Over the course of a year, the average Hungarian visits the doctor 13 times. Over the same period the average Briton goes just over five times.

It is an exasperating statistic for Agnes Horvath, Hungary’s energetic 34-year-old health minister. For her, it is part of a catalogue of concerns with the country’s health system, which she believes is badly in need of reforms.

“Surveys show that patient satisfaction levels are quite low,” she says. “There are quality problems. We are having problems with quality, efficiency and financing,” she says.

Ms Horvath feels her reform proposals are the solution. One of the centrepieces of a five-part reform ppackage is perhaps the most controversial. All visits to doctors now bear a Ft300 (€1.20) charge, which goes straight to the practice or hospital. The aim is to instil a sense of responsibility in patients, obliging them to weigh up whether they need to make a visit.

“The consultation fee means trips to GPs have gone down dramatically,” she says. But despite the seemingly small sums involved, such measures have taken a political toll. However enthusiastically she outlines her reform vision, Ms Horvath has sunk to the very bottom of the popularity surveys, enjoying the approval of just 6 per cent of the population.

Hungary’s total spending on healthcare ran at 8.1 per cent of gross domestic product in 2005, placing it in the midfield of Organisation for Economic Co-operation and Development countries. In the same year, however, average life expectancy stood at just under 73 years, placing it near the bottom of the OECD field.

Some of the cost-cutting has been painful. Some 9,000 hospital beds have been lost around the country, while five of the country’s 164 hospitals have been closed. Ms Horvath argues that the resources in place were ill-targeted. “People who should have been outpatients were being treated as inpatients,” she says.

But, if public approval has not been forthcoming, Ms Horvath believes she has brought healthcare financing back on track. The health budget is now in balance and next year, for the first time in many years, the drugs bill will not rise.

In the past, drugs have cost the state up to three or four times as much as in Germany or the UK. Here, a multi-pronged programme that included measures to deregulate the pharmacy trade and promote the use of generic alternatives has succeeded in cutting the drugs bill by Ft90bn to Ft300bn over the past year. “We introduced competition to cut the cost of drugs by around 20 per cent. Manufacturers have slashed the prices of between 1,500 and 2,000 drugs,” she says. This has made it possible to cut drug subsidies substantially, though Ms Horvath claims the final cost to patients remains similar.

Even some pharmaceuticals executives concede grudging respect for this achievement. Lajos Hegedus, managing director of a pharmaceuticals plant in Debrecen owned by the Israeli generics manufacturer Teva, says: “She has done a good job in bringing down prices, but it has certainly been hard for the industry.”

This will do little to assuage popular dissatisfaction at hard reforms. Istvan Mikola, health spokesperson for Fidesz, the largest opposition party, says there was insufficient consultation. “The government failed to seek social support for its reforms.” he says.

The same applies even to specific aspects of the programme. Hungarians’ frequent visits to the doctor are justifiable, he argues, in view of prevailing levels of health. He says the government should stick to the now-abandoned national health programme he devised as health minister when his party was in office between 1998 and 2002.

The most dramatic pillar of the reform, though, is still in preparation. The government plans to replace the single state health insurance fund with a network of regionally-based insurers. Though they will be majority-owned by the state, private companies will be invited to take a 49 per cent stake in the funds, which will compete for customers throughout the country by offering different levels of service.

Ms Horvath admits that this solution is the result of an awkward compromise between her party and its senior coalition partner. “The Socialists wanted a single company that would become a genuine insurance provider, while the Free Democrats wanted to let absolutely private companies into the market. We met in the middle,” she says.

The details have yet to be thrashed out, and, without knowing the full details, big insurance companies are reluctant to commit themselves.

Peter Varadi, who is in charge of an existing private health insurance fund run by Axa, the insurer, is cautious. With no cross-party consensus, he points out, it is impossible even to know whether the new multi-insurer model will survive the next elections. “An insurer can sustain a commercial risk,” he says, “but we cannot take the risk of our investment being destroyed at the stroke of a pen. We do need some kind of guarantee.”