No easy cure

  • 2002-08-08
It takes a lot to shock a population used to corruption, but a recent incident in Riga has caused indignation. While everybody in Latvia knows that doctors are not above taking "gifts," a case in which a patient died before she could stump up cash seems to be the thin edge of the wedge.

Perhaps this tragedy has raised such an outcry because it seems so close to home. Politicians and bureaucrats take bribes, but the results of these acts are not as ghastly or immediate as a helpless patient being left to rot by a greedy medic.

Who knows - could you be next?

Of course, the actions of this doctor were wrong. But while the moral judgments are easy to make, ensuring that this scenario doesn't repeat itself is a lot more difficult.

That's because human nature is tough to change, arguably even more so in a post-Soviet society where ethical standards are pitifully low. Rather, what is needed is a complete overhaul of an outdated and inefficient medical system.

It is fair to assume that Latvian doctors do not study for years and assume stressful responsibilities because they enjoy squeezing under-the-table payments out of patients. But the medic involved in the recent scandal, one of the country's top neurosurgeons, receives a salary of about 200 lats (316 euros) per month. On average, his colleagues pull in some 130 lats. To say that these wages are insulting is an understatement. To believe that doctors will not expect bribes under these conditions is wishful thinking.

So Latvia is left with two choices unless it wants things to go in the current sad way. First, find more money for medicine. This could mean raising taxes. It could also involve abandoning the pretense of having universal free medical care and restricting state-funded services to just the desperately needy. People might even welcome the regulation of a sphere that is effectively user-pays now anyway.

The second way would be to conduct radical surgery on the national health system to bring it up from its abysmally low standards.

According to data from The Economist newspaper, there is one doctor for every 294 persons in Latvia, compared with 333 each in Finland and France. Latvia has 10.3 hospital beds per 1,000 people, compared with 4.6 in Denmark and 3.7 in the in the United States.

This would be well and good if Latvians were getting a standard of medical care equal to or even better than Western countries. But anyone who has visited a local polyclinic, to be shouted at, misdiagnosed and mistreated, knows this is not the case.

There are many fine, professional medical workers in Latvia. But there is also a lot of dead wood draining resources and providing little or no service to the public.

Perhaps some parties in the upcoming election campaign will have the courage to raise these issues instead of making the usual empty promises to throw more money at various groups.

But don't hold your breath.