Romania is\u00a0one of the European Union’s most corrupt countries, according to Transparency International. Informal payments seem to be especially widespread in health care, with about a quarter of Romanians reporting<\/u><\/span>\u00a0that they’ve recently been asked for a bribe by a doctor or nurse. A recent court decision declared gratitude payments to doctors illegal, because the medics are government employees. Subsequent protests by doctors and nurses <\/b>forced the government to give them a 25 percent raise in salary, but everyone knows that won’t be enough to stop envelopes from changing hands.<\/p>\n That is a common problem for post-Communist countries, which have inherited vast, centralized health care systems that they could only afford when their governments had full control of the economy. Privatization seems an obvious answer, and it has worked in some countries such as Georgia, where most hospitals are now privately owned and the government only subsidizes the treatment of relatively poor citizens. Yet it’s not always politically feasible, and running a private hospital in a poor country isn’t a particularly attractive business proposition, either.<\/p>\n So some reformers have relied\u00a0on the formalization of informal payments. In Cambodia, out-of-pocket\u00a0payments made up 82 percent of all health spending in 1999. After the government introduced an official fee schedule, locals soon found medical services were more cheaply available than before. The cost of surgical hospitalization, for example, dropped from a minimum of $40 to $26.70. Doctors welcomed the system because it\u00a0guaranteed them higher incomes without having to engage in ad hoc negotiations with their patients. In Albania in the early 2000s, the introduction of official price lists quadrupled doctors’ official incomes in some hospitals.<\/p>\n In 2012\u00a0Anders Sundell of the University of Gothenburg described how Sweden — now one of the world’s least corrupt countries — went from a system based on bureaucrats’ right to charge direct fees, or\u00a0sportler<\/em>, for their services to one that established official schedules for such fees, then one that imposed stamp taxes\u00a0for specific actions, before arriving at its\u00a0contemporary\u00a0system of entirely tax-financed government. Every stage logically followed the previous one, with bureaucrats gradually giving up their freedom to charge as much as they wanted for\u00a0a slightly smaller but officially mandated income.<\/p>\n <\/p>\n The radicalism of this idea goes further than Indian economist Kaushik Basu’s 2011 proposal\u00a0\u00a0to decriminalize bribe-giving in order to encourage whistleblowing among people with first-hand knowledge about corrupt officials. Basu, who went on to become chief economist of the World Bank, was still thinking in terms of\u00a0monitoring and punishment, and his idea, if anyone ever implemented it, would probably have struggled to overcome the long-term relationships between bureaucrats and the business people who enable their corruption.<\/p>\n The biggest problem in taking this approach beyond health care is that it would require a government to inventory its services and decide which ones are unnecessary. Otherwise citizens could be forced to pay one bureaucrat for a certificate required for no good reason by another one or purchase licenses to breathe state-owned air. Health care is a convenient place to start because the list of necessary services is well-known. Even a government that doesn’t really know what it’s doing can work out a reasonable price list. And that’s guaranteed to work better than trying to jail doctors who are simply trying to make ends meet.<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" Should bribery be legalized? \u00a0 Leonid Bershidsky writes:\u00a0 The first step toward getting rid of bribery\u00a0may be to legalize it. Romania could soon try that\u00a0controversial approach with its underfunded health care system. For the many countries without the money to … Continue reading ![\"Legal](\"http:\/\/www.w-t-w.org\/en\/wp-content\/uploads\/2015\/09\/6004d6e605d914077193df286cd89cf885dc73ec.jpg\")
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