Ambulance in the streets of Bucharest - © LCV/Shutterstock

Ambulance in the streets of Bucharest - © LCV/Shutterstock

Despite some positive signs, corruption continues to weigh on the Romanian healthcare system. The main victims are citizens, forced to pay under the table to obtain the services of doctors and nurses

06/12/2023 -  Mihaela Iordache

The healthcare system in Romania remains the most corrupt in the European Union. At the same time, life expectancy in the country is only 72.8 years, compared to a European average of 80.1. According to Eurostat, Romania occupies the penultimate place in Europe  (the last belongs to Bulgaria, 71.4 years) in terms of life expectancy at birth.

In addition to the financial difficulties with which the country has never stopped struggling, Romania also "boasts" the first place in the ranking of the most corrupt healthcare systems. Patients are often forced to bribe their doctors in exchange for services that they should receive free of charge based on the contributions paid.

The phenomenon of corruption in healthcare systems in Europe has also been analysed by the FRONTIERS research platform. The conclusions of the research were taken up by the Romanian press, also because Romania once again appears at the top of the negative ranking. Among the reasons that push patients to give bribes, the first place would be the desire to receive better care or at least not be denied it, followed by the desire to express "gratitude" towards doctors. Of course, in many cases there is little freedom of choice, especially when the doctors themselves ask for money.

Another tool that allows "measuring" corruption in the Romanian healthcare system is the Patient Feedback Mechanism , promoted by the Ministry of Health. In 2022, 311,374 people responded to the questionnaire: of these, only 5,883 (1.89%) said they had been asked to pay at the hospital. The percentage has almost halved in the last five years: in 2018, in fact, 3.16% of patients declared having given "a tip".

If, however, we look at the latest Eurostat survey , published by the European Commission, the data is worse. In fact, one in five patients admits to having given money or expensive gifts when they needed care in a state healthcare facility. In waiting rooms or even in front of hospitals, patients and their relatives continue to exchange information about how much they have to pay to be well treated. 18% of Romanians admit that they still deliver an envelope with money to doctors' offices: an envelope that is slipped directly into the doctor's or nurse's pocket, perhaps when they approach the hospital bed for visits and checks. It does not matter if the practice is illegal, nor if the patient may have had to ask for a loan for that money.

Backward system, corrupt system

Thus Romania remains first in the EU for corruption in the healthcare system. Greece follows, while at the opposite end there are countries such as the Netherlands, Sweden or Finland. As regards Eastern countries and in particular Romania, the phenomenon of corruption in the national healthcare system is a legacy of the communist period, when it was almost unthinkable to go to the doctor without a gift or an envelope with money.

On the other hand, a poorly modernised and reformed healthcare system, without sufficient means and places for hospitalisation, without doctors or nurses - who prefer to emigrate - encourages corrupt practices. Practices that seem consolidated in the collective mindset, including doctors', despite the latter having benefited from significant salary increases. At the beginning of the year, wages in the healthcare sector increased again, by 25%.

Salaries can change based on the specialisation or importance of a hospital: a head doctor can reach over 2400 Euros gross per month, while a resident doctor receives around 1600 Euros gross, plus allowances.

The map of corruption in hospitals in Romania

In Romania, bribes for doctors are directly proportional to poverty: the poorer a county, the more widespread the practice of bribes. Based on the surveys, created the “bribe map ” in Romanian hospitals. It turns out that in Teleorman County, characterised by significant levels of poverty, 5.2% of people who responded to questionnaires said they had been asked to pay.

In recent years, some doctors who have received money or goods in exchange for their services have made headlines, and some have been indicted. A recent case, from a few days ago, concerns the head of the oncology department of the Suceava hospital (in eastern Romania), sent to trial for 280 acts of corruption.

The doctor allegedly received money from patients, but also honey, cheese, pork, perfumes and other goods. The specialist received sums between 10 and 50 Euros from cancer patients or their relatives, as well as various food products. According to investigators, only on December 13, 2022 the doctor accepted bribes from 21 people in exchange for medical consultations, prescriptions, hospitalisation tickets. Subsequently, the doctor was arrested preventively for 30 days, and was then placed under judicial supervision.

Doctors who accept bribes risk up to ten years in prison and although they are few compared to the scale of the phenomenon, there are doctors who have actually ended up behind bars.

Anti-corruption solutions are being sought

Asking for or accepting bribes to provide medical services is unworthy and unacceptable and "every such case risks casting a shadow on the medical profession. This is not right, we need to intervene”, says Catalina Poiana, president of the College of Doctors of Bucharest. It is a problem of mindset, but also of education. Therefore, among the solutions in sight, the Ministry of Health offers anti-bribery courses and professional ethics courses. Furthermore, it is planned to send an inspector to each hospital to carry out checks on possible acts of corruption.

According to the Romanian Minister of Health, Alexandru Rafila "automatically, a patient who gives money is better cared for than one who does not want to do so", and therefore the presence of a person in the hospital who carries out checks is necessary.

Although studies indicate a slight decrease in the phenomenon, the problem of corruption in the Romanian healthcare system remains a burden for citizens. The increase in the number of private hospitals does not help the majority of the population, who have to deal with poor living standards and insufficient wages.

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