them to take care of a sick child. Additional ongoing family allowances were available for families with two or more children. In spite of this assistance, child rearing was a large expense to families. The various forms of assistance, while clearly beneficial to young families, actually amounted to only 15 to 20 percent of child-rearing costs.

Data as of September 1989