Transparency International Romania opposes the legalization of informal payments for doctors and advocates for increasing the efficiency of the health care system to achieve fair remuneration of medical staff

Following the statement of Romanian Prime-Minister, Victor Ponta, from august 18, 2015 regarding the policy initiative to legalise informal payments made by patients to doctors, Transparency International Romania requests a thorough analysis of this measure. The measure violates human dignity, shifts the employer’s responsibility of remunerating the medical personnel on the patient’s shoulders, and doesn’t eliminate the judicial risks caused by legislative ambiguity. Based on this reasoning, Transparency International Romania considers that the need for fair and honorable rewarding of medical work should be covered by making the healthcare system more efficient. Transparency International Romania welcomes the concern for fair remuneration of doctors and for the elimination of the legislative ambiguity that leaves them at risk.

Regarding the fact that “the Minister of Justice, together with representatives of the healthcare sector, will make a legislative proposal, not an emergency ordinance (…), which will provide that the supplementary contributions that patients wish to pay to doctors, nurses, etc. must meet the following cumulative conditions: the payment is not constrained by the doctor, it takes place after the medical procedure, and it is fiscally declared”, Transparency International Romania firmly asserts that legalizing informal payments is erroneous, due to the following problems, brought forth by this measure:

• It violates human and professional dignity. The measure affects the human dignity of doctors and the prestige of the medical profession, by transforming a public service and a vocational service into a direct transaction between patient and doctor, even if it is initiated by the former.
• It shifts the employer’s responsibility of remunerating the medical personnel on the patient’s shoulders. The initiative substitutes the health care unit’s obligation to remunerate the doctor’s work for the unit and its clients. In other words, instead of a wage that covers the specifics of the work, the investment in one’s career and the importance of the profession, as well as the challenges of workforce migration in the EU space, the proposed measure would place the burden of compensatory payment on the patient’s shoulders.
• It does not eliminate the judicial risks that arise from the legislative ambiguity. In reality, it is extremely difficult to determine if the patient was in any way constrained, explicitly or tacitly, to make the informal payment. This increases risks for doctors and medical personnel, related to the case-by-case interpretation.
• The need for fair and honorable rewarding of medical work needs to be covered by making the healthcare system more efficient. As a solution for the appropriate remuneration of the prestige, importance and specific of the medical work, Transparency International Romania advocates for the prevention of corruption and closing of loopholes, which permit health care fraud, redistributing the resources in investments in human capital and technology for the medical system. Fraud in the handling of resources in health care units reaches an estimated 18% and there are 21% injurious practices on the pharmaceutical market, with an estimated budgetary impact of 340 million euros. Consequently, tackling and eliminating health care fraud could be sufficient to close the gap between the average of income and living costs for Romania and the EU average, for the medical sector.

Call to action. Taking the aforementioned aspects into consideration, Transparency International Romania requests a legal act that eliminates legislative ambiguity regarding the moral integrity of the doctor – patient relationship, through task wage on payroll for merit and performance, along with a medium-term plan for the redistribution of the resources of the health care system into investment in human capital and the necessary technology for performing new investigative and therapeutic operations. Furthermore, we request that the initiators of the public policy balance urgency and transparency in developing this public policy and mediate between the legitimate interests of the medical professions and the interests of beneficiaries of and contributors to the public health care system.

For more information, please contact
Victor Alistar
CEO Transparency International Romania
e-mail office @ transparency.org.ro