The echoes of the scandal in which the doctor Cătălin Cîrstoiu, the manager of the University Hospital in Bucharest, until yesterday a candidate in the race for the Capital City Hall, was involved, are far from being extinguished. His practice, of treating patients in the state hospital, and then in his own private clinic, reveals a situation that seems to have always been brewing in the system: the redirection of patients from the state to the private and vice versa. Juggling considered immoral. What should be done? A legislative regulation, Minister Rafila proposes.
How fair is it to a patient to be treated in a state hospital, and then sent for further investigations to a private clinic with which the doctor has a contract and where the patient has to pay for the services received? It's not fair, it's not ethical. The outcome? 1-0 for medical workers who increase their accounts from the pocket of the sick. However, the reverse situation is equally immoral, the one in which the doctor sends the patient from the private system to the state system, where the treatment is free. The outcome? 1-0 for the patient, who saves money, while the clinic loses financially. The puppeteer of this juggling is the doctor, who often has his feet in two places: when he helps the patient, when he helps the private clinic, when he helps himself… even himself.
Minister Rafila wants to regulate the idea of ethics
Regardless of the situation, we are talking about a phenomenon that should be regulated in such a way that no one suffers: neither the patient, nor public hospitals, nor private polyclinics. “I believe that the two sectors, public and private, should not be considered opposites, but should be considered complementary, but we must play on an equal footing in terms of how services are settled”, Minister Alexandru Rafila declared the other day. He announced that he will try to find a legislative solution to regulate situations when patients are directed from the state to private clinics and vice versa. “We are thinking of working on a legislative point of view that will be done sparingly and that will respect two principles. One principle is that a doctor can work equally in the public or private system, but this must be done in compliance with the work schedule, if he works in the public hospital, in its entirety. The second principle is that patients can choose between public and private, but I explicitly referred to the situation where, for example, a patient is called to the public hospital, is investigated at the public hospital, if which one is directed to a private clinic“, the official also specified. “I want us to find a legislative solution that allows for such a situation where the patient is first treated in the public system and has to go to the private one, or vice versa, when he goes from the private system to the public one”concluded the minister.
Juggling “go, come!”, the explanation of a legal but not ethical phenomenon
But, until the authorities figure out what needs to be done and until they decide to do something concrete, patients are often treated like ping-pong balls placed in opposing fields: sometimes in the state, sometimes in private and inverse. Although, according to Dr. Mihai Negrea, specialist in health management, such situations do not happen very often. And when it happens, the patient is also to blame. “Such situations occur, rather, in the case of famous doctors, on whose list many patients wish to end up. For any trivial condition they want to be seen by a teacher. The doctor is also human: he has only two hands and two legs. It does not cope with the large number of requests and tries to sort them, divide them, direct them as it can”.
Radu Gănescu, president of the Association of Patients with Chronic Diseases, is of the same opinion. “They want to reach the most famous professor, the greatest academician. And this creates a syncopation in the system, in the sense that some hospitals are overcrowded, and others, smaller, admittedly, are almost empty. And this is how we end up with very long waiting lists and doctors who can no longer cope with the created situation”.
But, draw attention, Dr. Mihai Negrea, we have already entered a gray area, we are treading on quicksand. “Medicine is a profession that can be practiced in any form as long as ethics are taken into account. The doctor is free to choose where he works, in the public or private system. Likewise, the patient is free to choose his doctor. Problems arise when a doctor works at a public hospital and consults at a private one at the same time or when he redirect patients from one side to another. In the last case, the patient's right to choose his hospital, respectively the commercial contract signed with the private clinic, is violated.” the expert also specified.
Radu Gănescu even comes with a concrete example speaking from his own experience. “Many times, it happens that doctors who work in both the state and the private sector cheat the state system. “At 2:00 p.m., let's say, he should be on schedule, at the state, but you can't find him because he's already started his schedule privately. There are things out of control because we don't have any boundaries.”
“It's hard, really, to split yourself into seven places,” also recognizes Dr. Ovidiu Telegescu, manager of a private clinic. “You can't dilate time, you can't do them all, but also wake up to the fact that you're actually supposed to be at hospital X, and you're still at clinic Y. Unfortunately, that's a big problem with the system. Everything starts from the funds and the lack of staff”.
Dr. Mihai Negrescu tries to explain the phenomenon of redirecting patients from the state to the private sector by also touching on a more sensitive topic: that of money. “Some doctors, who also have contracts with private clinics, receive certain commissions from them, depending on the number of patients they treat. While they receive nothing from the public hospital”.
Dr. Ovidiu Telegescu completes the idea by mentioning the poor financing of public hospitals, but also the lack of basic equipment. What to talk about state-of-the-art equipment! “As long as the wait for an MRI in the public health system takes months, it is normal for the doctor, in emergency situations, to send the patient privately. Where the investigation can be done even the next day. We are talking about investigations settled by the insurance company”.
Either in the cart or in the sled
We are talking about a situation that needs to be fixed, commented Radu Gănescu, president of the Association of Chronic Disease Patients: “It is total chaos where everyone does as they interpret or as they see fit. There are situations in which some of the patients arrive privately and are sent to the public or vice versa… the state doctor does not have time, he is busy, he is on the ward, he is in surgery and sends the patient to the private practice. This should not happen! It is not normal! The two systems should not be competitive, but complementary“, he said. “If you ask me, it should be either state or private. You can't mix them up and say you work ethically here and there. Take money from both sides. There is the interpretation of the conflict of interest. So, either in the cart, or in the bargain”.
Doctor Ovidiu Telegescu comes up with a counterargument. He is of the opinion that such a separation is not possible for now in Romania. “In the personal chapter, we are very bad. I don't think we would ever be able to separate the public from the private system, because we would run out of doctors in state hospitals. In the private sector, there are other salaries, other working conditions. Here, doctors have a real chance to do their jobs. Let's not forget that state hospitals are underfunded, many are not equipped to 21st century standards”.
Radu Gănescu believes that the state should be decisive in this problem, and the authorities should clarify the problem as soon as possible. “Let it be good for everyone: patients, doctors, state and private hospitals.”
On the other hand, said Dr. Mihai Negrea, the problem is in the hands of the doctors. The specialist is of the opinion that the College of Physicians should be involved here first. “We have ethics commissions. We should regulate ourselves and say: what is happening is not ethical!”
