Ethical flaws in Romania's health reform

Abstract

As Carmiola Ionescu reports (April 22, p 1307),1Ionescu C Corruption targeted in Romania's health reforms.Lancet. 2006; 367: 1307-1308Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar the Romanian government has forced approval of several new laws intended to profoundly reform the Romanian health system. This reform follows 15 years of poor management and underfinancing. The Romanian health system is deeply corrupt, as evidenced by the huge informal payments made to doctors.2Ionescu C Romanians pay $1 million extra a day for health.Lancet. 2005; 366: 1515Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar A 2003 law on patients' rights still allows such informal payments, but only after care has been provided.This new package includes a law on organ transplantation, which, in my opinion, contains a questionable regulation which could have huge ethical implications. Despite the fact that transplantation is said to be an altruistic activity, the law includes the possibility that organ transplant recipients can directly pay for the care offered. This “opportunity” was apparently introduced in an effort to avoid slowing down transplant activities because of the limits of public funding. Organ trafficking was a reality in Romania in recent years. Newspaper advertisements have thankfully now stopped, but they continue on the internet.3Ionescu C Donor charged in Romania's first organ trafficking trial.Lancet. 2005; 365: 1918Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar By this new law, wealthy patients can afford to pay for their care, can directly “reward” their doctor, and with a little “luck” can have a compatible organ “offered” to them.I declare that I have no conflict of interest. As Carmiola Ionescu reports (April 22, p 1307),1Ionescu C Corruption targeted in Romania's health reforms.Lancet. 2006; 367: 1307-1308Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar the Romanian government has forced approval of several new laws intended to profoundly reform the Romanian health system. This reform follows 15 years of poor management and underfinancing. The Romanian health system is deeply corrupt, as evidenced by the huge informal payments made to doctors.2Ionescu C Romanians pay $1 million extra a day for health.Lancet. 2005; 366: 1515Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar A 2003 law on patients' rights still allows such informal payments, but only after care has been provided. This new package includes a law on organ transplantation, which, in my opinion, contains a questionable regulation which could have huge ethical implications. Despite the fact that transplantation is said to be an altruistic activity, the law includes the possibility that organ transplant recipients can directly pay for the care offered. This “opportunity” was apparently introduced in an effort to avoid slowing down transplant activities because of the limits of public funding. Organ trafficking was a reality in Romania in recent years. Newspaper advertisements have thankfully now stopped, but they continue on the internet.3Ionescu C Donor charged in Romania's first organ trafficking trial.Lancet. 2005; 365: 1918Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar By this new law, wealthy patients can afford to pay for their care, can directly “reward” their doctor, and with a little “luck” can have a compatible organ “offered” to them. I declare that I have no conflict of interest.