Healthcare black market frozen in time

Last month Romania’s Health Ministry began a massive reform programme, kicking off with the burial of the ideology that healthcare should be free at the point of access

June 2009 - From the Print Edition

By July 2009 a government commission will have drawn up a scheme detailing which medical treatments will be free under the state system, and which ones patients will have to pay for.
Learned brains on the left-wing have the right to argue that this is a disgrace. Especially because Romania, an EU country with an increasing level of poverty, is now introducing a system which will create a further disparity between those in need and those who can afford medical care.
But in Romania, the reality is never as clean-cut as political analysts would like to believe.
The nation’s healthcare and education systems have both been frozen in time since the 1980s. While the rest of the country has fumbled through an anarchic and kleptocratic form of capitalism, buoyed by EU and NATO entry, hospitals and schools have remained in a Communist bubble, with all the contradictions of that system intact.
Although both were always theoretically free for every citizen, the truth is that these public services have been powered by bribes in a criminal system which has thrived over the last 20 years. Encountering corruption in hospitals and schools is as common a part of Romanian daily life as being attacked by a stray dog or almost run over by an SUV when trying to cross a road at a green light.
In this issue of The Diplomat, we investigate the shame of Romanian hospitals, where it becomes clear that almost everyone on the site of even the most well-regarded Romanian hospitals are on the take – from the security guard to the senior surgeon. Medical staff, taking advantage of the fact that patients are terrified of being in hospital, solicit for money and patients themselves are too scared to refuse. A recent trend in bribery in hospitals is that patients now must pay for all their medicine and linen – from surgical alcohol to bedsheets.
Romania has historically spent little public money on its healthcare. This year it will allocate around 3.5 per cent of its GDP for the medical system – well below the EU average of 6.5 per cent. Successive Governments have failed to increase this proportion. How can they justify this? They are all well-aware that patients top-up doctors’ and nurses’ small salaries with cash and gifts – so one can only assume that they have ignored the needs of the system because they thought it could take care of itself. Authorities have placed money elsewhere, while allowing a black market in medical care to hold the nation’s health to ransom.
Now the Government is reforming healthcare by introducing patient payments. At present Romania’s health system is funded by taxpayers through a national insurance scheme, which is then redistributed to hospitals. The Government is also decentralising the ownership of hospitals, moving from the authority of the Ministry of Health to that of the city and county councils. Bucharest will be a test case for this initiative.
Although the Ministry of Health does not specify its intentions in clear language, a guarded hope is that this new scheme will indirectly reduce bribery in the system. However unless the Ministry conducts proper research into the prevalence of this crime, the fear is that it could persist. Otherwise there could be a system where patients pay three times for a service – once through the national health insurance, again through the new patient payment scheme and a third time through bribes to doctors, nurses and orderlies.

Michael Bird