How should the state deal with medical corruption?
Paying doctors more money is one way to end unofficial payments to doctors in Eastern European countries. This approach has worked well, for instance, in Slovenia and the Czech Republic. But then, you have to have the extra money in the first place.
Another approach, one championed by Sergiu Negut, head of SVP Consult and former director of hospital chain Regina Maria, is to follow the approach of a park keeper charged with working out where paths should go. As he says: “You put them where people are already walking.”
In other words, a solution involves understanding who pays what, and simply converting these payments into official payments. Negut says that, in practice, these payments make up a complete system: “Typically, the patients with contacts get served first, then those who can make big payments – after that, the doctors will typically prioritise those with the greatest medical need.” Patients will also be asked to pay for dressings and other consumables used in any operation.
Negut suggests that, in poor countries, these payments should all simply be made official, taxed, and controlled. “If you pay officially, then you will not be ready or willing to pay a further bribe – so the official payment will wipe out the bribe.”
Why bother to make the change? For one: a system based on bribery is unaccountable and lacks transparency. In a new, all-inclusive system, much of the payment will go to doctors and nurses. Currently, most of the unofficial payments go where the power is, rather than reflecting the real contribution of medical staff. “It will typically end up with the head of department getting the lion’s share,” says Negut.
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