Review Article

Transformation of Factory Health Care Service and the First Year Activities of the New Occupational Health Service in Hungary

György Ungváry, Lajos Béleczki and Éva Grónai

National Institute of Occupational Health Budapest, Hungary
Corresponding author: Prof. György Ungváry, M. D., Ph. D., D. Sc.
Director General
National Institute of Occupational Health
Nagyvárad tér 2.
P.O.Box 22.
1450 Hungary
Phone: (+36) 1 215 7890
FAX: (+36) 1 215 6891

CEJOEM 1997, 3:3-23

Key words: Factory health care, occupational health care services 

The authors review the development of the organized prevention and treatment of occupational diseases and factory health care in Hungary. The factory health care service adapted to large enterprises prospering in the 1960s and 1970s had achieved significant results. Since the 80s, however, the curative activity of the service had prevailed and the preventive work had not met the expectations, which made professional renewal necessary. After the changes in the political, socio-economic regime – that occurred in Hungary in 1989–90 – the reorganisation of the factory health care became also necessary. The Hungarian Government realising this need and considering the suggestions of the professional experts as well as the Chamber of Factory Physicians reorganised the factory health care in 1995. The report summarising the experiences from the years of 1995 and 1996 indicates that this reorganisation has been successful. The transformed occupational health care service is capable of covering the small enterprises and, at the same time, performing the preventive tasks. About 70% of the Hungarian employees were covered by the service in 1996. 


According to the data of the International Labour Organisation (ILO) 120 million people meet with occupational accidents annually in the world and 200,000 of them die (WHO 1994). Four-hundred-thousand work-accidents occur and 600–800 persons die at their workplaces daily. In Hungary the annual number of work-accidents is 35–40,000 and 150–170 of them are fatal. This means that every other day a person dies at a workplace (OMMF 1996). The number of occupational diseases is 58–150 million in the world, which means 19–50,000 new cases daily (WHO 1994). In Hungary, 600–800 occupational diseases are reported annually, more than two daily (OMÜI 1996). These are the most meaningful data, which indicate that the work environment is with 1–3 order of magnitude more dangerous than any other sub-environment. It is obvious that occupational health care is of great importance.
    Approaching the year 2000, a new attitude to occupational health is needed, an attitude that can cope with the challenges appearing in the new world of work. The 1990s are characterised by a growing demand for information on the work environment, work strain and stress; for better service and better decision-making; and for new methods. At the same time the society has to face with an increasing rate of unemployment and underpayment. Maintaining good health in the working-environment, managing psychosocial stress, dealing with the increased incidence of work-related diseases along with decreasing frequency of work-accidents as well as classical occupational diseases, also call for changes.
    In this paper we wish to present the history of occupational health care in Hungary to make the evaluation possible for those who want to criticise it, suggesting them considering the historical circumstances. We will make it clear, that its transformation into occupational health service was required by professional development, at least as much as by the economic changes caused by the change of the political, social regime that occurred in 1989. Lastly, the results caused by the successful transformation as well as the future plans on which the programme of the coming years should be based, will be summarised briefly.

Factory health care service between 1950–1988

Already in the 1800s the workers in Hungary established aid associations to get support in case of sickness or disability. In 1970 the first General Aid Fund for Sick and Disabled Workers was established, which provided free medical care, medication and financial aid for its members. Today’s factory health care can be traced back to the doctors working for the aid associations and the sickness-insurance of workers. Later, the treatment of workers became more organised within the framework of the National Workers Insurance Fund and then the National Social Insurance Institute (OTI).
    Recognising the importance of occupational diseases OTI established a Lead Control Station in 1934 and periodic examination of the exposed workers became a rule. In 1940 the task of the Station was expanded and it was developed into an Occupational Disease Examining Station with adequate laboratory background (Kapronczay 1988, Ungváry 1994).
    Between World Wars I and II many factories (both those owned by the state and private ones) employed factory physicians, whose responsibility was the performance of fitness-for-work examinations and the treatment of the sick workers.
    Hospitals were also built near the biggest factories by the owners for the treatment of the workers and sometimes also their family members (Csepel, Diósgyõr, Pécsbányatelep).
    After World War II, provision of health care for workers became pressing, because in 1945–46 a survey initiated by the Ministry of Industry in 1923 factories, proved that the health of the undernourished workers was gravely endangered due to extremely unhealthy working conditions.
    This survey also proved that the working environment was much more dangerous than any other part of the environment, for example the dwelling environment. The decisive role of this circumstance became obviously one of the main reasons of the poor state of health of the workers. Due to the unfavourable working conditions, a great number of the so called “classic” occupational diseases appeared in grave form, following a short latency period (Ungváry 1993).
    After 1945, on the initiative of the trade unions, the training of occupational physicians began and their number quickly increased (150 physicians participated in the first training course). At that time (similarly to the pre-war period) physicians and nurses were employed by the factories, there was no demand for harmonised professional guidance, moreover it was not possible at all.
    In 1951 a state-organised factory health care service was established. An organisational, operational code was published in the same year, which identified the tasks. It is worth to review this, because the basic ideas remained the same for the following decades. (Ungváry 1993).

The main responsibilities of the factory physicians were:

1. Curative-preventive care. This task involved:
– pre-employment and periodic medical examination of the workers and examination when changing their job;
– treatment of the workers;
– participation in deciding to put diseased workers on the sick-list and in the supervision of those on sick allowance;
– statistical analysis of the diseases of factory workers;
– recording and reporting of work-accidents, occupational diseases, poisonings, infectious diseases;
– study and identification of the causes the probable work-related diseases;
– organisation of care for factory workers with the aid of care institutions and other health institutions (hospitals, polyclinics), regarding
– pregnant and lactating women;
– adolescents;
– old people;
– workers with limited working ability;
– disabled;
– those who were regularly or frequently ill;
– workers with TBC;
– workers with venereal disease;
– workers with gastric or duodenal ulcer;
– workers with organic heart disease and hypertension;
– diabetics;
– workers with cancer;
– workers with trachoma;
– those working in jobs under extremely hazardous conditions.

    At that time factory physicians were not responsible to judge the workers’ fitness for work (they were entitled to give one day sick leave, or three days during the epidemics of contagious upper airway diseases). They treated mainly acute cases and cared for workers with chronic diseases, who were able to work.

2. Public health activity. These tasks included:
– inspection of health conditions of the factory at least bi-annually, involving the occupational nurse, keeping the records of factory visits;
– participation at the monthly inspection by the management;
– preparation of plans for the development of occupational health in the factory;
– supervision of the building plans of the factory with the involvement of the factory safety officer;
– setting health standards prior to the introduction of methods hazardous to health and to use of new materials with health hazards, together with the safety officer;
– participation in the planning of investment, development, and refurbishment in connection with factory health of the factory;
– regular inspection of the factory kitchen, canteen and catering with the help of the factory nurse;
– regular public health inspection of the welfare institution and training workshop of the factory.
Unfortunately, due to many reasons, these tasks were more and more neglected.

3. First aid activity. To this belonged:
– organisation of first aid in the factory, guidance and control of the work of the first aid stations and first aid training, control of the quality and quantity of medicines and dressings used for first aid.

4. Activity regarding the factory health protection regulation
This activity stopped when the protection regulations were cancelled.

5. Other tasks. To this belonged:
– maintaining of close contact with the Red Cross and co-operation with it, within the factory;
– recommendation for providing protective ointments and protective food;
– suggestion for the assignment to suitable jobs of pregnant, lactating women and workers who suffered occupational diseases.

    The heads of the local Health Departments had the right to employ factory physicians whose salaries had to be covered by the budget of the local councils. Disciplinary matters involving physicians were also handled by Health Department heads. Health Departments were entitled to join factory physician consulting rooms to the respective territorial polyclinic. The head of the territorial polyclinic was responsible for
– the material supply of the factory physician consulting room;
– organising monthly workshops for the factory physicians at the polyclinic;
– the regular control of their work and discipline;
– their professional training.

    Professional guidance of the occupational health network was the responsibility of the county, town chief physicians, based on the views published by the Ministry of Health. The professional activity of the newly organised National Institute for Occupational Health made its way indirectly through the Ministry of Health.
    In 1951 the State Sanitary and Epidemiological Inspectorate was organised. The state sanitary inspectors worked within the organisation of the council health departments, to control the observance of public health norms regulated by law and other orders related to public health issues in their areas of activity – such as industrial, transport and catering firms. The connection between the factory health care service and the public health inspectorates was realised through the council health departments.
    In 1954 State Sanitary and Epidemiological Stations were established, with occupational health departments in their county institutes, led by physicians specialised in sanitary-epidemiology and experienced in occupational hygiene. Laboratories in the county institutes became increasingly capable of performing instrumental examinations of the workplace factors. The factory health service and occupational hygienists were connected in the fields of both service and authority work (Ungváry 1993).
    From the late 1950s there was a growing demand for the curative and related preventive activities of factory physicians. This activity in the factory physician’s office was necessary mainly due to the growing number of workers who went to work in the factory daily from the neighbouring villages. At that time the increase of production was ensured by the increase of the staff. At the same time the coverage by general practitioners was unsatisfactory, particularly at the small places. One physician had to provide care for the population of several villages and the workers coming home from work were unable to meet the home physician during the consultation hours. Beginning from 1961, this activity involved also the judgement of fitness for work, first in the biggest factories, later also in most of the medium-sized factories.
    The legislative regulation on occupational rehabilitation came into effect in 1967, though such caritative activity had occurred earlier – mainly in the big factories. The precondition of successful occupational rehabilitation makes both employers and employees interested. Though the basic order was several times amended, no solution was provided for promotion of interest; so the problem of occupational rehabilitation remained unsolved, particularly in those cases, when it was impossible to rehabilitate someone at his/her original workplace.
    In the field of factory health care a significant milestone was the new possibility of obtaining the “occupational health specialist” degree in 1968. The Department of Occupational Hygiene and Medicine of the Postgraduate Medical School was established and with contribution of the staff of the National Institute for Occupational Health, it became the guiding centre of postgraduate education.
    Terms of reference of factory health care were formulated by the Health Act in 1972, a summary of the previous regulations. According to this, the responsibility of factory health care is the provision of treatment and prevention for workers at the workplace and the promotion of the enforcement the work-related public health requirements. “Promotion of the enforcement the work-related public health requirements” meant that factory health care had no authority rights and could not enforce the public health requirements.
    Several regulations were attached to the Health Act, e.g. a ministerial order regulated the provision of treatment and prevention for workers at the workplace, including the guiding number of staff according to branches.
    According to the above mentioned regulations a factory health care service had to be organised and maintained in every
– mine, foundry, chemical, food industrial plant and construction site, where at least 300;
– iron works, where at least 400;
– other plants and factories, furthermore agricultural co-operatives, state farms, where at least 500 workers were employed.
    In addition, a full-time factory physician had to be employed in the firms belonging to the first group above for every 1200, belonging to the second group above for every 1400, and belonging to the third group above for every 1600–1800 worker, respectively. In the biggest firms factory health consultancies (surgery, gynaecology, laboratory, dermatology, etc.) were organised.
    This order regulated also the financial side of the establishment and maintenance of factory health care service. According to this, furnishing and equipment of medical nature and all material expenses had to be covered by the maintaining council from its budget. The provision of the premises required to establish factory health care service together with its maintenance were the responsibility of the employer.
    This enacting close summarised the tasks of the service as well as the responsibilities of the head of the service and those of the head of the firm. Separate articles referred to the topic of first aid at the workplace.
    At this time two levels developed for the treatment of occupational diseases, the first was the factory health care service in the factories, the second was the care provided by the occupational health consultations and the in-patient department of the National Institute for Occupational Health.
    In 1975 there was a significant change of the professional guidance and organisation of the factory health care network. From this time on, professional guidance and control were carried out directly by the National Institute for Occupational Health, with the contribution of the inspecting chief factory physicians. The Factory Polyclinic of the Csepel Iron Works (the biggest institution in Hungary of this kind) turned into a basis for organisation and methodology of the national institute and was incorporated into it (Fig. 1).
    Due to the organisational changes of the factory health care, the services became parts of the health institutions, and were guided locally by the occupational health deputy directors. This was the beginning of the organisation of factory health consultations that handled occupational out-patients on a higher level, and at the same time, provided factory health care for the employees of the small enterprises. This way three levels had been developed for the coverage of occupational health outpatients. These were:
– primary care;
– factory health consultations;
– consultations and in-patient departments of the National Institute.

Figure 1. Professional guidance for factory health care

    Noteworthy is the fact that one internal department of the Central hospital in each county was appointed, where – along with the other patients – patients with occupational diseases could be referred for hospital treatment. In practice, however, this type of provision never worked because of lack of demand.
    In 1979 a new regulation for organisation and operation of the factory health care service was issued, covering the  whole range of its tasks (Ungváry 1993). In order to take into account the special characteristics of the different industrial branches the organisation of the Occupational Health Bases was begun on the fields of mining, textile industry, road-traffic, oil industry, foundry and metallurgy as well as agriculture. This theoretically good idea was made inefficient by the rule that the field of activity of the Bases was limited to the very county where their headquarters were founded.
    At the beginning of the 1980s (between 1981 and 1983) the orders governing the work of factory physicians were amended. The factory health care service became fully developed in the industrial branches and in the bigger farms and agricultural co-operatives. In the year 1989, 2989 factory physicians and 500 factory-district physicians were employed in the fully developed factory health care service.
    During its stay the factory health care service tried to comply with the demands appearing in different periods of economic development and arising from the national health (within this mainly medical) coverage and from the widening of social security service. The factory health care service deserves to be credited, because due to its activity a great number of grave occupational diseases occurring after the war disappeared or after a longer latency period only few and mild cases occurred (Fig. 2). The service did its best to prevent occupational diseases, by periodic fitness-for-work medical examinations. It deserves mentioning that the reporting and investigation of overexposure cases were made compulsory in Hungary which was among the first countries to have a regulation of this kind in the world. This resulted in a significant decrease of the incidence of occupational poisonings.

Figure 2. Reported occupational diseases and poisonings (altogether)

    Activities of the factory health care service included health information and education on the right behaviour at the workplace and on a healthy life style. It is very difficult to evaluate the effectivity of this activity as it is not known what the morbidity and mortality indices of the working population without this activity were. Knowing the present data on these indices, one can assume that health information and education activities have not reached the expected results.
    Besides the unquestionable results, a number of mistakes delayed the continuous updating of the service. Among these the prevalence of curative activity should be mentioned first, which was about judging the fitness for work. This was not justified already in the 80s, moreover, it became a drawback by surpassing the preventive activity (Ungváry 1993).

Factory health care consultation and the small enterprises

Factory health care could not cope with the provision for small enterprises, though the demand for this was only moderate (the majority of small, medium and big enterprises had their own factory health service). Except of fitness for work examinations for the small enterprises, factory health consultation performed hardly any other activity. Since the second part of the 70s, factory health care has belonged definitely to the organisations providing primary health care. Together with this or because of this, there was generally no lasting and operative connection between factory physicians and general practitioners, despite the fact that outpatient workers were generally provided for by factory physicians and bed-patients were always treated by general practitioners. Their relationship was often characterised by some kind of rivalry. The smallest villages were exceptions where the factory physician and the general practitioner was the same person (so called factory-district physician). The co-operation was hindered also by the lack of appropriate regulation. All this resulted in many overlappings, parallelity, duplications and at the same time a considerable part of the workers (40–48%) was deprived of satisfactory health care.
    In summary, factory health care service, together with its results and mistakes, achieved a high standard and practically prepared the way for the transition into occupational health service, which was difficult and full of conflicts.

The crisis of factory health care (1989–1995)

During the socio-economic regime transition that began in the 80s and dramatically sped up in the early 90s – parallel to the process of privatisation – the big enterprises disappeared and dissolved into smaller firms or became unable to function. In 1989 slightly more than 40,000 economic units and 4.5 million employees were registered. The majority of the latter were employed in medium-size or big enterprises, which received factory health care at the premises of the firms. Factory health care coverage of the employees was around 50%. The care was provided by nearly 3000 factory physicians and 500 factory-district physicians. Parallel to privatisation process, the number of self-owned, small enterprises increased dramatically; in 1995 already about 900,000 economic units, enterprises were registered. At the same time the number of organised employees decreased; in 1993 the number of employees was estimated as 2,8–2,9 million. Unemployment appeared; the number of unemployed was 600 thousand in 1993 and black economy was flourishing.

Crisis of organisation and provision

Primary factory health care

Factory health care provided for about 1,4 million and 1,1 million employees in 1991 and 1993, respectively. In 1992 the minister of welfare dissolved the factory health care services. In 1993 the number of factory physicians was half of that in 1989 (Table 1).

Table 1. Change of the number of factory physicians and factory-district physicians between 1989 and 1994
Service Specialist consultation  Factory-district 
Year Full-time Part-time All Full-time Part-time All
1990 899 1404 2303 80 94 174 498
1991 853 1326 2179 89 154 243 203
1992 654 1178 1832 87 141 228 cancelled
1993 551 1047 1598 88 138 226
1994 520 935 1455 97 151 248
    The specialisation of physicians working in the factory health care services providing primary care, or to be more exact, the proportion of occupational health specialist among them is disputable. In 1991 only 42% of physicians were occupational health specialists, 35% of them were specialists in other fields, 23% of them had no specialisation; in 1993 52.2% were occupational health specialists, 18.5 % were specialists in other fields, 21.5% had attended occupational health courses and 7.5% of them had no specialisation. With decrease in the total number, the proportion of those specialised in occupational health increased, because those with other or no specialisation were the first to leave the service. The number of qualified assistants were 3511 and 2077 in 1989 and 1993, respectively.

Factory polyclinics

In the big firms – depending on the profile and the sex-distribution of the workers – other specialists’ consultations and other specialist physicians also worked. The number of full-time specialists in 1991 was 216, including 182 dentists.

Factory health consultative service

The employees of the firms that did not have their own factory physicians were provided for by the factory health consultative service, working in the county or town health institutions. The figures for these are:
in 1989 127
in 1990 136
in 1991 146
in 1992 125
in 1993 141
in 1994 248

The number of physicians (full-time and part-time together) providing factory health consultation was:

in 1989 178
in 1990 174
in 1991 243
in 1992 228
in 1993 226
in 1994 248

    Factory health consultations were provided for about 800 employees per year between 1991 and 1993. This provision, however, did not include any factory hygiene or preventive hygienic activity.
    For the years 1991 and 1993 the distribution of physicians carrying out factory health consultation according to specialisation is the following: in 1991 20% occupational health specialists, 64% other specialists, 16% non-specialised physicians. In 1993 40% occupational health specialists, 56% other specialists, 4% non-specialised physicians. There are fewer occupational health specialists among those taking part in factory health consultations than among those working in the factory consulting rooms.
    In 1991 there were 244 qualified assistants at the factory wards, in 1993 the number was 252.


Enterprises have appeared in the health sector since 1990 as a new type of organisation in factory health care. This way limited companies, and small privately owned firms were established and in 1993 nearly 40 physicians worked as private factory physicians. Without support, this otherwise viable initiation could not have developed. In 1995 the organisational crisis of factory health care became obvious, and nearly paralysed the service.

Operational indexes of factory health care

The proportion of clinical preventive to preventive activity can be estimated as 60 : 40% within he therapeutic-preventive service supplied for employees by the factory health care service operating as part of the primary health care (Table 2).
Table 2. Main data since the starting of the reform processes (thousand persons)
Year Fitness for job 
First-aid Ongoing care Other treatment Total
1989 2271 307 1324 6567 10471
1990 1973 290 1245 5882  9381
1991 1576 220 1059 5066  7922
1992 1236 168 0738 3820  5961
1993 0982 129 0556 2736  4405
1994 1409 118 0546 2589  4008
    All indices but one show a continuous and significant decrease. Compared with the therapeutic-preventive work, the hygiene work of the service showed an increasing tendency in 1993. There were:
    9540 documented factory inspections;
      990 hygienic recommendations;
      217 expert opinions on new technologies.
There was no continuation of the trend in 1994.
    The factory health care consultative service carried out clinical preventive activities, mainly fitness for job examinations. The figures are:
in 1989 772 203
in 1990 722 476
in 1991 863 951
in 1992 748 895
in 1993 588 691
in 1994 554 633

    In contrast to the expectations, this work is not increasing either. An increase was expected because the task of factory health care consultation is to provide for small enterprises, the number of which significantly increased already in the early 90s. The reason for this may be the loose control and lack of specific knowledge of the new entrepreneurs.
    Besides the above mentioned tasks, the county and large town factory health consultations also give advice in the diagnosis of occupational diseases. Another opinion on job-fitness is given here too. This consultative service – usually working within health institutions – utilises the diagnostic and advisory possibilities provided by the institutions (laboratory, X-ray, specialists, etc.). Supervision of workplaces is not within the terms of reference of the factory health care consultative service.
    By 1995 a total organisational and operational crisis of the factory health care service developed: it became obvious that the state factory health care service adapted to the large enterprises is unable to provide for the small, mainly privately owned enterprises.

Lagging behind the international professional development

In 1988 Hungary promulgated the Convention 161 of the International Labour Organisation in an order with legal force that came into effect on 24 February 1989.
    Summarising the results of the most developed industrial countries and that of the development history of the profession this Convention identifies the health promotion tasks as the most important preventive task of occupational health (an internationally used term instead of factory health care).
The most important tasks planned are:
    – examination of employees’ fitness for a given job;
    – investigation of occupational diseases, cases of over-exposure to pathogenic factors;
    – identification of the sources of hazards at the workplace, investigation of health hazards connected with work;
    – medical first-aid, organisation of first-aid facilities in the workplace;
    – advising on solving occupational health, physiological, ergonomic, and hygienic problems;
    – providing information on the working conditions.

    Considering these, the aim of the occupational health service is the provision of the optimal or near optimal workplace stress of the workers. For this purpose the service determines and continuously monitors the individual’s ability to cope with stress and the matching optimal physical, physiological, psychic strain, and it monitors and helps by advising to keep the workplace’s pathogenic (physical, chemical, biological, psychosomatic, ergonomic) factors at an acceptable level. The new occupational health service, which should cover all employees, is expected to meet the professional and structural requirements and at the same time to join functionally the new Hungarian health care system with insurance-based funding, modified by the basic reform processes. The occupational health care should cover all employees, at all firms, in all economic areas (ILO Convention 161, article 3).
    As it was demonstrated earlier, the Hungarian factory health care adapted to state owned big enterprise economy was not able to cope with this task. One reason of this was the significant number of not satisfactorily specialised physicians working in the service. The physicians not specialised in occupational health had not even theoretical knowledge on workplace prevention. The other reason – and maybe the more determinant – was that the Hungarian regulation expected therapeutic activity from physicians of the service first. These together caused that the Hungarian factory health care was unable to meet the challenges arising from professional development, and to cope with the preventive and health promotion tasks, got into professional crisis, its attitude and activity were lagging behind modern expectations. In 1995 the need for a change became urgent, because of the signs of crisis and being below the standard in professional development.
    The organisational, functional and financial principles of the essence of the transformation were worked out by the National Institute of Occupational Health and the Department of Occupational Hygiene and Medicine of the Postgraduate Medical School jointly with the Scientific Society of the Hungarian Factory Physicians and the Factory Physicians’ Section of the Hungarian Medical Chamber. In 1991 the first conception on the professional, organisational, and financial transformation of the service was submitted to the Ministry of Welfare by the four leaders of the above mentioned institutions. The idea was accepted by the ministry, but no progress was made despite the fact that the Labour Protection Act (XCIII/1993) came into effect on 1 January 1994. This Act declares that in Hungary every employee has the right to occupational health service the provision of which is the responsibility of the employer.
    Eventually the creation of the Hungarian occupational health service became connected to the so called programme for stabilisation. In 1995 summer the No 89/1995 Governmental Order on Occupational Health Services, signed by Lajos Bokros Minister of Finance, and the No 27/1995 Order of the Minister of Welfare on the Occupational health Services were issued.
    As for their contents the following are to be stressed. The organisational structure of occupational health is in a state of transition. Activity and structure of the services operate under the NPHMOS, professional guidance is provided by the National Institute of Occupational Health.
    The occupational health services may operate as:

    Primary occupational health care is provided by the primary services. The primary service consists of an occupational specialist physician and a nurse. The number of employees that may be provided for by the services is determined based on their occupational health categories. The employees are assigned into occupational health categories (A, B, C, D) by the employer, based on the risk arising from work and work environment. The number of those to be provided for is inversely related to the risk; one service may provide for 1000 workers belonging to category A with the highest risk or 2000 workers belonging to category D with lowest risk. Capacity for provision is registered and controlled by the NPHMOS.
    The primary service is funded by the employer. The employer may employ his own service or may hire one. Unfortunately the professional model of funding the service through the so called accident insurance system (which would have been the third branch of the Social Insurance Scheme) has not been implemented. The solution implemented endangers the independence and objectiveness of the professional decisions. Tasks of occupational health are exactly determined by the regulation.

Tasks of the primary service are:

Tasks of the occupational health consultations: Tasks of the National Institute for Occupational Health:     Tasks of occupational health became identical with the tasks of modern occupational health, formulated by ILO Convention 161 and the Labour Protection Act, based on the No 89/391 EU Directive.
    Organisation of occupational health services was astonishingly quick. Hardly two months after the No 89/1995 Governmental Order and the No 27/1995 Welfare Ministerial Order had come into effect, 1.1 million employees, 43–44 % of all employees were covered by the services. The following is worth to mention about the situation on October 27, 1995:
    Enterprises – Between August 31 and October 27, 1995, 317 licences for enterprising in occupational health were granted by NPHMOS. The number of licences changes daily. Giving of licences by NPHMOS is lagging behind the number of applications. Licences for private proprietorships were granted to 122 physicians. In a few cases general partnerships established co-operatives.
    Private praxis – altogether 17 physicians work privately.
    Employment by firms – There are 214 firms in Hungary employing their own occupational health service (most of them without official licence – registration and NPHMOS licensing have been delayed).
    Enterprising of health institutions – 138 health institutions undertake occupational health provision (without an official licence, at an unfoundedly low price).
    Enterprises and foundations of NPHMOS – a few cases are known. These enterprises are ethically questioned by the professional area. They will not be allowed to operate in the future.
    Number of factory health specialist physicians – There are 946 factory health specialist physicians in the country (NM GYÓGYINFO 17 October 1995). The estimated number of those working in the services is 500–600; many of them (400–500) have applied for a licence.
    Employers, employees – 61 000 employers reported the provision of occupational health service for their employees. Altogether 1.1 million workers had been covered by 27 October 1995. Nearly one million more workers were found to have been covered on 31 December 1994. The present rate of covering is 40%. On a world scale this cannot be regarded as low coverage. In some developed industrial countries the coverage is hardly more than 10%.
    In some counties the number of workers covered is low (Heves, Vas, Borsod-Abaúj-Zemplén, Gyõr-Sopron-Moson), in other ones it is promisingly high (67–74% in Tolna, Békés, Fejér).
    According to the county or capital chief medical officers and occupational health chief physicians with specialisation required by the No 27/1995 (VII. 25) WM order, article 3, full coverage can be achieved in 8 counties, partial coverage in 4 counties and in the capital, 2 counties reported that solving of the task is impossible, while 5 counties gave no answer at all.
    In summary, on 27 October 1995 (two months after the orders came into effect) it was found that transformation of factory health care into occupational health care started quicker than expected. Interest in this speciality grew. The great number of physicians volunteering to become specialised in the area indicates that occupational health tasks could be solved on a high level within 2–3 years. At the same time it is obvious that transformation of structure and function requires help.
    Considering the recommendations of the National Institute and NPHMOS and following the actions of the Chief Medical Officer of State and the Ministry the transformation sped up but did not go smoothly (which is understandable).
    The assessment resulted in very important findings that required legislative measures. The number and distribution of physicians meeting the professional requirements of the No 27/1995 WM order do not make possible the occupational health coverage of all workers in the country.

    The following measures were taken to solve the issues above. At the end of 1995 the No 44/1995 WM order was issued to modify the professional requirements determined by the No 27/1995 WM order. This order solved the problem of missing physicians in the occupational health services, though there was a big difference between the professional requirements and the recommendations for specialisation.
    In January, February, May and August 1996 further assessments were made by NIOH, using a questionnaire and seeking answers to the following questions:

    The questionnaires were received by the county or capital Institutes of NPHMOS and the county or capital occupational health chief physicians. The assessments had two objectives: To achieve the above goals the following were studied:     The assessments revealed that the number of occupational health services is continuously increasing. First, the number of occupational health enterprises owned by a physician or a group of physicians, increased. These occupational health enterprises were mainly private enterprises or limited partnership.
    Figure 3. shows the numeric development of the occupational health services. There are 805 occupational health specialist physicians, 1406 general practitioners and specialist physicians in internal diseases or oxyology, 461 physicians with no specialisation (candidates for specialisation) working in the service. 549 physicians are doing exclusively occupational health activity, while 2123 of them are doing also some other medical activity (mainly general practitioner) (Fig. 4).
    The occupational health services provide for 95963 economic units (33 times more than in 1994). 51.7% of these economic units employ less than 10 workers and only 10% of them employ 101–500 workers (Fig. 5).
Figure 3. Numbers of occupational health services of different types


Figure 4. Number of occupational health physicians and nurses – 1996

Figure 5. Number and size of enterprises with occupational health service – 1995

Figure 6. Percentage of employees covered by occupational health service between October 1995 and August 1996


Figure 7. Occupational health activities within the consulting room in 1995

Figure 6 shows the changing percentage of the occupational health coverage of those working in organised employment. Two months after the transformation of the service 43.5 % of the employees were covered. In August 1996 this proportion was 71.1 % which proves the successful forming and development of the service. The most comprehensive provision exists in Finland, where coverage is more than 90 %. With the above mentioned result Hungary is among the first five countries in the world.

    Transformation of the activity of the services also has been followed. Activities within and outside the consultation room were treated separately. The primary activities within the consulting room are the different types of fitness examinations (Fig. 7). Outside the consulting room activities are shown on Figure 8. The demonstrated data indicate that services do mainly preventive work, the number of occupational hygiene examinations and advising increased 10-fold, compared to the preceding years.

Figure 8. Occupational health activities outside the consulting room in 1995 and 1996

    Assessment data prove that successful privatisation, successful organisational and professional transformation have taken place in the field of occupational health. Regarding its organisation, tasks and operation a new type of service has emerged.

    Transformation, of course, is a process that cannot be regarded as completed. While organisational transformation is relatively prompt, longer time is required for the transformation of attitude of the services, similarly to the achievement of adequate educational level and quality assurance. The next important steps of occupational health: organisation and operation of consultative services, education and training of specialist physicians and specialist nurses, updating of quality assessment and assurance systems.


WORLD HEALTH ORGANIZATION: Declaration on Occupational Health for All. WHO/OCH 94.1. World Health Organization. Geneva 1994.

NATIONAL AUTHORITY FOR WORK SAFETY AND LABOUR (OMMF) (1996). Information on the occurrence of work-related accidents (in Hungarian). Budapest.

NATIONAL INSTITUTE OF OCCUPATIONAL HEALTH (OMÜI) (1996). Occupational diseases and (intoxications) and excessive exposures. OMÜI, Budapest.

KAPRONCZAY K. (1988). Remarks on the development of the country’s industrial health until 1994 (in Hungarian). Ergonómia 198:211–219.

UNGVÁRY GY. (1994). “National Institute of Occupational Health: Occupational Health in Hungary.” In: Publications of the National Institute of Occupational Health 1976–1990. NIOH Budapest pp.:19–28.

UNGVÁRY GY. (1993). “Occupational Health in Hungary.” In: Occupational Health and National Development. (Yejaratnam, J., and Lim, S.C. eds). World Sci. Publ. Co. Pte Ltd River Edge. London, Hong-Kong, Banglore. 1993. Chapter 6. pp:1–20. 

| Vol.3. No.1. |

Posted: 17 November 1998