From Informal Exchanges to Dual Practices. The Shadows of the Romanian Health Care Reform

Open access

Abstract

The current frailties of the Romanian health care system are often explained by resorting to the previous regime’s institutional framework, rarely accepting that they are also the product of post-1990 reforms and the neoliberal means of system reconfiguration. This paper provides an ethnographic account of the ways in which two “products” of these reforms actively contribute to the augmentation of private medical services and to the diminishing access to quality care in the public system: the bureaucratization of primary medicine and the “dual medical practice”. More specifically, I use the concept of “informal exchanges” in order to explore the variety of transactions that occur between patients and the health care staff and to document the means through which its main social actors understand, reproduce, legitimize or blame the very existence of these practices. Then, I analyze how referrals to private medical units increasingly replace informal payments, simultaneously laying even harder obstacles in the access to health care for those in need.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • Baschieri A. Falkingham J. (2006). Formalizing informal payments: The progress of health reform in Kyrgyzstan. Central Asian Survey 25(4):441-460.

  • Cherecheș R.M. Ungureanu M.I. Sandu P. Rus I. A. (2013). Defining informal payments in healthcare: a systematic review. Health Policy 110(2-3):105-114.

  • Doboș C. (2006). Dificultăți de acces la serviciile publice de sănătate în România. Calitatea vieții XVII(1-2):7-24.

  • Ensor T. Savelyeva L. (1998). Informal payments for health care in the Former Soviet Union: some evidence from Kazakstan. Health Policy and Planning 13(1):41-49.

  • Ensor T. (2004). Informal payments for health care in transition economies. Health Policy 58(2):237-246.

  • Ferrinho P. Van Lerberghe W. Fronteira I. Hipólito F. Biscaia A. (2004). Dual practice in the health sector: review of the evidence. Human Resources for Health online source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC529467/ [Last accessed: 07.06.2014].

  • Irvine R. (2002). Fabricating ‘health consumers’ in health care politics. In S. Henderson and A. Petersen (eds.). Consuming Health. The Commodification of Health Care. London: Routledge pp. 31-47.

  • Institutul European din România - IER (2002). Studii de impact realizate în cadrul proiectului PAIS I. Sinteze. Studiul 10 pp. 49-82. http://www.ier.ro/documente/studiideimpactPaisI) [Last accessed: 07.06.2014].

  • Kaminska T. (2014). Informal Health Economics in Ukraine. Management in Health VIII(1) pp. 5-7.

  • Koycheva L. (2013). Fading Ink and the Elusive State: Technologies of (Dis)Trust The Permeability of Paperwork and Postsocialist Modernity in Bulgaria. Online source: http://psychole.soup.io/tag/Europe [Last accessed: 10.03.2014].

  • Liaropoulos L. Siskou O. Kaitelidou D. Theodorou M. (2008). Informal payments in public hospitals in Greece. Health Policy 87: 72-81.

  • Macq J. Ferrinho P. De Brouwere V. Van Lerberghe W. (2001): Managing health services in developing countries: between the ethics of the civil servant and the need for moonlighting. Human Resources for Health Development Journal 5: 17–24.

  • Popescu L. Raț C. Rebeleanu A. (2007). Self-assessed health status and satisfaction with health care services in the new member states of the European Union. Studia UBB Sociologia 52(2): 125–150.

  • Popescu L. (2009). Serviciile de îngrijire a sănătății [Health care services]. In M. Preda (ed.) Riscuri și inechități sociale în România. Raportul comisiei prezidențiale pentru analiza riscurilor sociale și demografice [Risks and inequities in Romania. The report of the presidential commission for the analysis of social and demographic risks]. Iași: Polirom pp.152–167.

  • Rebeleanu A. Șoitu D. Gavrilovici C. Oprea L. (2013). Echitate și respectarea drepturilor asiguraților – implicații asupra accesului la asistența medicală primară [Equity and respect for the rights of insured persons – implications for access to primary medical care]. Revista Română de Bioetică 11(2): 66-76.

  • Savedoff W. D. (2006). The causes of corruption in the health sector: a focus on healthcare systems. In Transparency International. Global Corruption Report 2006: Special focus on corruption and health. London: Pluto Press.

  • Societatea Academică din Romania – SAR (2013). Raportul de Analiză și Prognoză [Analysis and Prognosis Report]. pp. 52-66. http://sar.org.ro/wp-content/uploads/2013/03/Politica-de-sanatate.pdf [Last accessed: 14.03.2014].

  • Stan S. (2012). Neither commodities nor gifts: post-socialist informal exchanges in the Romanian healthcare system. Journal of the Royal Anthropological Institute 18: 65-82.

  • Tepurko T. Pavlova M. Gryga I. Groot W. (2010). Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments. http://www.biomedcentral.com/1472-6963/10/273 [Last accessed: 12.05.2014].

  • Vlădescu C. Scîntee G. Olsavssyky V. (2008). Romania. Health system review. Health Systems in Transition 10(3):1-172.

  • Wright E.O. (2012). 2011 A.S.A. Presidential Address: Transforming Capitalism through Real Utopias. American Sociological Review 20(10):1-25.

Search
Journal information
Impact Factor


CiteScore 2018: 0.04

SCImago Journal Rank (SJR) 2018: 0.100
Source Normalized Impact per Paper (SNIP) 2018: 0.000

Metrics
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 167 68 2
PDF Downloads 88 47 1