A pressing question for any mother this winter is whether or not to get an H1N1 vaccine for her children. Julie Coleman of TRACE provides this comparison of “free” health care services.
For those of us in the United States, the decision to vaccinate turns on two basic factors: availability of the vaccine and a personal assessment of the risks and benefits of the vaccine. One factor we do not have to consider is price: the H1N1 vaccine is free thanks to the U.S. government. And here, because free means free, I took my children to a clinic where professional nurses administered the vaccine. The only cost I had to bear was dealing with three slightly cranky, but vaccinated, children who were only partially pacified with lollipops and stickers (also free).
Nevertheless, despite my best efforts at prevention, all three kids predictably fell ill several weeks later. Because I have health insurance, I was able to look at the co-pay on my insurance card and make another informed decision: I returned to the doctor, paid the co-pay, and had a few tests run. And, for the time being, I now have healthy children.
The scene is much different in Ukraine, as reported recently by The New York Times (Fragile Care Worsened Swine Flu in Ukraine). In Ukraine, health care is officially free. However, patients typically must pay cash bribes to doctors and nurses, who themselves are very poorly paid. Due to a number of factors, not the least of which is the unpredictability of the cost of medical care, people who fell sick this fall as flu descended in Ukraine avoided hospitalization until the need became dire. In short, people would not go to the hospital until “their lungs were so saturated with blood they could barely gasp.” The article in the Times profiles one patient – Galina, a 43 year old dentist and the mother of two – who went to the hospital only after her breathing became very labored. After a battery of tests – and about $4,300 in cash bribes paid by her family to doctors and nurses – Galina died.
Today, TRACE issued its fourth BRIBEline report on bribery patterns in Ukraine. Not surprisingly, the 2009 BRIBEline Ukraine Report supports the anecdotal evidence reported in The New York Times. Key BRIBEline findings include:
· 90% of all bribe solicitations in Ukraine were made by a government official (an employee of a state owned entity, a member of the police or the judiciary, or a city, state of local government official). Significantly, 43% of all bribe solicitations in Ukraine were made by employees of state-owned entities.
· Cash (or its equivalent) was demanded in 87% of the reported incidents of bribe demands in Ukraine.
· 82% of the bribe demands made in Ukraine were for amounts less than US$5,000, and a full 11% of all demands made were for amounts greater than $10,000.
· 66% of survey respondents reported that a bribe demand was recurring (i.e., a bribe was to be provided more than once).
· Nearly 60% of the Ukraine reports cited extortion as the primary purpose of the bribe demand.
The BRIBEline Ukraine report tracks very closely to Galina’s experience. In Ukraine, a government official, such as a doctor or nurse at a state-run hospital, is likely to repeatedly request a modest cash bribe (which requests quickly add up to a significant amount of money). In Ukraine, bribes are generally extortionate in nature, a particularly frightening experience when healthcare is at stake.
For Galina’s family, the incentive for succumbing to the bribe demand was overwhelming: to attempt to gain access to life-saving medical treatment for their mother. Sadly, these attempts by her family were futile, and serve as a distressing example of how bribery’s negative impact can be felt from large economic systems down through individual lives.