EDITORIAL

The health sector’s anti-bribery system or the law is open to bargaining

I would like to live in a country in which I should not be ashamed of not giving the doctor a bribe. Or scared. In which I should not feel guilty for leaving the doctor’s office satisfied with the medical services received and without, out of principle, placing anything in the large and accommodating pocket of the gown worn by a doctor who has an embarrassing salary in Romania. In which I should not fear that once I turn my back the loved ones I took to hospital will be ignored. But I can’t. Not yet…
Because the health system is unsafe. You never know what you risk if you paddle upstream like a trout that swims in unfamiliar waters, if you are adamant to be the hero that dares not to give the doctor or nurse any “gifts.” Because there is a tradition in Romania and we, as patients, are afraid to break it when our health is at stake. Back in the times of Ceausescu, and even before, each slightly well-off family, especially those in urban areas, kept in a bookcase drawer a carton of Kent cigarettes, or at least several packages, and a Johnny Walker bottle, extremely difficult to get a hold of back then, to be used in the difficult times when a family member needed medical services. At the country side the custom was for those heading for hospital to take what was most valuable in their household, apart from the personal items needed for hospitalization. Thus, it was not out of the ordinary to see in trains old women or men holding turkeys, bottles of palinka, satchels of grain and baskets of pies “for the doctor.” Then, as time passed, we emancipated ourselves. The famous cash envelope replaced the fowl and the Kent carton. Thicker or slenderer, based on one’s possibilities. One could not avoid offering something to the doctor or nurses in order to “be on their good side” and to sit calmly, confident that they would take care of you or your ailing family member. No trace of revolt. Everyone saw this as something natural. Why? Because everyone knew that doctors are poor, they have very low salaries. But also that once you step into their office they have life and death powers over you and there is nobody to protect you anymore.
So the practice of bribes for doctors became a system. Nobody admitted to giving bribes, nobody admitted to taking bribes, but everyone did both, and this practice became part of our culture like something normal. Recently the system – because yes, one can talk about a system – has been kept in check. The pockets of doctor’s gowns are no longer displayed ostentatiously, hospital security guards are even afraid to touch a file forgotten on a chair, and the nurses no longer “fix” hospitalizations and refuse, maybe for the first time in their lives, the “gifts” offered to them by shaky hands, despite the fact that their salary barely covers their bills. Because a legal provision according to which bribes for doctors are forbidden came into force on August 7, following a decision adopted by the High Court of Justice (ICCJ) after the institution was faced with a case in which a doctor, accused of passive bribery, pointed out that the bribe was in fact a donation, thus making use of a legal article that stipulated that doctors can receive donations. Thus, the Supreme Court decided that it is illegal for doctors to receive from patients extra payments, donations or small gifts. Moreover, the ICCJ linked passive bribery and active bribery, so, overnight, patients turned from “generous” to criminals that could face 10 years in jail.
On Wednesday, as if excusing itself for this sudden break with tradition, the Government approved the 25 per cent salary hike for health system workers. Far too little however, bearing in mind that doctors in Romania will continue to earn four or five times less than their European Union counterparts – a resident doctor currently has a base salary of RON 1,400, a specialist doctor earns approximately RON 2,300 per month, and a primary care doctor earns around RON 3,000.
As if admitting its inability to offer doctors as much as they deserve, the Government is trying to mend matters. Basically, dust has hardly settled on the Official Gazette stipulation according to which bribery for doctors is illegal that Victor Ponta has already proposed the finding of a solution through which medical staff could nevertheless receive “gifts.” Legally, the Prime Minister cared to emphasize. His initiative was immediately met with vehement criticism, both from the public opinion, which yearns for a country clean from all points of view, as well as from the Alliance of Doctors, which pointed out that this is not the appropriate solution, the latter consisting instead of decent salaries and optimal conditions in order to offer patients high-quality medical services. The Government however cannot guarantee these things so, according to Health Minister Nicolae Banicioiu, a new extra payment system will be introduced after the medical service is offered, a payment that will be made at the hospital’s pay office and that will be taxed 16 per cent. A gimmick that will make things even more complicated.
So, the anti-bribery system in the Romanian health sector, an absolute novelty in our history – which promised to deter such practices in other domains too – is turning out to be limp. Limp, as any measure implemented rashly in the country that once again proves that the law is open to bargaining.

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