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Armenia: Will Medics Pay Rise Curb Corruption?

Patients say increases unlikely to stem culture of bribe-taking in health service.
By Lilit Harutyunyan
Armenia is set to significantly raise the price of medical services in part to fund health service pay increases – but there’s scepticism the move will deter medical staff from allegedly demanding bribes from patients.



Karlen Antonyan, deputy director of the state health agency, said the average price increase will be twofold, although some services will get dramatically more expensive. The rises will contribute to increases in salaries for doctors and, possibly, other health service workers.



“A serious price rise is expected in casualty departments and urology. After the price increase, the average doctor’s salary will rise to 1,000 US dollars a month,” he said.



Officials said the price rises were intended to bring the cost of medical services out into the open. At the moment, doctors and other medical staff are accused of regularly demanding bribes, as some claim their salaries are not enough to live on.



Ara Babloyan, chairman of parliament’s standing committee on social affairs, healthcare and environmental protection, said the price rises should be understood as a recognition of the real cost of medical services.



“I must honestly say that prices today include not only the official payment, but also under-the-table money,” he said, pointing out that only a handful of medical centres in Armenia do not demand bribes.



IWPR spoke to several doctors and nurses who said that corruption in the health service was widespread.



“After our shifts, we give part of the illegally received money to the manager of the department, who in turn gives a sum to the senior doctor in the hospital. I think he must give money to even more highly-placed officials. This is compulsory, so not that much remains with us,” said one doctor.



Nurses who spoke to IWPR said hospitals regularly did not give them their actual salaries, forcing them to fall back on demanding money from patients.



“I do not get [my 27,000 drams (70 dollars) a month salary], and anyway my monthly expenses are double it, and that comes from money I get from patients. Of course it would be good if I could legally be paid 150-200,000 drams. Then I would not take money from patients,” said one nurse.



A surgeon said he was sure that salary increases in the health service would stop the practice of taking bribes, since medical staff would prefer to live without them.



“Why do I not receive a sufficient salary to stop me having to deal with the sick in this way? As a doctor, I feel degraded. Do you think that we doctors like this? But officially I receive 40,000 drams per month. How can I support my family with that?” he asked.



But patients who spoke to IWPR as they waited in hospitals did not believe the reforms would stop medics from taking bribes.



“When these reforms are implemented, people will have to pay even more, but I am sure this will change nothing when it comes to corruption,” said Ruzanna, who had brought her mother to a hospital in Yerevan for treatment.



“They demanded money from me and said all services were included in that sum. But then I had to pay the doctor, the nurse and the hospital orderlies separately. I do not believe that prices will become more stable.”



According to a study published by the World Bank in November last year, 2009 was the first year for a decade when the amount of poverty in Armenia increased. Some 29 per cent of people were living below the poverty line last year, up from 26 per cent the year before.



In the circumstances, it is increasingly hard for Armenians to pay for state services, but patients and their relatives are particularly vulnerable to bribe demands, since they are often desperate for help.



Vardanyan, for example, had come from the town of Gyumri to Yerevan to bring his wife to hospital.



“They demanded an extra 1,200 dollars to operate on my wife’s chest. I cannot complain, because I am worried about her health,” he said.



“She needs another operation and if the doctor finds out I complained then he will either refuse to do the operation or demand more money. You have to give the doctor as much money as he demands, and if their salaries are raised, it will be even worse, it will just sharpen their appetites.”



IWPR approached a number of hospital directors, but only one agreed to give an interview on condition that his name and hospital were not identified.



“You are raising a very delicate question, and no one can give an accurate picture. This is a closed issue. I, like you, have heard that [corruption] exists and is widespread. As for the medical institution that I head… I can say we do not have these [problems],” the director said.



The issue of alleged medical corruption occasionally appears in the media. On December 27 last year, Dr Ashot Basghdasaryan, who works in the ambulance service, was fired for demanding 5,000 drams in exchange for admitting someone to hospital. The Yerevan health authorities downplayed the incident, saying the patient was not harmed, and was hospitalised in time.



Artyom Petrosyan, head of the city’s ambulance service, said it was the first case of its kind in four or five years. “Our services must be provided as part of the state health service. And so as not to set a precedent, we decided to sack this doctor,” he said.



But Basghdasaryan himself, who worked in the ambulance service for 21 years, said he had never been the subject of a complaint and said the money he requested had been entirely legal. The patients’ relatives, he claimed, had even agreed to the payment.



Basghdasaryan said he had written to Health Minister Harutyun Kushkyan to ask to be reinstated.



Amalya Kostanyan, of the international anti-corruption group Transparency International, said she and her colleagues receive many complaints from Armenians about alleged health service corruption, although most of the complainants prefer not to be identified.



“We do not make specific investigations, but it is possible that there is a secret deal on bribe-taking between the management and the workers. They say, ‘If you do not receive enough money for your work, do what you want. Take, if you can. Ask, if you can. Demand, if you can,’” she said.



Hayk Darbinyan, the deputy health minister, said he could not confirm or deny that there were problems with corruption in the health service.



“If I deny this, then maybe I am mistaken; and if I confirm it, then maybe I will be mistaken again. We do not have facts about this, but everything is possible. If we receive official complaints, then we will try to uncover whether there is corruption in this area. However, until now we have not received such appeals,” he said.



Lilit Harutyunyan is a correspondent for Radio Liberty in Yerevan.