Monday, March 9, 2009

Medical Care in Romania Comes at an Extra Cost

The New York Times

BUCHAREST, Romania — Alina Lungu, 30, said she did everything necessary to ensure a healthy pregnancy in Romania: she ate organic food, swam daily and bribed her gynecologist with an extra $255 in cash, paid in monthly installments handed over discreetly in white envelopes.

She paid a nurse about $32 extra to guarantee an epidural and even gave about $13 to the orderly to make sure he did not drop the stretcher.

But on the day of her delivery, she said, her gynecologist never arrived. Twelve hours into labor, she was left alone in her room for an hour. A doctor finally appeared and found that the umbilical cord was wrapped twice around her baby’s neck and had nearly suffocated him. He was born blind and deaf and is severely brain damaged.

Now, Alina and her husband, Ionut, despair that the bribes they paid were not enough to prevent the negligence that they say harmed their son, Sebastian. “Doctors are so used to getting bribes in Romania that you now have to pay more in order to even get their attention,” she said.

Romania, a poor Balkan country of 22 million that joined the European Union two years ago, is struggling to shed a culture of corruption that was honed during decades of Communism, when Romanians endured long lines just to get basics like eggs and milk and used bribes to acquire scarce products and services.

Alarm is growing in Brussels that Romania and other recent entrants to the European Union are undermining the bloc’s rule of law. The European Commission, the European Union’s executive body, published a damning report last month criticizing Romania for backtracking on judicial changes necessary to fight corruption. And Transparency International, the Berlin-based anticorruption watchdog, ranked Romania as the second most corrupt country in the 27-member European Union last year, behind neighboring Bulgaria.

Those who have faced corruption allegations in recent years have included a former prime minister, more than 1,100 doctors and teachers, 170 police officers and 3 generals, according to Romanian anticorruption investigators.

Romanians say it is the everyday graft and bribery that blights their lives, and nowhere are the abuses more glaring than in the socialized health care system.

Interviews with doctors, patients and ethicists suggest that the culture of bribery has infected every level of the system, sometimes leaving patients desperate.

One doctor said a patient recently offered him a free shopping trip to Dubai, an offer he declined.

The issue of health care corruption gained national attention in January when a 63-year-old man, Mihai Constantinescu, died of a heart attack in the waiting room of a hospital in Slatina, in southern Romania. Mihaela Ionita, the nurse who wheeled him from room to room trying to get a doctor to treat him, said in an interview that she believed he had been refused care “because he appeared poor and could not afford a bribe.” The hospital said Mr. Constantinescu had not seemed an emergency case.

Dr. Vasile Astarastoae, a biomedical ethicist who is president of the Romanian College of Physicians, which represents 47,000 doctors, blamed a pitifully low average monthly wage of about $510 for doctors for the bribe-taking.

“Patients don’t want to go to a doctor who is distracted thinking, ‘How will I feed my kids or pay the rent?’ ” Dr. Astarastoae said. “So there is a conspiracy between the doctor and the patient to pay a bribe.”

He said that unlike in many Western countries, where doctors are respected and handsomely rewarded for years of hard study, the medical profession here had been denigrated under Communist leaders who made workers in factories the country’s heroes.

A 2005 study conducted by the World Bank for the Romanian Ministry of Health concluded that so-called informal payments amounted to $360 million annually. When an illness requires hospitalization, patients typically pay bribes equivalent to three-quarters of a family’s monthly income, the study showed.

Some doctors say that the bribery culture is so endemic that when they refuse bribes, some patients become distraught and mistakenly conclude it is a sign that their illnesses are incurable.

Doctors and patients say the bribery follows a set of unwritten rules. The cost of bribes depends on the treatment, ranging from $127 for a straightforward appendix-removal operation to up to more than $6,370 for brain surgery. The suggested bribery prices are passed on by word of mouth, and are publicized on blogs and Web sites.

Victor Alistar, director of Transparency International’s Romanian branch, said public hospitals routinely exchanged “supplementary payment” lists to ensure that they had the same rates.

Dr. Adela Salceanu, a psychiatrist and antibribery advocate, recalled that one friend, a 42-year-old lawyer, recently broke two legs in a basketball game and was taken to a hospital for surgery. When he did not offer money to the orthopedic surgeon on duty, his procedure was postponed for a week; he finally received treatment, but only after paying the doctor an extra $510.

Mugur Ciumageanu, a psychiatrist who has practiced in public hospitals in Bucharest, said that when he was a young doctor, a senior physician forbade him to talk with patients for three months. She explained that by spending more time with patients than she was, and appearing more caring, he was putting a dent in her bribery earnings.

Marilena Tiron, 26, a recent graduate of a medical school in Bucharest, said the issue of bribery did not come up in her optional medical ethics class at the University of Bucharest’s Medical School “since the teachers were taking bribes themselves.”

Dr. Astarastoae, of the Romanian College of Physicians, acknowledged that bribery needed to be rooted out. He said that the college had the power to revoke the licenses of doctors implicated in a bribe but added that few patients were willing to identify their doctors for fear they could be shunned by other doctors.

The Ministry of Health has taken some steps to try to change the culture of bribery. It recently set up a free phone line for patients to report abuses. Within an hour, it was jammed with calls. Hospitals here are plastered with antibribery posters.

But Liviu Manaila, Romania’s secretary of state for health, said in an interview that the culture would not change fundamentally until doctors’ pay increased. While he said the government’s budget was too strained to raise wages, he proposed revamping Romania’s socialized medical system so that patients took on a greater burden of the costs. He said their payments could be used to pay doctors higher fees.

Ms. Lungu, Sebastian’s mother, said that whatever changes were made, they should start now, before other children suffer like her son, who will probably spend his life in a vegetative state.

“The problem is that all this black money absolves doctors of their moral responsibility toward their patients,” she said. “It has got to be stopped.”


Anonymous said...

Wow, that is a real depressing issue, that poor baby and family. It is unreal how people are , so uncompassionate and full of themselves. What ever happened to people with morals. As a disease managementprofessional and health advocate

I am very disturbed by this

Anonymous said...

You already printed this a few weeks ago when it appeared in the NYT. Why the re-post?

Anonymous said...

@medical call center, are you Romanian, familiar with Romania at all?! The years of Ceausescu explain the medical situation in Romania as well as mnay other aspects of the current Romanian society. I don't think the nurses and doctors are uncompassionate, I think they don't make any money without bribes.

Romania News Watch said...

posted the article because it was published on NYT site yesterday...

Anonymous said...

Stories like this really make for a depressing day . Socialized medicine is apparently not the way to go when it comes to healthcare. I hear nothing but horror stories from england,canada, and romania all with socialized or universal meidcal coverage. I mean don' they have any checks and balances.

ask a nurse said...

It is very important to stay on top of your health and have a check up at least once a year to ensure that you remain healthy. Many health problems are curable but you need to catch them in time. Do not wait to go see a doctor because it may be too late.