Medicine is an area that certainly should not be affected by corruption. However, bribery is common. What situations can any resident of Russia face when applying for medical care, we will tell you in our article.

The fight against corruption: three problems that exist in medicine

News anchors daily tell us about the waste of public funds allocated for the purchase of medicines for the needy, the transfer of bribes to doctors and the resale of medicines. Yes, corruption in healthcare is rampant both in Russia and abroad. Let's find out which 3 problems are especially relevant.

Falsification of certificates

If you believe the statistics, one out of seven conscripts is marked “unfit” by the medical board. However, how many young people from this number actually fit into category D - that is the question. It is quite easy to purchase a fake certificate signed by a doctor - there are dozens of organizations on the Internet that provide such services.

Levada Center surveyed 1.5 thousand Russians for the Committee of Civil Initiatives (CGI) on how they assessed the level of corruption in public health and educational institutions. In clinics, hospitals and universities, survey participants most often had to pay bribes.

Polyclinics have a good reputation only among 49% of Russians surveyed. This is the lowest figure compared to other institutions social sphere, says the OIG report.
The respondents justify their opinion by the fact that in clinics “negative informal practices” prevail over the positive aspects of interaction with patients. If “sincereness” and “individual approach” were noted by only 25% and 24% of respondents, respectively, then 36% of respondents spoke about corruption.
In public hospitals, corruption is also perceived as commonplace. Here, “informal payments” were noted by 41% of Russians, “heartfelt attitude” towards patients – 29%, and “individual approach” to them – 28%. The report's authors highlight the formalism and lack of resources to serve patients in public medical institutions. “The spaces of these institutions are “foreign” for patients. Let us first note the formalism of doctors: it is not so much the doctors themselves who are blamed for it, but the current medical insurance system, which obliges doctors to spend a lot of time filling out forms (manually) instead of examining the patient and talking with him. Doctors are accused of a lack of “human” attention to patients, that is, of a lack of that informal component that is considered an essential element of a quality medical service, and, on the contrary, of an excess of impersonal standard attitude. Added to this is the status distance established by health workers in relation to patients, to patients,” the report says.

As a result, patients try to switch to informal relationships, including through “gifts” to health workers. In general, corruption is perceived by Russians as a common phenomenon: more than 50% of Russian residents are confident that a bribe can get both services required by law and those not required by law.

Unlike budgetary institutions, commercial medicine is considered exemplary in terms of its level medical care. Russians are convinced that best forces and resources transferred to paid medicine, which is free from corruption, and a doctor from a district clinic works better in a paid clinic.

Levada Center surveyed 1.5 thousand Russians in 2017, asking them to evaluate the work of healthcare and educational institutions (kindergartens, schools, universities, clinics and hospitals), including regarding corruption practices. Based on the survey results, OIG prepared a report on “formal and informal relations in the health and education systems.”

Introduction 3

Corruption in healthcare and its types 4

Causes of corruption in healthcare 8

Corruption in the Russian healthcare system 11

Conclusion 16

List of sources used 17

Introduction

Corruption has been and remains one of the global problems facing the international community. Russia is one of the most corrupt countries in the world. Besides, Russian companies the most active people in the world give bribes in developing countries, and they are used “in huge, unacceptable sizes.”

Corruption permeates all spheres of society, including healthcare. The importance of the healthcare sector can hardly be overestimated: it allows achieving such goals as natural population growth, reducing morbidity, increasing labor productivity, extending the working period of workers, which contributes to the growth of the country’s national income and improving the well-being of the people.

The purpose of the abstract is to analyze corruption in Russian healthcare. To achieve this goal, it is necessary to solve the following tasks:

Consider the types of corruption in healthcare;

Identify the causes of corruption in healthcare;

Analyze corruption in the Russian healthcare system;

1. Corruption in healthcare and its types

Corruption in healthcare is a recurring and constantly evolving complex negative socio-legal phenomenon, which is expressed in the selfish use by medical workers of their official position in the state (municipal) and private healthcare systems for the purpose of unlawfully obtaining material, intangible benefits and advantages, as well as in the illegal provision of such benefits to individuals or legal entities, causing or capable of causing significant harm to the interests of society and the state in the field of protecting public health, as well as destroying normal social relations in the sphere of realizing the rights of citizens to health care and receiving medical care.

The level of corruption offenses in this area can vary from extremely high (state government level) to low (doctor-patient system).

There are several most typical types of corruption in healthcare:

1. Waste and embezzlement of funds allocated for health care or income received through payments from consumers. This can happen both at the state and local levels, and directly in the medical institutions that receive such funds. Medicines, other resources and medical equipment are stolen for personal use, use in private practice or for further resale.

2. Corruption in public procurement. Involvement in various collusions, bribery and kickbacks in the field of public procurement leads to overpayments for goods and services received or to the inability to ensure the quality stipulated by contracts for such goods and services. Hospital costs may also include significant costs for capital construction and the purchase of expensive equipment.

3. Corruption in payment systems. Here, corrupt practices may include free service, falsification of insurance documents or use of funds medical institutions in the interests of certain privileged patients; issuing illegal invoices to insurance companies, government agencies or patients for unlisted or unprovided services in order to maximize revenue; falsification of invoices, receipts, consumable documents or registration of fictitious patients. In addition, such forms of corruption as: development own business by creating financial incentives or paying kickbacks to doctors for referring patients to a particular organization; unlawful referral by doctors of patients of public medical institutions for services to their own private structures; carrying out unjustified medical intervention in order to increase one’s own income.

4. Corruption in the drug supply system. Drugs can be stolen at various levels of the distribution system. Government officials may demand “remuneration” for issuing permits for the sale of products or the operation of certain structures, for conducting customs clearance, or for setting favorable prices. Violations of market codes of conduct result in doctors being forced to give preference to certain drugs when writing prescriptions. Various concessions may be extorted from suppliers in exchange for prescriptions for their products. Another possible form of corruption is the issuance of permits for the sale of counterfeit or substandard medicines. The problem of combating corruption in the supply of medicines became most acute at the end of 2009, when, due to the swine flu epidemic, prices for medicines were artificially inflated and drugs from individual manufacturers had an advantage in the medicine market.

In addition, corruption in health care providers can take other forms. For example, the most common types of “bribes” are the following:

For receiving a certificate of temporary disability and various certificates: about unfitness for military service, about fitness to drive vehicles, about permission to perform certain works, about permission to engage in one or another sport, about exemption from physical education;

For a high-quality operation for the patient (i.e., not “like everyone else,” but with an individual approach). In this case, the patient is guaranteed high-quality preoperative and postoperative care, the use of the best medications, sutures and dressings;

For confirmation or concealment of certain medical facts (most often - beatings and other bodily injuries);

For issuing the “necessary” prescription;

For distortion the real reason death (the size of such bribes is one of the largest in medicine, since in many cases they are directly related to the commission of crimes);

For early discharge of a patient from the hospital or, conversely, for prolongation of the patient’s stay in the hospital, etc.

Wherein we're talking about not so much about small bribes in the form of “offerings” to doctors for treatment, but about the increasing frequency of last years more dangerous manifestations of corruption:

Artificially creating a “deficit” in the provision of medical services, when people who are in dire need of certain medical studies are forced to wait for months for them. At the same time, for a certain fee, these studies are carried out more quickly. At the same time, forced payment for medical services does not always guarantee their quality;

The gradual transformation of medical institutions into “trade” institutions, in which honest, qualified doctors are replaced by medical businessmen.

Corruption in healthcare undermines citizens' trust in representatives of the medical community, because initially in people's minds medical worker is a person dedicated to helping people, often giving the last hope when life and health hang by a thread. However, in reality everything is different: rudeness, negligence, incorrect diagnoses and often a direct hint of bribery. This attitude disgusts people in white coats.

Undoubtedly, there are doctors who work “for the idea,” and there are many of them, but it is the bribe-takers who make up people’s preconceived opinions about doctors. This leads to a decrease in the moral standards of the population. Many have stopped believing that the fight against corruption will bring visible results, and its very manifestation has become a common norm of life.

According to Investigative Committee Russian Federation, for 2011 on facts of corruption investigative authorities 362 health workers were prosecuted. Charges were brought against both ordinary doctors and high-ranking officials.

Corruption crimes in the healthcare sector

3. Corruption in payment systems. Here, corrupt practices may include providing free services, falsifying insurance documents, or using funds medical organizations in the interests of certain privileged patients; issuing illegal invoices to insurance companies, government agencies, or to patients for services not provided in order to maximize income; falsification of invoices, receipts, expenditure documents or registration of fictitious patients.

4. Corruption in the supply chain medicines. Drugs can be stolen at various levels of the distribution system. Government officials may demand “remuneration” for issuing permits for the sale of products or the operation of certain structures, for conducting customs clearance, or for setting favorable prices.

Violations of market codes of conduct may result in doctors being forced to give preference to certain drugs when writing prescriptions. Various concessions may be extorted from suppliers on the condition that prescriptions for their products are issued. It is also possible to issue permits for the sale of counterfeit or other low-quality medicines.

5. Corruption in organizations providing medical services. Can take many different forms:

• solicitation or consent to receive illegal remuneration for services officially provided free of charge;
• charging for special privileges or medical services;
• solicitation or consent to receive bribes for interfering with the hiring, licensing, accreditation or certification practices of certain structures.

Taking into account the above classification of corruption crimes, these forms of corruption in the healthcare sector can be presented as follows.

Main group of corruption crimes:

1) abuse of official powers (Article 285 of the Criminal Code of the Russian Federation);

2) inappropriate spending of budget funds and funds of state extra-budgetary funds (Articles 285.1, 285.2 of the Criminal Code of the Russian Federation);

3) entering obviously false information into the unified state registers (Article 285.3 of the Criminal Code of the Russian Federation);

4) abuse of official powers (Article 286 of the Criminal Code of the Russian Federation);

5) bribery (Articles 290, 291, 291.1 of the Criminal Code of the Russian Federation);

6) official forgery (Article 292 of the Criminal Code of the Russian Federation);

7) illegal issuance of a passport of a citizen of the Russian Federation, as well as the entry of knowingly false information into documents, which resulted in the illegal acquisition of Russian citizenship (Article 292.1 of the Criminal Code of the Russian Federation);

8) abuse of power and commercial bribery in the field of private medicine (Articles 201, 204 of the Criminal Code of the Russian Federation).

The country's healthcare system is the most affected by bribery. Inappropriate spending of budget funds allocated for healthcare needs is also common. The Accounts Chamber published the results of an audit of the effectiveness of the use of funds allocated for the modernization of healthcare, according to which only a little more than half of the money (59.3%) was spent for its intended purpose.

An additional group of corruption-related crimes in the healthcare sector is represented mainly by three subgroups of crimes:

1) crimes against personal freedom: illegal placement in a mental hospital (Article 128 of the Criminal Code of the Russian Federation);

2) crimes against property: fraud by a person using his official position (Part 3 of Article 159 of the Criminal Code of the Russian Federation), misappropriation or embezzlement using his official position (Part 3 of Article 160 of the Criminal Code of the Russian Federation);

3) crimes against public health: illegal production, sale or transfer of narcotic drugs (NS), psychotropic substances (PS) or their analogues, as well as illegal sale or transfer of plants containing NS or PS, or their parts containing NS or PS (228.1 of the Criminal Code of the Russian Federation); illegal issuance or forgery of prescriptions or other documents giving the right to receive NS or PV (Article 233 of the Criminal Code of the Russian Federation); theft or extortion of NS or PV, as well as plants containing NS or PV, or their parts containing NS or PV (Article 229 of the Criminal Code of the Russian Federation).

More often officials occupying leadership positions in health authorities, commit theft using their official position. This is exactly the situation presented at the beginning of our article.

In conclusion, we note that general provisions on the responsibility of the previously mentioned subjects of corruption offenses (crimes) are contained in Art. 13, 14 of Law No. 273-FZ. According to Art. 13 citizens of the Russian Federation, Foreign citizens and stateless persons for committing corruption offenses bear criminal, administrative, civil and disciplinary liability in accordance with Russian legislation.

Wherein individual who has committed a corruption offense, by a court decision, may be deprived in accordance with the law of the right to occupy certain positions in the state and municipal service.

Thus, all corruption offenses (crimes) that are the basis for imposing legal liability, are contained in industry legislation.

Citizens tend to rate hospitals and clinics as more corrupt places than schools, kindergartens and universities, experts from the Committee of Civil Initiatives (KGI) of ex-Finance Minister Alexei Kudrin found after studying a Levada Center survey conducted at the end of February. This follows from the report “Formal and informal relations in health care and education systems,” which RBC has.

Andrey Novitsky, chief physician City Hospital No. 15:

From the text provided by the media, it is not very clear what is meant by corruption in this case. Is it procurement and supplies or so-called everyday corruption - roughly speaking, bribes received by doctors from patients? And if the patient sincerely wants to thank the doctor for his excellent work, as a result of which his health, or even his life, was saved, is this also a bribe? How to interpret this? And how did the experts and respondents interviewed during the study interpret this? Sometimes it is not possible to clearly distinguish between criminal and non-criminal, ethical and unethical; the truth is concrete.

In addition, today, due to financing or other reasons, some medical institutions lack consumables and medicines (I am not taking into account large medical centers, where, as a rule, everything is in order). And a request, a doctor’s recommendation to a patient to independently purchase this or that drug or something no less necessary - is this also a violation, is this also corruption? How was it qualified?

IN public consciousness There is a stereotype according to which the situation in domestic healthcare provokes manifestations of corruption. As a specialist, I can say that there is a fairly strong emotional component in such assessments: patients, when faced with some problems for which the doctor is not necessarily to blame, do not always restrain their emotions.

As for direct extortion of bribes from doctors, today it is much more a rare event than before. Doctors' salaries in most government institutions are quite high. In St. Petersburg they perform “ road map”, adopted several years ago, on increasing the salary of employees of medical institutions. In general, the salaries of health workers now correspond to the target indicators. I would not say that doctors now receive little and are therefore prone to abuse. If we talk about the institutions that I have led in recent years, doctors are satisfied with their earnings - especially those payments that came at the end of last year and the beginning of this year.