People like Karen Papiyants are at the mercy of corrupt doctors in Russia. The country has been plagued by these doctors and staff leading to a major health crisis.
Karen Papiyants lost his leg in a car accident. He is entitled to a free treatment like any other Russian but the hospital made him go through his worst nightmare. The doctor asked him to pay $ 4,500 into their St. Petersburg hospital's bank account, or be deprived proper care — and perhaps not even survive.
The 37 year truck driver's family had no other option but to pay the whole amount. Scraping together the money with great difficulty they paid the whole amount. Still this did not ensure them good treatment or sevice. The nursing staff was in attentive. When the patient screamed in agony did the nurse attend to him and give him pain killers.
It's nothing but blackmail and extortion on the part of doctors," Papiyants said.
According to experts medical care in Russia is the worst in an industrialized nation, in spite of its booming economy and the government spending billions for the improvement of the health care system.
Russia with its socialist background is supposed to provide free basic medical care to its citizen. But the present practice tells a very different story according to the patients and experts. The doctors, nurses and surgeons routinely demand payments — even bribes — from those they treat.
A 2000 World Health Organization report ranked the country's health system 130th out of 191 countries, on a par with nations such as Peru and Honduras.
In 2004, according to the Organization for Economic Cooperation and Development, Russia spent $441 per capita on health care, about a fifth of what the EU spends. Over the past two years, the government has more than doubled health care spending to some $7 billion, but that still works out to only about 3.4 percent of all government spending, and the World Health Organization recommends at least 5 percent.
This is one of the few nations in the world where life expectancy has declined sharply in the past 15 years. The average Russian can expect to live only to age 66 — at least a decade less than in most Western democracies, according to a 2005 World Bank report. For men, the figure is closer to 59 — meaning many Russian men don't live long enough to start collecting their pension at age 60.
Mixed with alcoholism, heart disease claims proportionately more lives than in most of the rest of the world. Death rates from homicide, suicide, auto accidents and cancer are also especially high.
Russia's population has dropped sharply in the past 15 years, to below 143 million in what President Vladimir Putin calls "the most acute problem of contemporary Russia."
The state covers all Russians under a standardized medical insurance package, while well-heeled citizens can buy extra insurance and be treated privately.
In the Soviet era, patients occasionally rewarded doctors with money or gifts, but were largely guaranteed free treatment. The Soviet Union's public health system was, for a time at least, considered among the world's best.
After the Soviet collapse, the health care system declined as it failed to keep up with the western medicine. Today, many who can't afford to pay or bribe — especially those in remote provinces — may never receive proper care.
Experts here say new spending does little if it fails to tackle corruption.
"Corruption in health care is a threat to Russia's national security in the broadest sense of the word," said Yelena Panfilova, head the Russian branch of Transparency International, a global corruption watchdog.
According to a summer 2006 study commissioned by the group, 13 percent of 1,502 respondents who had sought medical help during the previous year had to pay an average of $90 under the table, out of wages averaging $480 a month. The poll had a margin of error of 2.6 percentage points.
Panfilova also said medical and pharmaceutical companies routinely bribe health officials so that hospitals buy their equipment and medicines, even though their quality is often not the best.
Kirill Danishevsky, a health researcher with the Russian Academy of Sciences' Open Health Institute, has estimated that up to 35 percent of money spent on health care consists of under-the-table payments.
At the Dzhanelidze Emergencies Institute where Papiyants was treated, spokesman Vadim Stozharov denied that doctors refused to provide free care. But he conceded the hospital has received so many similar complaints it set up a hot line to deal with them.
The Health and Social Development Ministry declined to comment on the bribery allegations. But Galina Lavrishcheva, the top health official in Stupino, an industrial town in the Moscow region, acknowledged that health care workers sometimes demand payoffs.
Overspecialization, a legacy of the Soviet era, is a big problem because patients are shuttled from one narrowly focused specialist to another. Meanwhile, no physician generally takes responsibility for their overall state of health.
But critics say these changes are no substitute for radical change -- just a high profile way of spending the country's oil-driven wealth in an election year. They insist the reform does not address bribe-taking by emergency health care providers and medical specialists.