White coat,white envelope
Do you think this
anti-bribery campaign will work? Are there other measures which should be
taken? Do you think the distinction
between a gift and a bribe given in the article is accurate and clear, or is it
likely that the line between these two will be blurred? What has your experience been of bribery
(and especially bribing doctors) in Slovakia?
Corruption is an ever present problem in our country. I believe it is a relict of the past regime, which was left and is not going to be fully rooted out, not until there will not be a single generation possessing memories of it. As one person, a former dissident - Matej Bútora, I met during summer, put it: “Regime can change instantly, but it takes one hundred years for a society to reform.”
ReplyDeleteFrom my point of view, what is seen as a bribery, are in fact, in most cases, only deliberate decisions of people to show gratitude to doctors. Unless a doctor explicitly, or implicitly asks for a “gift,” it should not be called a bribe, whatever the size or value. Whether such “gift” should be accepted by doctors, is a matter of morality. It brings me to contemplate about the refusal of private physicians to wear the badge. A simple question should be raised. Would it harm their image or they comply with profit-seeking attitude of most private businesses, and thus see bribes as an extra pay for well-executed work? On the second thought, they may just find it convenient to stick with this nation’s tradition…
General belief of Slovaks is that such gifts provide an incentive for doctors to perform better, to care more, and to utilize their full abilities during operation and/or treatment. I am not saying it is right, but it gives people a better hope, and if it, even only by a bit, improves the doctor’s attitude towards patient, it is worthy. I admit it might now look that I would be happy to keep the bribery live’n’kicking, however, opposite is true. It is just that I prefer another route.
I will confess to having a personal experience with bribes. Once, a few years ago, my grandmother had serious problems. Her operation was supposed to be difficult, and there was a non-zero chance it may go wrong. Knowing the circumstances in Slovakia, my family had decided to leave nothing on luck, and wanted to motivate the surgeon to work better, with an envelope with money. Surprisingly, this doctor refused the gift, or bribe if you like. Here I come to my point. Fight against bribery is important, but educating people such that they would never dream of accepting a bribe should take even higher priority. A single fact supports this conclusion. Since the bribery comes also from people, we need to show them that such expressions of gratitude are unnecessary so they themselves would stop offering them. Similar conclusion was also introduced by LOZ lawyer Anton Chromik.
I fully realize it is easier said than done, though, fighting such Don Quixote-like fight requires long term solutions, and eliminating bribery at present, while we still have disrupting factors entering the system is illogical, useless, and surely not a long term sustainable counter-measure.
I think that bribery in healthcare is not nearly such a problem as the article implies. Yes, it may give the "more generous" patients better treatment, but it doesn't necessarily mean that other patients get less attention. As Michal said, this phenomena is probably a relict of last regime, where bribery was considered usual almost everywhere, including medical sector. It might have helped then, I don't know, but now... I don't think that there is a big number of doctors who would clear their throat and play with their pocket when asked for better treatment.
ReplyDeleteThere is a thin line between a gift and a bribe. I think it is almost impossible to provide reliable guidelines for distinguishing these two, as there will surely be someone who WILL find a hole in such system. However, there must be some quotas which will distinguish large bribes from small gifts, as a bouquet of flowers cannot possibly be a bribe and a Ferrari surely is. Only questionable part would be items between, as any amount of cash can be considered a bribe. Such issues would have to be decided by doctor (if he doubts whether to take it) or jury (if it comes to that) for every particular case.
I can't say I have much experience with corruption in healthcare - in fact, I don't have almost any experience with healthcare at all. However, I remember that my parents used to give the doctor who treated my grandfather a bottle of wine, and she gladly accepted. Same goes for flowers. My parents have never used cash at any time, at least not to my knowledge. I don't think that I will ever bribe doctors, even if they ask me to. Such cases I will decide later, though.
Bribery, as an act of implying money or gift giving has a purpose of altering the behavior of a recipient. Bribing a public official is a felony. However, in case of bribing doctors, it is unclear and controversial. Some may consider bribing doctors immoral, others may consider it a cultural habit. In Slovakia, bribing doctors with envelopes filled with money or with gifts is common. A lot of patients (patient families) are able to pay a high amount of money to doctors to make sure that their beloved one is well taken cared of. A doctor’s job is to treat his/her patient as best as he/she despite the additional money. The amount of afford a doctor puts into his job should not be affected by a bribe. If so, that would mean that poor people that cannot afford to bride a doctor are in a disadvantage. I don’t consider bribing doctors morally correct or acceptable. However, in Slovakia doctors get a monthly salary, relatively low contemplating the work they do. As a matter of fact, I do understand that other people therefore think that doctors need bribes. It is also clearly understandable why some doctors accept the prosperous bribe.
ReplyDeleteLike Michal, I also had a personal experience with bribes in my family. Both of my parents are doctors and had worked in the hospital for several years. They are perfectly aware of how bribing doctors in Slovakia works. According to my parents, a bribe helps the contact with the doctor and the patient in most cases. Most of the doctors are more open to the patient’s family and generally pay more attention to the patient’s medical situation. I must confess, in important cases, our family never goes to doctors without a gift or white envelope.
I definitely do not think my family has a correct and moral approach but it is hard to change today’s situation and convention in case of bribing doctors. However, Michal Mázik and others are trying to do so. I think that people should follow and suport these figures to decrease the amount of accepted bribes by doctors and to demotivate people in offering brides to the doctors.
As my classmates, I believe that the line between bribes and gifts is blurry. In a country like Slovakia were doctors earn less than in other European countries it happens quite often that doctors get a “gift”. Personally, I think it is not a crime if a patient gives his doctor a present. It is a crime and it is unfair if the doctor decides to pays one patient more attention than the other just of a “gift”.
ReplyDeleteSince I was a small child my parents gave always my doctor a present for Christmas or New Year’s but that’s only chocolate or wine. Never has a doctor received an envelope with money or a very expensive gift from my parents. However, I never stayed in a hospital for a longer period of time because I never had a serious disease and I was never in critical condition. Maybe my parents would decide to give an envelope to my doctor if it would be more serious. What is interesting is that my parents never gave a present to my doctor in Germany because it is a crime there and the doctors earn enough money. In Russia it is even worse than in Slovakia. Many people are scared to go to the doctors because all the good doctors go to the big cities or other countries were they get better money for their job. That means that bribery is not only a normal thing but is considered to be an important factor in how you will be treated. I personally don’t think that an anti-bribery campaign will work in Slovakia until Slovak doctors will be better paid for their job.
After reading this article, I asked myself what I would do as a doctor. Would I take the envelope? The answer is probably no .I would take only gifts which are not very expensive. The reason why, I would not take the money is, that I would feel guilty and I know I could not pay one patient more attention that the other just because of an expensive gift or money. I would take gifts like flowers, chocolate and alcohol but never money. On the other side, if my daughter would be in a serious condition I think I would give the doctor an envelope just to feel like I did all I could in that moment to help my daughter get better.