Hopefully some of you have already seen this article in today's New York Times about the corruption in Romania's health care system. Basically, it's impossible to receive [any] quality health care--albeit universal coverage is provided to citizens by the government--without excessive bribes to doctors (about $1 million USD's worth of "informal payments" per day, according to a survey by the World Bank, mentioned in this article). Otherwise, patients are simply refused care.
There have been some measures to reduce the bribe system, but it has been a problem for many years (i.e., rule under the Communist party). Many doctors believe they deserve to earn more than they actually do--according to the Southeast European Times , Romanian doctors earn about 10 times less than those in western EU nations. In order to prevent an exodus of doctors, Romania has proposed measures requiring new doctors to remain in the country, in an attempt to prevent their health care system from crumbling any further.
It's tricky finding any current health sector reform projects from outside groups (WHO, World Bank) that directly mention dealing with bribery, although one specifies investigation of patient deaths "within 48 hours and discharge for patients with major trauma or cardiac emergencies arriving alive at the hospital emergency department." Hm. The NYTimes mentions that patients are regularly ignored if they don't appear to be 'emergency-cases' or if they fail to offer a substantial enough bribe.
Additionally, many Romanians are afraid to report making bribes for fear that they will not be accepted by other doctors! Interesting to see how 'socialized medicine' works in the EU's No. 2 Most Corrupt Country...after Bulgaria (surprise!).
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I stumbled across this nytimes article this morning. Such an interesting topic since it seems like Eastern European nations get overlooked when it comes to news in the U.S.
ReplyDeleteI thought the article addressed a very important issue, but I don't think there are any clear or easy solutions. Eastern European nations developed economies based on black markets and bribes while under Soviet control...and the farther east the nation, the worse it was. Yes, the nations have been out from under Soviet control for some time now, but in the scheme of nation building, they're still babies. Plus, they have to continually fight Russian efforts to reassert control in the region. These conditions haven't allowed for much opportunity to transform their political systems and overcome the corruption that is systemic in so many parts of their governments.
Romanians, in particular, are also fighting the legacies of Ceausescu, a cruel communist leader who oppressed his people in nearly every facet of life. Of relevance to health care, Ceausescu banned abortion in the late 1960s in an effort to increase population. This lead many women to seek dangerous illegal abortions. I would venture to say that this decree combined with oppressive Soviet rule are two of the main contributing factors to the corrupt health care system in Romania today.
How can Romania move past this system of corruption? I think it will take time. A more dedicated effort by the EU would also help. In the wake of recent economic crises, the EU has let its Eastern European members fend for themselves, a decision which is (and will continue to be) very destructive to the EU as a whole. Without economic stability, we won't see any anti-corruption movements in Romania.
If Romania under Ceausescu is of any interest to you, I'd (cautiously) recommend the film "4 Months, 3 Weeks, and 2 Days" to you. This is one of the most horrifying but powerful movies I've ever seen...just to give you fair warning, it's about a girl trying to get an illegal abortion and it's very graphic.
p.s. Eastern Europe is my area of interest...so I apologize for the super long (and rambling) comment!
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