Hell and Health Care in Romania


Party animal that I am, I spent Saturday night watching a 180-minute long documentary-style black comedy/satire about the Romanian health care system called The Death of Mr. Lazarescu. 

The nominal star of the film is Dante Remus Lazarescu, an alcoholic 62 year old retired engineer from Bucharest who wakes up with a stomach ache, which turns into a splitting headache, and which leads him to call 911 for an ambulance. About an hour into the film the ambulance arrives, and the rest of the film follows him as he’s led on his own journey through the nine circles of Romanian health care hell: he’s ignored by nurses, abused by doctors, and shuttled from one hospital to the next, each one eager to get this problem case off their hands. Meanwhile, Mr. Lazarescu himself gets increasingly incoherent as the bleeding in his brain grows worse. His guide in the trip is the ambulance driver, though it is never clear whether she’s dragging him around because she actually cares for him, or because she just needs someone to sign off so she can get her gurney back. 

All told, it is not a loving portrait of Romanian medicine. But at the same time, there isn’t a lot to it that is specifically Romanian about the parody– had the movie been shot in English it could have been set in Toronto or New York.  In fact, if anything, the truth of the matter seems to be far worse than the film portrays it. Today’s NYT has a piece about the epidemic of bribery in the Romanian health system:

A 2005 study conducted by the World Bank for the Romanian Ministry of Health concluded that so-called informal payments amounted to $360 million annually. When an illness requires hospitalization, patients typically pay bribes equivalent to three-quarters of a family’s monthly income, the study showed. Some doctors say that the bribery culture is so endemic that when they refuse bribes, some patients become distraught and mistakenly conclude it is a sign that their illnesses are incurable.

Doctors and patients say the bribery follows a set of unwritten rules. The cost of bribes depends on the treatment, ranging from $127 for a straightforward appendix-removal operation to up to more than $6,370 for brain surgery. The suggested bribery prices are passed on by word of mouth, and are publicized on blogs and Web sites.

But then again, is this even all that alien to Canadian experience? My spider sense says it is not. 


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Hell and Health Care in Romania

  1. Your spider sense is wrong . I am not aware of any documented cases of bribery within Canada’s health care system.

    • I am.

      • The Hair Club for Men doesn’t count.

      • Well then, out with it; isn’t that what journalists do?

      • Your implication is reckless. Your editor would never let you print that suggestion in the magazine without backing it up, and you should do so here. For starters, point us to the “blogs and websites” that list the going bribes for medical care, and tell us how much we have to bribe a specialist for an appendix removal.

  2. Whoa!! I’m willing to accept that the medical systems of Romania and Canada may share some of the faults you described. But are you really saying that bribery — as a set of unwritten rules spread by medical professionals by word of mouth and websites — is not alien to the Canadian medical system? You will need more than “spider sense” if you want to be taken seriously on that claim. To me, that’s like saying the moon landings were faked. If you want to have a serious discussion on the matter, please back up what you say with some evidence and personal experience.

  3. I’m sure doctors in Canada are offered bribes from time-to-time; I’m also quite certain they almost never accept them. There is no way the experience “is not all that alien” in Canada.

    • Having worked in health care for thirty-odd years, the only bribery I’m aware of is the continuing offer of freebies to doctors from pharmaceutical and medical equipment marketers. ” Conference ” trips to golf resorts , “stipends” for joining marketing studies, free samples, etc.
      To be fair, some doctors take as many free samples as they can and hand them out to people who otherwise couldn’t afford to fill prescriptions.
      But I guess some people would call all this business, not bribery. And that would make it ok.

  4. I presume you are alluding to the future of health care in Canada after private-public care is the norm. In which case its opponents should use the Romanian film as an argument against any additional privatization.

  5. I have no experience of the health system in Canada, except for some friends’ horror stories of Montreal hospitals in the 90’s; but this does remind me of Les invasions barbares. Was the bribery in that movie based on what really happens, or was it satiric hyperbole? I wouldn’t put much past the hospital system in Montreal.

    • I think it was satiric hyperbole, although loosely grounded in truth.

  6. The suggestion that “had the movie been shot in English it could have been set in Toronto or New York” is stupid and misleading. Normally, pieces like this post do nothing to advance the discussion, serving only to pander to those who assume that things are utterly awful in Canada (despite never having experienced far worse systems abroad) and could be improved with a healthy injection of profit and free enterprise (nice in theory, lacking in proof). The weird inversion of this post is the suggestion that a terrible system abroad, in this case Romania, bears any resemblance to ours. That’s sophomoric bunk.

    The Canadian system is far less costly than the US healthcare maze and has the same or better healthcare outcomes. Those are the aggregate facts. I’ve lived for many years under both the US and Canadian healthcare systems (I grew up with inside exposure to several East Coast US hospitals). I and everyone I know has received superior care in Toronto. To suggest otherwise is to do so with willful, if not malicious, disregard for the facts.

    You want better healthcare? Move to a city with teaching hospitals. Whether a system is public, private or mixed has less to do with healthcare quality than does proximity to providers. As for cost, our single-payer insurance system works far better than do the many tiers of county, state, federal, HMO and full premium payers and insurers in the US. Even when I lived in New York, the cost was higher and the quality no better.

    But to compare Toronto’s hospitals to Romania’s? That’s moronic.

  7. Star athletes can get same day MRIs when injured. That is a fact. And while not due to bribery, these incidents do show a certain amount of “flexibility” in the system where corruption could flourish.

    And, idiots, we already have a two-tier system. The other tier is over the border for those with resources. Certainly friends of doctors have been known to get faster access to diagnostic scans on occasion.

  8. Actually we have 3 tiers. (1) A fairly bad and unresponsive free system for those who are poor and without connections. (2) A quite good and responsive free system for those with connections to the government and to the hospitals. (3) A good and expensive paid system for the wealthy which is partly in Canada and partly in other countries.

    Bribes and extortion are common in the bad, unresponsive free tier. For example, in a recent provincial election I am told that when a TV station interviewed a campaign worker at a provincial cabinet minister’s HQ celebration, he said that he volunteered for the campaign after he telephoned the minister’s office to complain about the MRI waiting list and was shot to the front of the queue. Someone else told me that when their relative was desperately ill they contacted a provincial minister’s office threatening to mount a campaign of public complaints in the press about the standard of care. A minister’s flunkie made a deal with this person, that their relative would get bumped up several notches in care on the strict condition that they promise to say nothing whatsoever to anyone in the press.

    Sorry to disappoint all you Polyannas leftist daydreamers, but out-of-control costs, rationing and corruption are the harsh and unvarying realities of socialism. It is not as bad as Romania yet, but give it more time, continue killing private wealth and driving away entrepreneurs and capital, and see what happens.

    • Wow. I’m neither rich nor politically connected. When I needed an MRI to see if a shoulder injury might need surgery (not urgent), I was told I’d have to wait 6 to 8 weeks. Unless, that is, I was willing to come on short notice of a cancellation or at off hours, such as at night or on the weekend. I said I could come at odd times and, bam, had an MRI 72 hours later at 9:45 pm. No call to a minister necessary, no queue jumping, because I choose to live in a community that has many healthcare resources. It’s one of those quality of life choices we all have to make. If my idea of quality of life had me living on a lake 9 hours north of the city, I’d likely have a tougher time getting easy access to healthcare. Downtown it’s a different story. How long to see my family doctor: 2-5 days. A specialist: 1-2 weeks. Need care sooner: walk-in. Bleeding out: go to emergency. Where you live is a major factor in the quality of your healthcare. And that’s the truth in the US, too. Lefty daydreams be damned.

  9. Are you speaking Potter of Doctors being bribed with swag from pharma-companies to prescribe their meds or are you talking about patients bribing doctors before surgery? The former is despicable enough, but the latter I simply refuse to believe. Er, unless you can provide incontestable proof for it.

    To those who site squeaky wheels getting bumped up the wait time list– that’s what it is, squeaky wheels getting greased in a system that is always going to have wait times no matter what. It’s unfortunate, but it’s not bribery. And even if it were “bribery,” it’s not bribery of doctors by the patients in their care. Where’s your expose Potter? Spider senses don’t count…

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