Free medical care? There is no such thing; if state can’t pay doctors in public hospitals, patients will have to do so

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March 18, 2011, 12:13 a.m. | About Kyiv — by Kostyantyn Zelensky
Ukrainians often wonder how many decent doctors stayed working in state hospitals and polyclinics instead of joining private practices. “When you say “decent”, what exactly do you mean, doctor?” you might inquire. I mean highly qualified and altruistic doctors whom you would want to find for love or money. As a person who worked in a state hospital for a few years, I can tell you they’re as rare as gold dust. And the reason is that it’s hard for them to survive there.

But even a professional state-employed doctor can either help, or pass the patient on to the hospital or to another doctor, depending on circumstances. Almost any doctor, however, will do their best if they receive additional motivation.
It’s common knowledge that for a state general practitioner the main sources of income are his salary and extra “rewards” for medical certificates or spravkas – such as sick leaves – and the patients’ little extras. This second component of their income is often much higher than the official salary.

The doctors, who for various reasons work in the state medical sector, have evolutionary developed ways to make money, as well as various personal insurance methods against the “difficult” patients. They have ways to pass on the patients who give them too much of a headache.

The story I am about to tell you is a good case in point.

My former classmate’s little son got sick. His temperature was up to 38.3. The father got scared, called an ambulance, doctors arrived, diagnosed a common cold, gave him a shot of a fever relieving drug and left. What to do next, they said, was not a part of their job.

The resentful father called the emergency service again, but before that he called me to ask for advice. What should I do? How should I thank the doctors?

Since my classmate worked in the State Security Service (SBU) for several years, and then moved on to the tax police, for him this issue was a professional challenge. Rather than “thanking” by slipping a few bills into someone’s hands, he was more used to, maybe, giving someone a bottle of liquor for a present.

So, now he was asking me if there was a right way of thanking a state-employed doctor, and – importantly – where he should find a decent doctor for the future.

My advice was to not reinvent the wheel, call the local doctor from the polyclinic and “thank” him or her with a bit of cash for a visit. If they like the doctor, they should exchange telephone numbers and be friends from then on, or rather work together as a team of a good doctor and a grateful patient.

He listened very carefully, inquired how much he should pay and said farewell. When his child got sick in a month’s time and my friend once again called me in the middle of the night, I asked him whether he had found the right pediatrician.

He told me he had solved the problem with doctors another way: he went to the local polyclinic, flashed his scary ID card and bullied all the doctors. Now they’re afraid of him and run to him at his first call. All was well, but once again he was calling me at home asking why his child is once again being sent to the hospital.

Any doctor is capable of treating a common cold – not in the least because the cold just passes by itself! So, why were they sending his child to the hospital?

I come across similar questions all the time. So, what is the answer, and what is the moral of my classmate’s story?

Although it is a violation of laws and constitution, had the child’s dad spent Hr 100-200 in the first place (ideally, without flashing his credentials), his son would have been perfectly fine and stayed at home. He would not be taken from one hospital to another, having to take tons of drugs he does not really need. That’s not to mention money spent in vain on drugs, taxis and so on.

His other option would have been to go to a private hospital, but that’s another story.

He could, of course, complain, but it’s not going to work. It’s not just a single doctor who does not want to and cannot play by the rules, the whole system is flawed. And, to beat a system, you need another system – you can’t do it alone.

It’s been a while since all those officials and bureaucrats in healthcare have done anything for the healthcare. They work like surgeons – chopping chunks off the budget. They can’t care less about the problems at the bottom of the food chain and are governed by their own set of interests.

So, it’s up to you to decide whether you should thank a doctor or not. Just remember that counting on your constitutional rights and hoping that someone else will sponsor your free medical care these days are just as naive as hoping that the minister’s black Mercedes will stop at the red light.

Kostyantyn Zelensky is a general practitioner in Kyiv. You can read more of his blogs and op-eds.
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