Corruption In Healthcare System Of Russia: Challenges And Effects

Abstract

One of the key factors hindering stable development of the national economy is corruption. Corruption increases an amount of crimes, has a negative impact on regional and national economies. Health protection at the national and international levels is a supreme value of any government. The article analyzes the contemporary state of corruption in healthcare. The article deals with corrupt practices in the national healthcare system. Healthcare corruption involves giving gifts (boxes of chocolates, bouquets of flowers, alcohol, money in envelopes) as signs of respect, gratitude, etc. Corruption in the health care system brings discredit to the medicine community. It is reasonable to believe that health care workers who made the Hippocratic oath should help people. Sometimes health care workers are considered as the last chance when life and health are on a thread. However, the reality is rather different: rudeness, negligence, erroneous diagnosis, extortion. This behavior excites aversion to health workers. According to investigative practice, in all Russian regions, corruption growth is influenced by economic factors, in particular economic instability. The article analyzes approaches to healthcare corruption, its contemporary state, identifies forms of corruption, analyzes facts of corruption, suggests measures to decrease a healthcare corruption level.

Keywords: Corruptionhealthcareshadow and criminal economy

Introduction

Chapter 2 of Article 41 of Constitution of the Russian Federation says: 1. Everyone shall have the right to health protection and medical aid. Medical aid in state and municipal health establishments shall be rendered to individuals gratis at the expense of the corresponding budget, insurance contributions, and other proceeds. 2. In the Russian Federation, federal programs of protecting and strengthening the health of the population shall be financed by the State; measures shall be adopted to develop state, municipal and private health services; activities shall be promoted which facilitate the strengthening of health, the development of physical culture and sport, ecological and sanitary-epidemiological well-being.

3. The concealment by officials of the facts and circumstances posing a threat to the life and health of people shall entail responsibility according to the federal law. There are some other legal acts which regulate the issues of life and health of patients: Federal Law No 474-FZ of November 21, 2011 “On the fundamentals of health protection in the Russian Federation”; Federal Law No 474-FZ of December 29, 2014 “On peculiarities of the legal regulation of relations in healthcare and medicine circulation in the Republic of Crimea and Sevastopol”; the Government Decree of the Russian Federation, No 1018 of October 8, 2012 (as revised of July 29, 2016) “On the government health protection committee”; the Government Decree of the Russian Federation No 907 of September 10, 2012 “On the criteria according to which non-commercial healthcare establishments can be entitled to perform certain healthcare protection functions in the Russian Federation”; the Government Decree of the Russian Federation No 1006 of October 4, 2012 “On the authorization of commercial healthcare service delivery regulation”.

Corruption can have a negative influence on performance of the healthcare system which has to render quality medical aid. According to the World Healthcare Organization, annual expenditure of the global healthcare system is 4,1 trillion dollars. According to the document approved by the Government of the Russian Federation, 362 billion rubles instead of 544 billion rubles provided for in the federal budget are allocated to the healthcare system. At the same time, the main source of healthcare financing is the Federal Compulsory Medical Insurance Fund which intends to spend 1,69 trillion rubles (in 2016, it spent 1,68 trillion rubles) (Sabanin & Kuznetsova 2011).

Problem Statement

Corruption in the health care system brings discredit to the medicine community. It is reasonable to believe that health care workers who made the Hippocratic oath should help people. Sometimes health care workers are considered as the last chance when life and health are on a thread. However, the reality is rather different: rudeness, negligence, erroneous diagnosis, extortion. This behavior excites aversion to health workers. Healthcare corruption involves any corruption actions violating legal acts and hindering development of the healthcare system. They often are committed by persons entrusted with positions of authority to acquire personal or corporate benefits to the detriment of social interests.

To eliminate the causes of corruption, it is necessary:

• to develop a legal definition of a healthcare official and include it in legal acts of the Russian Federation which regulate the issues of healthcare corruption;

• to identify corruption determinants;

• to identify forms of corruption;

• to analyze efficiency of anti-corruption measures;

• to identify loopholes and develop amendments to legal acts of the Russian Federation

Research Questions

Corruption in contemporary Russia is not a one-element criminal phenomenon which can be eliminated with one legal rule. Corruption is a complex multi-structural negative social and economic phenomenon. It is a global problem of the national economy which destroys the economic system (Tatarnikov, 2015; Boskholov, 2014).

Current laws do not contain definitions of the term “corruption”. Therefore, one can find different definitions of this phenomenon:

Corruption is the abuse of power, bribe giving, bribe taking, excess of power or any other illegal use of power against public or social interest for personal or third parties’ benefits.

Corruption (from Latin сorrumpure – destroy completely) is a form of illegal and unethical conduct by a person entrusted with a position of authority to acquire personal benefit. According to the international experts, Russia is one of the most corrupt nations in the world. It ranks only after African and Asian countries. The scale of Russian corruption is enormous. It can equal to the amount of the federal budget. At present, corruption is a systematic problem which breaks economic development of Russia, undermines the total national safety.

Corruption is absorbing different social and economic areas – healthcare, education, businesses, public government, law-enforcement agencies, agriculture and a defense system. Urgent measures are required to ensure the normal course of economic development and remove social tension. (Turkova, 2012; Turkova, Archipova & Kitaev, 2017)

Purpose of the Study

Corruption hinders business development, decreases efficiency of public administration, discourages investment activities, hinders economic and political development, generates social inequality, disorders political processes. Healthcare corruption hinders implementation of tasks which are a priority for social and economic policies of any government. Due to this fact, healthcare corruption issues are a topical research area.

Research Methods

According to the Department for Economic Security of the Ministry of Internal Affairs of the Russian Federation (Convention against Corruption, 2006; Ministry of internal Affairs of Russia, 2018) corruption-related crimes were identified (24980 crimes were solved). 11443 crimes (9670 crimes were solved) were cases of bribery, including 3094 bribe-taking crimes (2201 crimes were solved), 2166 bribe-giving crimes (1966 crimes were solved), 763 bribery facilitation crimes (488 crimes were solved). In comparison with 2016, the number of registered corruption-related crimes decreased (32924 registered crimes and 30256 solved crimes) which is a positive trend which speaks for efficiency of anti-corruption measures. However, one should not jump to conclusions about a decrease in the corruption level. It should be taken into account that corruption-related crimes are very latent.

According to the head of the Investigation Committee of the Russian Federation, General A.I. Bastrykin, key figures of corruption-related crimes are often officials of law enforcement agencies, municipal bodies and companies, employees of education and healthcare institutions and military servants. For example, among the accused, there were 845 law enforcement officers, 571 officials of municipal companies and institutions, 529 officials of municipal bodies, 490 military servants, 277 employees of the education and science system, 221 employees of the healthcare system.

Findings

Corruption-related crimes committed by health workers play a special part in the structure of healthcare corruption-related crimes. These crimes are especially dangerous as far as they deal with human lives and health. Quality of medical services influences prosperity and development of the contemporary healthy society. For example, in Article 4 of Federal Law No 323-FZ of November 21, 2011 “On the fundamentals of healthcare protection in the Russian Federation”, among the basic health protection principles there is determination of the rights of individuals in the sphere of health protection, and establishment of guarantees for the observance of these rights; priority of patient interests during medical treatment; responsibility of public and municipal bodies, officials, organizations for patient rights protection; affordability and quality of medical services, prohibition on refusal to provide medical aid (Kombarov, 2016). Bribery in healthcare is a result of violation of these particular rules (Kitaev & Kitaev 2010).

The analysis of investigative practices identified that among corruption-related crimes committed by health workers, offenses provided for by Articles 159, 285, 286, 290, 292 of the Criminal Code of the Russian Federation are most widespread.

Evidence of Moscow Investigation Department of the Investigation Committee of the Russian Federation was declared insufficient for sentencing colonel of Medical Service Corps S. Svistunov, the former chief of the Central Military Hospital n.a. A.A. Vishnevsky, lieutenant colonel A. Melkonyan and therapist D. Mokritsky, the chiefs of the admission department and the 54th medical ward of the Central Military Hospital. They were found guilty of crimes provided for by Part 2 of Article 290 (bribe taking by an official, by a group of persons in a preliminary conspiracy, on a large scale), Part 1 of Article 291.2 (minor bribery) and Part 1 of Article 286 of the Criminal Code of the Russian Federation (exceeding official powers). It was established that for the period from June to December 2015, Svistunov alone and through Melkonyan, Mokritsky and Eduard Miklashevich, the chief of the 35th surgery department of the hospital took one million rubles for illegal hospitalization and medical treatment from ten citizens. Besides, Mokritsky alone took 225 thousand rubles for the same activities from four citizens. In the same year, Svistunov, exceeding his official powers, demanded and received a part of bonus salaries of his subordinates in the amount of 170 thousand rubles. By the decision of Moscow District Military Court, Svstunov, Mokritsky and Melkonyan were sentenced to 9, 5 and 3.5 years in a strict regime colony and fined 4.1, 2 and 1.25 million rubles correspondingly with disqualification to hold offices in healthcare establishments. Besides, Svistunov was deprived of the Medical Service Corps Colonel rank.

Let us give one more example. The investigation and court found that in 2008, in a preliminary conspiracy, two doctors of the former cardiology hospital and the head of the branch of Kostroma Chief Disability Examination Office took bribes for issuing false documents and determining false disability diagnoses. The doctors determined false disability diagnoses for money, negotiated amounts of money and money transference methods, prepared false medical records of medical treatment in the cardiology hospital and misrepresented data on their health status. Depending on their roles, they were found guilty of the commitment of the crimes provided for by Clause “a” of Part 5 of Article 290 of the Criminal Code of the Russian Federation (bribe-taking by a group of persons in a preliminary conspiracy), Parts 1, 2 of Article 290 of the Criminal Code of the Russian Federation (bribe-taking), Part 3 of Article 30 of the Criminal Code of the Russian Federation (attempted bribery), Part 1 of Article 285 of the Criminal Code of the Russian Federation (bribery facilitation). They were fined 2,5 and 4 million 995 thousand rubles with disqualification to hold offices in healthcare establishments and engage in medical examination activities for a term of up to four years. The bribery facilitator was fined 65 thousand rubles. The head of the Nutrition Hygiene Department of Minusinsk State Sanitary and Epidemiological Center was arrested in her office. She received a 2550 ₽ bribe for issuing an illegal sanitary and epidemiological certificate for a sausage department. In March, Igor Ivatchenko, a medical director of Eniseisk State Sanitary and Epidemiological Center, was caught red-handed. He received a 5000 ₽ bribe from a businessman for issuing a false certificate for rented areas. A doctor of Kansk psychoneurological hospital was also arrested when receiving a 4000 ₽ bribe. He issued a false alcoholic intoxication certificate. A medical director of Minusinsk district hospital was charged with receiving a 1500 ₽ bribe. A duty doctor of Kansk psychoneurological hospital was arrested for false medical examination. A physician of Sharypovo hospital and Krasnoyarsk city hospital No 8 were arrested for receiving 600 ₽ and 400 ₽ bribes respectively and issuing false work incapacity certificates. Medical workers of the Regional Drug Abuse Clinic received 7000 rubles for issuing false alcohol intoxication certificates. They were caught red-handed. The high-profile trial took place in February 2005. The Krai prosecutor’s office initiated a criminal case against Mikhail Sokolov, a medical director of Krasnoyarsk psychoneurological hospital. He was charged with bribery and extortion. The preliminary investigation lasted for six months. Then the case was referred to the Oktyabrsky district court. As a result of the six-month work of the Krai prosecutor’s office, the punishment was mitigated. Mikhail Sokolov was accused of bribe taking and sentenced to a fine of 400 000 ₽.

Conclusion

The corruption in the healthcare system causes negative social consequences. It discriminates citizens by their social status and has a negative effect on the public administration system and economic development of the country. Legally speaking, the corruption in healthcare leads to mass violation of constitutional rights and freedoms.

Frauds and briberies in the healthcare system have negative effects on the quality of healthcare services. They also have more terrible consequences. Due to corrupt practices of persons who are in charge of distribution of drug-containing substances, drugs are sold in illegal drug markets. A number of thefts of drastic psychoactive drugs committed by healthcare workers is increasing. One can conclude that the corruption in the healthcare system endangers the health of the nation.

Thus, healthcare workers receive bribes for:

• issuing sickness certificates, certificates of unfitness for military service, fitness for driving, performing specific tasks, physical education exemption, etc.;

• quality surgeries and surgical nursing, use of quality drugs and bandaging materials;

• certification or non-disclosure of medical facts (e.g., battery or other physical damages);

• writing out “required” prescriptions;

• falsification of true causes of death (these briberies hide evidence);

• premature release from hospitals or in-treatment prolongation;

• issuing mental health certificates.

In some large capital city hospitals, senior positions are sold. They can be sold to people who do not have medical degrees. It is one of the most awful corruption-related crimes. Pseudo-managers damage the healthcare system.

The corruption exists at all levels of the healthcare system – from nurses to high-level officials of the Ministry of Healthcare. The higher the level of the healthcare worker is, the more serious the crimes are: if doctors can receive a 100 ₽ bribe, health care officials receive thousands $.

A question arises as to how to measure healthcare corruption with regard to its forms. There are several forms of healthcare corruption which deal with public purchasing; certificate of sickness; embezzlement of healthcare financial resources; payment systems; bribe-taking for services which should be delivered free of charge; surgeries, etc. Most anti-corruption measures should be implemented using the following methods:

• development of mechanisms eliminating opportunities of delivering illegal fee-paying medical services (“over the counter”), utilization of healthcare facilities as a front for private practices;

• provision of information about patient rights and responsibilities, including the right to receive free medical services;

• implementation of additional salary incentives for health workers, non-monetary stimulation for anti-corruption activities (Pobegailo, 2004).

Shadow economy and large-scale corruption, including healthcare corruption, endanger the national security. The problem can be solved by implementing a range of measures aimed to protect human health.

References

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