by Monica Apostol
Interview with Bogdan Tanase, president of Doctors Alliance for the Modernization of Medical System.
What was the climax that led to the formation of the Doctors Alliance for the Modernization of Medical System? Who can join this Alliance and which are the terms of collaboration?
The first step was taken accordingly with HCCJ decision in August 2015, decision that clarified the status of doctor treated as a magistrate. In this regard, under the new Criminal Procedure Code, adopted in 2014, the doctor who receives benefits of any kind, at any time of exercise of the medical act commits avail. It was just the peak that led to the degradation of the doctor’s social status after the 50s. Then, the revenues were deliberately reduced, which led to the informal payments. This situation knowingly perpetuated by all post-revolutionary governments, in this case keeping the medical system underfunding and, of course, with low incomes for doctors.
From the start, our movement had, and still has the main objective: regaining our rights! From the beginning, our slogan was “we do not to take bribe, we want decent wages”. It all started as a group on Facebook, a team that, within a few days, grew to more than 30,000 followers. Of course, not all are doctors in this group, but there also also other Romanian citizens who resonated with our goals and who support us, as they are aware that we are indispensable.
To have a legal basis, we decided to establish an NGO “Doctors Alliance Doctors Alliance for the Modernization of Medical System.” We chose the members voting in the General Assembly to be only physicians. Up to now there was no organization to defend doctors’ rights. Now we exist. Of course, we have associate and honorary members, and in these cases there are no restrictions on the profession. To achieve our objectives, we are open to collaborate with any organization provided only that it does not contradict our goals and values.
The group ‘Doctors ready for general strike” is still on the agenda?
It depends from what angle we see the answer to this question. The dialogue group is active, open and mostly free. Any one can say his/her view there. Now, our goal is not the general strike, though the reality has shown us that, unfortunately, the pressure of the street and the strike movements are the only forces that can change something in Romania. Although every politician claims that things go wrong in Health and everybody agrees that a change is absolutely necessary, no one has the courage to do something in this way. At this moment we are not so strong as to provoke a strike of the doctors. In addition, the legal constraints make the doctors’ strike to be ineffective because they are obliged to treat emergencies. Here it is another problem. These constraints are not defined by the legislative body, which jeopardizes the very idea of strike. And one more thing. The medical career is not made for street protests. Doctors Alliance is fighting to change this reality, and it is time for the politicians to have the courage and the foresight to accept that radical change in health is really needed in the Health field and they have do something about it.
What really means this Alliance and how it aims to help and modernize the medical system in Romania? Where the patient stands and how can he call on the assistance of this body?
We want to be THE alternative to what currently exists in the Health system. For example, there are many trade union organizations of the medical staff, but most of them are discredited by collaborations with politics or scandals. We can talk about the Doctors College as professional organization of physicians, which is established by law, but also discredited. The latest news regarding this college were those concerning the elections’ invalidation. In this context, it feels like a different kind of such organization is desperately needed, which should call a spade a spade. We undertake to actively observe what is happening in the health system, and not only at high level, but at any level. We would like to be a kind of TelVerde that should warn the public and to the decision makers over the things that are not going well, and in this respect we wish to cooperate with the patient’s organizations and the patients with us.
What are the most sensitive areas which the Romanian medical system is facing from your point of view? What solutions do you propose? How will your organisation collaborate with the new minister of health?
For an honest observer, it is obvious that there are three major problems: the widespread corruption, be it large or small, the chronic under-funding the medical system and the poor management. And everything is caused by lack of adequate health strategies. Corruption, or delicately mentioned, the informal payments issue, is one of the largest current plagues of this system. It is a cancer that must be cured above all. Firstly, because it is an abnormal relationship between doctor and patient. On the other hand, it brings the public opprobrium on the entire medical profession, which is unfair to everyone and undesirable. The solution to this problem may be simple, but must necessarily include a substantial increase of the doctors’ revenues, and we don’t mean a 25 pc or 50 pc rise, but a revenue comparable to the European average. Thus may mean doubled and tripled salaries. The lack of finances is obvious. Its main causes firstly relates to the low contribution of the population, both in terms of the amount of individual contributions, but especially to the number of taxpayers. We have about 4 million employees supporting 15 million social assisted. Secondly, this contribution is not entirely directed to health, but it is used to cover “the black holes” in the budget, such as pensions. Thirdly, we do not have a basic package to this very moment. The message of the politicians to the population is that access to health care, whatever it is, is unhindered and immediate, which involves huge costs. These funds, in addition to being insufficient, are spent groundless, without prior documentation on the health and needs of the population and without any control over the efficiency and performance of investments.
Solutions can only come politically. To find solutions, politicians have to recognize the real problems and to accept them. We can become dialogue partners and we can actively participate in discussions to find solutions. Whateve these solutions are, they can be implemented only after a serious public consultation. We do not have to forget that health is the area where anyone is interested in. Regarding the cooperation with Ministry of Health, our Alliance wants to participate in any dialogue that envisages the modernizing and redefining of our professional status. Now, however, we do not feel that we count as a dialogue partner, willingly or not, they decided to ignore us. Perhaps, when we go stronger, and we will come to that, for sure, they will understand that problems can not be treated this way.
How does Doctors Alliance perceive “the imposed” health cards? There were extemely necessary in our medical context or they could have been introduced gradually? Endless queues in front of the family doctors cabinets and pharmacies are outrageous as the software crashes all the time. Who’s to blame for this abberant situation?
The idea of a centralized electronic system of regulation and control for the medical services is a good one. EU countries are still dreaming of such a system and we can not but be glad that it has been enforced in Romania. But the reason of introducing such a system is normally to ease bureaucracy, to make physicians’, pharmacists’ and patients’ life easier (bureaucratically speaking). What happens in reality, and I am sorry to contradict the official propaganda, it is that bureaucracy increased the access to medical services is hindered.
In the first months, we could put it on account of a system that is at the beginning, that needs time to be calibrated and adjusted, but it seems that this situation is perpetuating. Every Friday the system freezes, causing frustration for both doctors and patients. The National Health Insurance House should give honest explanations, but most of all it should provide solutions to this issue.
„Colectiv” case from the angle Doctors Alliance? Does Romanian medical system has resources to cope with such a situation?
„Colectiv” is a lesson. It was a crisis that showed where widespread corruption can lead and what it means in an offhand medical system. If you talk about training the medical system in Romania to provide great care to the burnt, we should discuss of the quality of this care service. We reacted after obsessively hearing how the decision makers claimed that we had everything needed in the country and the foreign aid would be useless. With these statements We could not agree to these statements and we tried to put them into question. The discussion remains open even now. I have never doubted, nor have questioned the quality of the care given by our colleagues, many of them behaved like heroes. But hero-doctors it’s not what we need, we need normal people to work in a normal system.