WHITE envelopes containing cash slipped into the pockets of physicians in the hope of better treatment should vanish from Slovakia’s hospitals if an anti-bribery campaign recently launched by the Medical Trade Unions Association (LOZ) proves effective. LOZ wants to persuade doctors countrywide to wear badges with the “Thanks, I do not take bribes” slogan, and about 300 physicians have joined the campaign so far.
A 2010 survey by the NGO Transparency International Slovensko (TIS), an anti-corruption watchdog, which indicates that every fourth Slovak household resorted to bribery when attempting to solve problems when dealing with the health-care sector, highlights the urgency of such an anti-corruption campaign in Slovakia.
“We want the patients to know that there is no need to go to hospitals with an envelope,” said LOZ lawyer Anton Chromík, as quoted by the SITA newswire, adding that the union wants to encourage patients to seek out doctors who do not take bribes. “On the other hand [we want] physicians to identify with our initiative and help to improve Slovakia’s health care,” he said.
The medical unions’ association however was not the first to initiate an anti-bribery campaign in the health sector, as a Žilina-based neurosurgeon, Milan Mrázik, had started a very similar campaign with an identical slogan.
Nevertheless, the campaign has also opened a debate in the media over the exact definition of a bribe and whether a box of chocolates or flowers, which are commonly given to doctors by patients in Slovakia, can be considered bribery.
As part of the campaign, patients will be able to access a list of physicians who have joined the campaign.
Before launching the campaign, LOZ had mailed the directors of hospitals a set of anticorruption measures but received little to no response. Now the union intends to resend the measures and plans to table them as draft legislation for the government, SITA reported.
LOZ has also asked the Interior Ministry to set up an anti-corruption phone line for the public to report complaints about physicians who ask for bribes.
“The Interior Ministry has had an anti-corruption line for almost a year and it has already handled 86 complaints, however only eight were cases that actually pertained to corruption,” Zuzana Čižmáriková, the spokesperson of Health Ministry told The Slovak Spectator, adding that the ministry has forwarded these cases to criminal prosecution bodies.
Nevertheless, LOZ also plans to provide patients with advice on how to proceed when a doctor attempts to solicit a bribe, as well as to widely publicise the aims of the campaign in doctors’ clinics, SITA reported.
The unions also seeks to change the general public’s perception that patients may not receive proper health care unless they offer bribes.
Before the LOZ campaign, Mrázik, who also is a member of LOZ, attempted to launch a similar campaign through his website somprotiuplatkom.sk back in May. LOZ claimed that the idea for its campaign came from a patient, Sme daily wrote.
“I do not demand authorship, I was not the only one who came up with this idea,” Mrázik told The Slovak Spectator, adding that he merely “succeeded in making it come to life”.
LOZ wanted private physicians to join the campaign as well, however President of the Association of Private Doctors Ladislav Pásztor said they would not join, claiming “we certainly do not accept bribes”, Sme reported. Former LOZ head Marian Kollár, who now serves as the president of the Slovak Medical Chamber (SLK), a professional organisation of physicians, said the campaign should be appreciated and supported.
Gift or bribe
However, LOZ has not specified what exactly constitutes a bribe and what can instead be considered by patients as merely a gift, given the culturally accepted practice in Slovakia of bringing gifts to physicians.
According to its website, LOZ believes that accusing patients who bring flowers or boxes of chocolate to thank their doctors after treatment “humiliates [their] dignity”.
Most doctors approached by Sme claimed to have received boxes of chocolate, flowers or alcohol after treatment as a display of gratitude. Some hospitals however have instituted a code of ethics to further clarify what constitutes a bribe. For instance, Martin Šenfeld, the director of Kysuce Hospital in Čadca, in the north-west part of the country, said that his hospital allows doctors to accept gifts worth up to €20, as quoted by Sme.
While analysts are sympathetic to the initiative, they also express doubts about whether a campaign alone can weed out corruption without the adoption of additional measures and clearer definitions.
“The right form of stigmatisation and strong public pressure could be successful but it also might not be, since a similar measure in Hungary has not removed corruption nor has it significantly decreased it,” Roman Mužík of the Health Policy Institute (HPI) said, as quoted by the Sme daily.
Director of TIS Gabriel Šípoš told SITA that while the LOZ campaign is a positive step it is not a breakthrough in the fight against corruption.
“Symbolism is really important, since most patients in our surveys claim that they offer bribes voluntarily … driven by concerns of receiving the best care,” Šípoš said, adding that it is therefore good if physicians send a message to patients that bribery is not necessary.
In the fight against corruption Šípoš considers defining the basic health-care package as the most important move, so that it is clear what the patient is entitled to receive and what is covered by their health insurance. He added that more frequent reports on relations between doctors and pharmaceutical firms would be useful as well, since firms ‘motivating’ physicians to increase prescriptions of specific drugs is a re-emerging problem, SITA reported.
An analysis by the Institute for Economic and Social Reforms (INEKO) shows that doctors earn an extra €500 in addition to their regular payments from health insurance companies. Bribes might also be included in this figure, said Peter Goliaš, the director of INEKO, as quoted by Sme.