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Corruption and Romania's healthcare system

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I’ve heard stories from my friends and family about my native country – Romania's – health care system.

Recently I’ve witnessed first hand the country’s struggle to reform its public health sector, which has fallen into growing problems.

Hospitals are complaining that they are understaffed, and short of specialists and modern equipment.

According to the Romanian College of Doctors – a professional organisation for doctors – the number of doctors leaving Romania for better jobs abroad is continuing to rise, further undermining the already dilapidated public health system. Around 1,605 Romanian doctors were headed abroad in 2012 alone.

The brain drain is particularly acute in the highest ranks. Most of those leaving are anesthesiologists and surgeons, followed by urologists, orthopedists and pediatricians. The favourite destination is Western Europe - usually France, Germany and the UK.

The average salary of a junior doctor in Romania is around 500-600 USD a month. A similarly qualified doctor working in Britain, for example, can expect to earn many times that figure.

While I was there, thousands of doctors and nurses marched through Bucharest demanding better salaries. http://bit.ly/18kcI3N (credits to Google)

Polls show that over 90 per cent of Romanians are unhappy with the services provided by the public health system. Many blame problems in the system on inefficient management, while others believe that insufficient financing is to blame.

Every day, there are news reports of a 30-years old mother who gave birth to a brain-dead baby because her gynecologist did not show up to deliver her baby and he was suffocated by the umbilical cord, or about a 50-some-years-old guy who died of a heart attack, while the nurse was wheeling him for room to room looking for a doctor to help him.

Unsurprisingly, Romania's healthcare system is considered one of the worst in Europe. In 2010 it ranked last among 33 countries, according to the European Healthcare Consumer Index.

Alongside the doctors’ and nurses’ unhappiness about their salaries, go the bribe-taking from patients.

Romania joined the European Union two years ago, and is still struggling to shed a culture of corruption that was honed during decades of Communism.

Receiving a bribe, giving a bribe, accepting undue benefits and influence trafficking are specifically prohibited by Romanian penal law. These laws are to varying degrees enforced. During the years 1994-1999 the Romanian government reports that 2,681 individuals were convicted for various acts of corruption. Of this number, the largest amount of convictions were obtained for accepting a bribe, 1359, just over 50%.

In 2000 Romania amended its corruption laws by expanding the scope of the pre-existing laws, and increasing some penalties. These amendments are now in force. Under these amendments, private business managers are now exposed to the same penalties as public employees for accepting a bribe or influence trafficking.

Romanian news media is highly publicizing every case of corruption and bribe-taking – especially those in higher ranks.

Despite these facts, when it comes to health care, there never was a higher level of corruption in Romanian history.

When an illness requires one week of hospitalization, patients typically pay bribes equivalent of a family’s monthly income.

The cost of bribes depends on the treatment, ranging from $150 for a straightforward appendix-removal operation, to up to more than $6,000 for a more serious surgery. The suggested bribery prices are passed on by word of mouth, and are publicized on blogs and Websites. Some doctors tell the patient what the cost will be up front, and the bribes are handed over discreetly in white envelopes.

We all know – and so do Romanians – that bribery is destructive, and illegal. In this context we could discuss the beaten spouse syndrome. One of the dynamics of the beaten spouse syndrome is that the behavior in all likelihood will continue unless the victim is willing to complain to authorities. In the absence of a complaint, the victim should expect the beatings to continue. The same is true in the corruption arena – the victim must stand up against the practice or he/she will surely be hit up again for more money.

Dr. Vasile Astarastoae, president of the Romanian College of Physicians, in an interview, blamed the low average monthly wage for doctors and nurses for the bribe-taking.

You’ll say that the problem starts with the patient, because in fact, he/she is the one offering the bribe in the first place, which is true.

What many people don’t know, is that a patient who does not pay a bribe in Romania, is left untreated, or at best, receives a very low form of care; so, what are the patient’s options when faced with this problem?

Older patients are extremely vulnerable, as many of them have such low monthly pensions, that they are in no position to bribe anyone. Some of them, despite giving a bribe, are still not properly cared for, because they are considered being too old, therefore, not high priority citizens.

As I mentioned, I've experienced this problem first hand recently, when my father broke his hip and required surgery. Despite the $400 bribe to the doctor, and another $200 to nurses, he was never walked after his surgery, leading to a blood cloth and some other serious complications, which eventually killed him. When I pointed to his surgeon that my father’s speech seemed impaired, the doctor’s response was: “Your father is 86-years-old; what do you expect?”

I told him on the most polite tone possible, that my father was 86-years-old two days prior to his surgery, and I expected him to be able to talk to me the same way he was before surgery. The doctor laughed, and told me to give it time, but time did not save my father.

My frustration grew when other people told me that when an old person is hospitalized this very mentality towards elderly, is considered routine.

My question for Dr. Vasile Astarastoae - who blamed the doctors’ low monthly wage for the bribe-taking – is: What gives a doctor whose monthly income is $500, the right to expect and accept a bribe from a retired patient whose monthly income is $100 or less, and who is supposed to receive free medical care?

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