Corruption in Polish Healthcare

Last week the head of the Department of Neurology at University Hospital was arrested on charges of demanding bribes for hospital services and arranging for patients to receive immediate care when they should have been put on waiting lists.

Police said they found 1,500 zloty in the desk of Dr. Ryszard Cz — money they said was bribes from three patients. A Krakow police spokesman, Dariusz Nowak, said the surgeon admitted taking the bribes. He faces eight years in prison for violating bribery laws.

His case is one of a growing number of medical-care corruption cases that have come to light recently. In February 2007, a heart surgeon at the Defense Ministry Hospital in Warsaw was charged with murder after prosecutors said he turned off the life-support system of a patient who family refused to pay him a bribe. The man had just received a transplant operation. The same doctor, whom prosecutors have identified only as Miroslaw G, has also demanded sexual favors in exchange for medical care, according to authorities.

The newspaper Fakt reported that the doctor refused to operate on one patient until one of the patient’s doctors agreed to have sex with him. These two cases were the tip of the iceberg against Dr. G, according to Mariusz Kaminski, head of the Central Anti-Corruption Bureau (CBA). He said there was a long list of evidence against the doctor, whom he described as a ruthless bribe-taker.

Although the Dr. G case was particularly shocking, scores of other doctors engage in bribe-taking every day, as the recent Krakow example shows. Medical-care bribery can occur between patient and doctor or between patient and other hospital staff. Patients pay to ensure quality care, to guarantee access to hospital treatment, to skip waiting lists for operations or complicated diagnostic procedures, even to get sick-leave certificates for their employers.

Another piece of the health-care corruption puzzle involves not saving patients but dealing with their bodies once they die. A funeral home will often pay health-care workers to let them know when a patient dies. While the patient’s family members are still in shock over the death, the funeral home swoops down on them to offer its services. The bereaved family often immediately accepts the funeral home’s offer.

Corruption also occurs in contacts between doctors and pharmaceutical firms, between pharmaceutical firms and Ministry of Health officials and between private clinics and National Health Fund staff.

Health-care corruption originated in the second half of the last century, according to a presentation that Grazyna Kopinska made at the 11th International Anticorruption Conference. After the Second World War, when the Communists began running Poland, they nationalized health care. Workers’ salaries were low so Poles got free access to basic services, including health care. Doctors were also poorly paid, so many patients gave them a gratuity for their service. Sometimes this involved ‘payment in kind’ – like a bottle of good alcohol or a box of sweets.

Since the start of capitalism in the early 1990s, the gratuity system in Poland has turned into bribery, pure and simple. And if a patient is rich, the bribe can be very high. Dr. G in Warsaw demanded 70,000 zloty for a heart transplant, for example.

The anti-corruption organization Transparency International said in its Global Corruption 2006 report that the health-care sector around the world remains an attractive target for abuse, due to the large amounts of money involved and the complexities of many care systems. The director of ethics at the World Medical Association, Professor John Williams, agrees that corruption is a problem.

“Physicians are human beings and, like everyone else, are subject to the temptation to put their own interests above those of others,” he said. “The best hope for improving physician behavior is a combination of reasonable and well publicized standards; continuing education about the standards and their foundations (beginning in medical school and continuing at all other levels); peer pressure from colleagues and medical associations; stricter government regulation of industry involvement in medical research and practice; and the threat of disciplinary action for egregious breaches of the standards. However, unless all interested parties cooperate to address conflicts of interest in health care, it is unlikely that progress will ever be achieved.”

Increasing indignation over health-care corruption in Poland indicates that some day soon officials may begin a comprehensive crackdown on the problem.

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