It remains to be seen whether Cătălin Cîrstoiu’s press conference, requested by coalition leaders, will bind the cut mayonnaise of the joint candidacy in Bucharest. The ball is in the court of Mr. Ciolacu and Mr. Ciucă, but even if he has not explicitly withdrawn, Mr. Cîrstoiu himself does not seem to have great hopes for the future.
The past tense verbs regarding his intentions for Bucharest, as well as the choice of the hospital as the location of the press conference, after Marcel Ciolacu announced that the era of independents is over, indicate an advanced separation. And the draft emergency ordinance regarding medical practice in the public and private sectors seems to be a blame from the coalition towards the situation in which its candidate would have found himself.
In fact, beyond the political issue, the most important thing is the subject from which the entire scandal started and which will remain even after these elections with their candidates have passed.
Premises
The extremely sensitive issue of doctors who move their patients between the public and private systems would deserve a much more attentive and serious discussion, if possible without emotion, than the one in the inflamed and passionate context of an electoral campaign.
And certainly, much more than an emergency ordinance with great unconstitutional potential, made hastily as an electoral passive discharge.
First and foremost, we should admit that in Romania, the phenomenon is widespread in both directions. There are patients who come to the public system and are directed towards the private system, and vice versa, cases initially taken over by the private system to be sent to the public one when things get complicated and exceed the ability of many private clinics to solve them.
There is also a lot of legend regarding the superiority of the private system, not necessarily better beyond the hotel conditions than the public one.
Malpractice exists in both sides, as well as terrible nosocomial infections. I personally know the tragic case of a patient, a doctor herself, killed by such an infection in a top private hospital in Bucharest. A case covered up, in the end, with the cynicism of taking advantage of the family's shock and the skill of some cunning lawyers.
The practice of transferring patients between public and private is not exclusive to Romania.
My colleague Magda Grădinaru recounted her own experience in Vienna on Facebook when the doctor at AKH called her to the private practice.
Which does not mean that things should remain as they are, but neither should populist solutions be advanced.
Iron Curtain between Public and Private
First and foremost, I do not believe that erecting an iron curtain between the public and private systems is a viable solution.
They are complementary, and I do not think that either could handle the influx of patients on its own. There are not enough doctors for both separate systems. Let's not forget that we have a shortage of doctors in many important specialties.
If faced with a radical choice, at least half of those with special competencies opt for the private sector, what remains in the public system? And we do not have a private insurance market to facilitate access to costly treatments in the private sector.
Moreover, an attempt to separate in this way, which is not imposed in other areas, would be profoundly unconstitutional and would violate the doctor's right to work. It would rightly be rejected by the Constitutional Court from the bench, as they say.
And if it were to be done through an emergency ordinance, it would not even reach the core of the issue, because the restriction of such constitutional rights is not allowed.
The problem here is the division of time between the two systems, and this can be done through a precise system of timekeeping. You can go wherever you want in the time remaining after you have completed your work schedule at the hospital. Not 3 hours at the public hospital with a full salary, and then in the private sector.
Waiting List or Money
Secondly, it should be understood that guaranteed access to medical services does not mean guaranteeing access to a specific doctor exactly when he is requested. It means that every person has access to a specialist doctor they need.
And often, it is the state that pushes patients into the private system. For example, as Cătălin Striblea said on Europa FM, in a county in Moldova, there is only one urologist, so the demand is met with the help of doctors from neighboring counties who provide medical services in the private system several times a week.
But if you have options and you specifically want a certain doctor, there is a major risk of competing with many other people who want the same thing.
And then, rightly, there are only two options. One is the waiting list. Do you want to see a specific doctor at the state hospital, based on your insurance card? You get on the waiting list, and when your turn comes, you are examined.
However, this waiting list must be transparent, so that everyone knows at any moment, based on the registration number, where they stand, how many numbers have been examined in a day.
If you want to be seen faster than the waiting list allows, you go to the chosen doctor in the private system and pay.
This system is already in place in some locations. An example is probably the best breast imaging specialist in the country, who has a waiting list for ultrasounds and mammograms at Fundeni Hospital for half a year.
Those who want to be seen sooner can go to the private practice, where the waiting list is a bit shorter, and those who want immediate attention pay an urgent fee.
Another essential rule would be for the procedure that starts in the public system to remain there from start to finish, until the last stitch is removed and the last wound is closed.
With one caveat, the patient's right should not be restricted either. If a patient is operated on in the public system but prefers to continue treatment and procedures in the private sector because there are better conditions, it is closer, they do not want to wait in line, or for any other reason, and they assume the cost, they should not be prevented from doing so. The important thing is not to be forced to move to the private sector.
However, it also happens the other way around. Interventions done in private lead to complications that can no longer be treated there and are sent to the public hospital to deal with them. Of course, you cannot refuse a patient with complications at the state hospital, but for such cases, private hospitals should have some form of insurance to cover the cost of these additional treatments.
Good practice models exist in the EU, as well as realistic solutions, but it takes a lot of political will to implement them, especially when they are not populist.
And it would be good if the subject, real and important, does not fade as soon as the scandal disappears from the radar, as is the case with most Romanian turbulences.