Original article

Praca oryginalna

CORRUPTION IN MEDICAL SPHERE OF UKRAINE: CURRENT SITUATION AND WAYS OF PREVENTION

Vladislava S. Batyrgareieva1,  Andriy M. Babenko2, Sandra Kaija3

1АCADEMICIAN STASHIS SCIENTIFIC RESEARCH INSTITUTE FOR THE STUDY OF CRIME PROBLEMS NATIONAL ACADEMY OF LAW SCIENCES OF UKRAINE, KHARKIV, UKRAINE

2ODESA STATE UNIVERSITY OF INTERNAL AFFAIRS, ODESA, UKRAINE

3RIGA STRADINS UNIVERSITY, RIGA, LATVIA

ABSTRACT

Introduction: All social life spheres in Ukraine are influenced by corruption. Ukrainian citizens were inquired in order to determine corruption rate in various social spheres. It was conditioned by reforming criminal justice and administrative management, which is directed, particularly, for liquidation of corruption in the state. Special emphasize is stressed on corruption rate in the medical sphere.

The aim of the article is to determine: 1) population’s attitude towards to corruption, in particular, in the medical sphere; 2) the most corruptive social spheres; 3) efficiency of anti-corruption measures; 4) readiness of population to participate into struggle with corruption.

Materials and methods: The study is grounded on dialectical, comparative, analytic, synthetic, sociological (special-purpose inquiry form, interview), statistic and comprehensive research methods. The study group consisted of 1 120 citizens and 513 medical and pharmaceutical professionals of Ukraine. Questions were related to: 1) citizens’ contact with corruption; 2) corruption expansion rate in state authorities, self-governing authorities, in various infrastructure spheres, particularly, in healthcare; 3) awareness about struggle with corruption in the state and in the region and determination of citizens’ readiness to cope with corruption.

Results: Corruption contact level of citizens remains steadily high. Corruption in the medical sphere is the most widespread: during the previous year before the inquire 63% respondents were involved into corruptive schemes. Corruption in the medical sphere can be subdivided in the following levels: from patient to doctor; inside the hospital – from a healthcare institution employee to the executive hospital staff; on state level concerning state procurements of medications. A bribe to health care professionals was given for: receipt of a sick leave certificate and various references (for example, about unfitness for military service, fitness for driving a car or fulfillment of particular works); high-quality conduct of an operation, medical servicing rendering; writing out a “necessary” prescription; approval or hiding of any bodily injuries; falsification of a true cause of death. All health care professionals have come across different corruptive practices, among which the following payments are widespread: for employment in a hospital, license for private medical practice or establishment of private clinics, “avoidance” of checks of healthcare institutions’ activity. The largest bribes are given state officials for participation in tenders for medical drugs supply by pharmaceutical companies. All health care professionals have come across different corruptive practices, among which the following payments are widespread: for employment in a hospital, license for private medical practice or establishment of private clinics, “avoidance” of checks of healthcare institutions’ activity.

Conclusion: Corruption on the sphere of medical practice is complex phenomenon. The conducted poll made it possible to structure the corruption problem, to see its various levels and levels. In respondents’ opinion, a scrupulous information campaign is a positive tendency: 45% consider this is a guarantee of anticorruption. Nevertheless, only 5% respondents assume personal notification of anticorruption bodies about receipt of a bribe by medical staff.

KEY WORDS: health care, patient, patients’ rights, defects in medical care

Wiad Lek 2019, 72, 9 cz II, 1814-1821

INTRODUCTION

The fight against corruption has always been and is now in the attention focus of the Ukrainian state. It is sufficient to say that there are numerous national and regional problems in the fight against corruption that have acted or continue to operate at present [1–6]. However, society, in the broadest sense of the word, is not yet ready to end this shameful phenomenon. Moreover, during the years of Ukraine’s independence, corruption and its core – corruption crimes- have become a systemic negative phenomenon of social reality that is widespread in all economic sectors and the activities of state and local government bodies along the entire vertical of public administration [7]. Corruption as a social corrosion constantly erodes state structures [8]. From the criminological point of view, corruption is a social phenomenon, a kind of legal cynicism, the content of which is the system of negative attitudes, instructions and actions aimed at satisfying personal, group or corporate interests through the use of power or official position by some officials in spite of the state’s and society’s interests [9]. Therefore, the preventing corruption problem for Ukrainian society, unfortunately, remains traditionally acute. And this is despite the fact that Ukraine is moving towards the development of numerous anti-corruption measures, their normative documentation and implementation. But, according to indicators of entities’ work of anticorruption activity, the implementation of normative prescriptions in law-enforcement activities remains extremely ineffective.

The fight against corruption is complicated by the corruption spread at all levels of government. It covers the various spheres of our society, affects more and more new social institutions. Corruption penetrates the everyday life of different segments of population. The effectiveness of anti-corruption decisions taken at the highest state level is offset by their deliberate blocking and neglect. According to non-governmental international anti-corruption organization and study of its level called Transparency International, in 2017, the index of corruption perception in Ukraine was 30 points from 100 possible, which is 1 point higher than in 2016 [10]. In 2018, the index even improved by 2 points (from 30 to 32), which allowed it to rise from 130 to 120 in the overall ranking, but Ukraine remains in the red zone of countries with a high level of corruption perception [11].

According to data-polling perfomed by the Kyiv International Institute of Sociology with the support of the United States Agency for International Development (USAID), which was conducted from 2007 till 2015, every year about 66% of Ukrainians are exposed to corruption, becoming participants in corruption relations [12]. That is, two-thirds of Ukrainian citizens are involved in corruption, most of them in some way recognize the need for this illegal activity, because corruption, in their opinion, is necessary to solve many problems.

It is alarming that corruption affects practically any sphere of public life and is twice as horrible when it is infected with the healthcare sector, because according to all-Ukrainian sociological survey conducted in 2018, 69% of Ukrainians believe that paying for medical services that are free and guaranteed by the state are corruption [13]. As a result, corruption acts repeatedly and repeatedly, becoming an approved way of behavior. So, of particular relevance is the corruption phenomenon in the field of health care [14]. In order to be effective, reforms to combat corruption must be informed by the theory, guided by evidence and adapted to the context [15].

THE AIM

The purpose of this study is to find out, based on the authors’ own sociological research in Kharkiv (Ukraine), and an analysis of published sociological surveys of corruption real state in the medical sphere for the period from 2007 till 2018, to identify levels of corruption and certain types of medical practices that are the most vulnerable as well as developing ways to prevent this negative social phenomenon.

MATERIALS AND METHODS

This study was conducted during 2013-2018 and is based on the results of public opinion polls on corruption in medicine in Kharkiv (Ukraine), which was conducted in 2014-2015, the results of other sociological opinion survey conducted in Ukraine from 2007 till 2018, the national regulatory acts, the data of the Corruption Perceptions Index 2016, 2017 and 2018 from International Organization Transparency International, research papers and opinions of progressive people in the field. The inquiry was conducted using a sociological method (special-purpose inquiry form and interview). In general, about twenty questions were put to respondents. They concerned: 1) experience of direct contact with corrupt practices; 2) degree of corruption prevalence in the authorities, local self-government, in different spheres of service of the population, in particular, in the medical sphere; 3) establishment of the most corrupted institutions; 4) awareness of combat corruption in the state and the region, as well as the elucidation of citizens’ willingness to counteract corruption.

Respondents’ distribution by key demographic parameters coincided with the population make-up registered by official statistics. Doctors and pharmacists were asked about the existence of corruption practices in the medical sector and their types. Besides, the study is grounded on dialectical, comparative, analytic, synthetic, statistic and comprehensive research methods.

RESULTS

Several years ago, with the support of the Kharkiv Regional State Administration, the creative team of the V.V. Stashys Scientific Research Institute for the Study of Crime Problems of the National Academy of Law Sciences of Ukraine with the involvement of scientists from other Law educational institutions of the country conducted a large-scale public opinion survey on corruption in Kharkiv city – a particularly large Ukrainian city. This study was carried out in 2014-2015 within the framework of the implementation of the Regional Program for Prevention and Counteraction of Corruption in the Kharkiv Oblast for 2013-2015, approved by the decision of the XXI Session of the VI convocation of the Kharkiv Regional Council on April 25, 2013.

Necessity for such a survey was predetermined by the reform of criminal justice and administrative governance, which was aimed, as well as, at overcoming corruption in Ukraine. The main purpose of the survey was to clarify the following issues: 1) attitude of pointed cities’ inhabitants to the phenomenon of receiving unlawful benefits (bribes); 2) level and structure of experience of urban population about collision with corruption, as well as reasons for participating in corruption practices; 3) assessment of the effectiveness of existing anti-corruption measures in the state and the city; 4) readiness of population to engage in anti-corruption activities. After conducting a pilot study and establishing a high level of perceived corruption in the medical sector, the idea emerged to analyze separately the state of corruption in medicine. In addition, the study aims were to determine the impact of various social factors on the effectiveness of activities in the field of combating corruption and to develop recommendations for their consideration during formulating the principles of the national anti-corruption mechanism functioning; to work out the methodology of carrying out social and legal research which allows to increase the complexity and comprehensiveness of the analysis of existing problem and substantiate recommendations of practical orientation.

Tendencies in the science development and effectiveness of its impact on law-making and law enforcement largely depend on its methodological principles [16]. Public opinion polls on the level of prevalence of corruption practices, including the medical sphere, were conducted using the appropriate toolkit – a specialized questionnaire posted on the Institute’s service in the Internet, in the online poll, as well as through the distribution of this printes questionnaire form among the staff and patients of medical institutions of state, of communal and private property, as well as pharmaceutical imployers of Kharkiv city.

It should be noted that, by this time in Ukraine, there is practically no research on anti-corruption in medicine based on clear ideas about the extent of spreading of this negative phenomenon precisely in this area of society’s life.

The materials of the conducted public opinion poll showed clearly that almost all branches of public life are permeated with corruption. At the same time, the corruption level remains stable in the Kharkiv region and does not differ from similar indicators of nationwide research. Thus, 63% of respondents in Kharkiv stated that during the last year, before the survey, they were personally involved in corruption relations or were informed about it by other persons. Corruption, according to the respondents, is necessary for solving many problems. Therefore, one third of Ukrainians find justification for corruption in solving personal cases [17]. That is, citizens perceive corruption as an acceptable mechanism, a kind of auxiliary tool for solving these problems, as “service” that allows you to save time, avoid extra worries and guarantee a good result that has its own market price.

The distribution of survey respondents by key demographic indicators coincided approximately with the population composition of the region, recorded by official statistics. Among the total number of respondents in Kharkiv, 48% were women, 52% were men [18]. The predominant segment of the respondents was persons of employable age (91%). Respondents belonged to different educational levels.

Approximately the same number of affirmative answers regarding the corruption of educational institutions, the police and the State Auto Inspection, which was eliminated at the end of 2015 (29%, 28%, and 24% respectively). Corruption in other areas (for example, in the servicing population of local self-government sector, as well as in judiciary and prosecutor’s offices) is lower (about 20%). According to the respondents’ opinion the lowest level of corruption was recorded among the employees of the Ministry of Emergencies (3%) and the State Registration Service of Ukraine (12%) (functions of this service were transferred to the Ministry of Justice of Ukraine in 2015). At the same time, almost half of the respondents (47%) personally witnessed the mercenary actions of medical professionals. Thus, in the Kharkiv region corruption is one of the first in the medical sphere among corruption practices. For comparison, it should be noted and the survey data conducted by the Ilka Kucheriva Foundation Democratic Initiatives, presented on December 7, 2017, at press conference in Kyiv. Over recent years, citizens personally or their relatives, acquaintances, most often gave a bribe precisely in medical institutions. 51% of respondents noted this (for comparison: 35% of respondents feed in higher education institutions or 15% in local authorities, and in patrol police (about 11%). In total, 2,000 respondents were interviewed according to a sample representing the adult population of Ukraine (except for the occupied territories of Crimea and certain territories in Donetsk and Luhansk oblasts). The sampling error does not exceed 2.3% [19].

By the way, a similar study has been conducted during a long time in some post-Soviet countries. For example, monitoring of the corruption’s state in the medical sphere, carried out in the Republic of Latvia, found, that in 2005 41.3% of respondents had to pay informally, make gifts or use acquaintances in case of treatment in medical institutions. In 2007 the quantity of such persons significantly decreased (33.7%). In 2011 33.3% of the respondents used the corruption schemes in the medical sphere [20]. However, as it was noted in the Bureau for the prevention of corruption of the Republic of Latvia, the situation with corruption in the field of medicine doesn’t change dramatically for the better, because the real measures for combating with this phenomenon aren’t effective [20].

In connection with the above, one of the areas in our study was to find out the specifics of corruption in this area and the reasons for its dissemination. It is known that corruption impact can be grievous and critical, especially when such corrupt practices are gaining ground and can lead to patients’ mortality [21].

The authors recall that the survey was attended by both ordinary citizens and directly medical professionals of private clinics and institutions of state and communal ownership, as well as pharmaceutical sector’ ones.

Corruption in the field of medicine can be conditionally divided into the following main levels:

– the first: from patient to doctor or other health professional;

– the second: within hospital – from medical professionals to hospital administration;

– the third: at the state level in regard to public procurement of medicines [22] and equipment.

As it stated in the special literature, forms of corruption in healthcare and medicine may include (but not be limited) the following: bribes and “kickbacks” characterized as corruption indicia, bribes and “kickbacks” can be paid by individuals and firms for (I) procure government contracts, leases or licenses for construction of healthcare facilities, and for medicines supply, goods and services, as well as ensure their contracts’ conditions; (II) preferences and fabrication (frame up) of bidding process; (III) manipulate and falsify records, and evidence alteration, giving the conformity appearance of procedures carried out to enactments of regulatory bodies; (IV) speed up of permission procedure to carry out legal activities, (e.g. obtaining institutional affiliation, company registration or construction permits); (V) influence or change legal outcomes so as to avoid punishment for wrong acting [23].

Here are some of the most widespread types of services for which the healthcare professionals were given improper advantage by the Ukrainian population (the so-called first level of corruption in the medical sector). Thus, improper advantage, according to the study results, was provided by:

– for receipt of certificate of sickness and various references (for example, certificates of invalidity, certificates of driving eligibility, admission to certain works’ fulfillment, permission to engage in certain sports, attend sports facilities, exemptions from physical education and etc.) (about 75% of the respondents indicated that they answered positively on corruption);

– for the quality of surgery conducting for a patient or providing medical services: consultations, scheduled or unscheduled inspections (that is, not “as everyone”, but with a special individual approach). In this case, patient is guaranteed high-quality pre-operative and post-operative care, use of the best medical products, sutures, dressing materials, anesthetic agents, out-of-the-box testing, better conditions for staying in medical hospital, etc. Approximately 50% of the citizens who received affirmative answers attracted this practice.

– for extracting the “desired” recipe (about 10%);

– for confirmation or concealment of certain medical facts (most often – assaults and other bodily injuries) (less than 10%);

– for pre-discharge of patient from hospital or, conversely, for prolonging patient’s stay in hospital (about 5%);

– for issuance of “necessary” certificates about the patient’s mental state (up to 15%);

– for distorting the true death cause. In the latter case, the size of such bribes is one of the largest in medicine, since it is possible to conceal criminal death in these cases (but, fortunately, few such cases – only a few responded units answered “yes”);

– separately, citizens indicated “charitable donations” in money or any goods, purchase of medicines, medical instruments, other medical materials in certain pharmacies or specific dealers indicated by doctors (more than 70%).

Similarly, the survey was conducted among the medical and pharmaceutical professionals. The main question was: “Are you aware of existence of corruption practices in the medical sphere? If known, then please, indicate what types do you know?”

Answers to these questions gave us an idea of the corruption of so-called the second and the third levels (let’s remind that corruption of the second level is: the improper advantage transfers from doctor to medical institution chief, the third – in regard to state procurement of medicines and equipment).

Absolutely all respondents answered affirmatively. The most common practices were:

– payment for the post (a doctor, a nurse, a nurse, etc.) in hospital;

– fee for obtaining a license for private medical activities;

– payment to officials of the Ministry of Health of Ukraine and its territorial bodies for the “avoidance” of unnecessary inspections of medical institutions;

– fees for opening of private clinics operating on the basis of public hospitals, that is, using the equipment and capacity of the latter.

Finally, the third level of corruption in the medical field. For this level, some explanations need to be given. The fact is that the state purchases drugs at its own expense through tenders from certain pharmaceutical manufacturers. These purchases’ volume depends on the population‘s needs in certain medicines. These needs from the regions are brought to the Ministry of Health of Ukraine, which organizes the medicines procurement process. It is in this procurement process that there are many corruption risks for determining the winners of the competitive bidding and purchasing the “right” dosages that are produced by the “necessary” pharmaceutical manufacturers. In addition, during long time, the same companies participate in the tender without allowing other companies to participate in this process. However, to prevent this fact becoming public, the said pharmaceutical companies create satellite companies belonging to the same business groups [22]. As stated in the Law of Ukraine “On the Principles of State Anti-Corruption Policy in Ukraine (Anticorruption Strategy) for 2014-2017”, losses from corruption arrangements during the conduct of public procurement procedures amount to 10-15% (35-52.5 UAH billion) of the expenditure part of the State budget every year [4].

Not disclosing the details of these corruption schemes’ essence, all respondents from medical and pharmaceutical professionals have shown that there are problems of so-called “rollback” to the Ministry of Health of Ukraine for tenders for a state order for the drugs supply by certain pharmaceutical companies. That is, in this case, they are forced to give bribes to pharmaceutical companies so their products can be accessed by consumers, including in hospitals. It is well known to everyone about this practice, but the analysis of the State Register of Judicial Decisions of Ukraine over the past year has not revealed any court decisions in this category of cases. Researchers are quoted as saying that in the field of health corruption actions include the same as tampering with data on the results of medicines clinical trials, misuse of pharmaceuticals and other resources, imposition of overestimated accounts to insurance companies [24]. In addition, it is noted that the fight against corruption in the health sector is a complex problem, because at one end of the scale are doctors and nurses, who charge small non-formal payments to patients to supplement inadequate incomes; at the other end, and far more pernicious, are the corrupt suppliers who offer bribes, and health ministers and hospital administrators who accept bribes, or siphon millions of dollars from health budgets, skewing health policies and dwindling funds that should be spent on building hospitals, buying medicines or employing staff [25].

During the poll, the Ukrainian public spoke about the main causes of corruption spreading in the medical sphere. At the same time, ordinary citizens’ opinion and medical sphere professionals was different. Some differences of opinion are determined primarily by the level of corruption practices in which they participate. Yes, ordinary citizens are aware of corruption as patients or relatives, that is, these persons are aware of the corruption causes the first conditionally designated level of corruption, which means “patient-doctor”. As far as doctors and pharmacists are concerned, they are aware of corruption in the medical sphere, so to speak, from the inside, often speaking directly to participants (the second and the third levels of corruption practices).

We analyze the existence reasons of the corruption phenomenon at the first level. The corruption spread contributes to: underfunding of the medical sector (82% of respondents); low professional level of doctors (71%); low quality provision of free medical services as a norm for patient care and patients’ fears that a doctor without bribes will not provide adequate assistance (54%); use of the medical institutions’ facilities first of all in the interests of privileged patients (49%); provision of unlicensed or unlicensed medical services outside of medical institutions (40%); the tradition to thank the doctor for the best conditions of stay in medical hospital, “good attitude”, etc. (39%); lack of appropriate drugs and the spread of counterfeit drugs that do not meet accepted standards or are completely counterfeit, which is a direct threat to the life and health of patient (27%). As it is rightly noted in the special literature on the traditions of “being grateful”, the corruption that was an integral part of “shadow” economies of the communist countries has left a legacy of corruption throughout the region, especially in the health sector [26].

With regard to the corruption causes at the second and the third levels, the following are: practice of protectionism in obtaining workplaces, posts, and any other preferences (92%) (this practice implies the continued presence of doctors in illicit proceeds that would allow them to compensate for the expenditures for bribes); high competition in the market of services related to the state order for medicines (85%); bureaucracy that is in the health sector (80%); Organized criminal business controlling the areas of drug redistribution (42%); concealing the facts of embezzlement and theft of public funds allocated for public health, violations of public procurement rules, use of public health facilities for private business in the field of medicine (39%); high cost of raw materials for drugs manufacture of (32%); unjustified taxes (31%).

During conducting the questionnaires, respondents (the patients of medical institutions) were interrogated: who was a bribe initiator? To this question 41% of respondents answered that medical staff was an initiator of “remuneration” for the received medical services; half of the respondents (50%) showed that they had given the bribe allegedly on their own initiative, but in a situation where it was clearly possible to understand that such a step was necessary. And only a small part of respondents didn’t answer this question (9%). We give data on this and foreign researchers of the post-Soviet countries. Thus, according to the results of Russian scientists, 32.4% of the respondents who fell into the situation when they needed a reward for solving any medical health problem showed that medical institution staff was a bribe initiator; 6.4% of interrogated persons didn’t answer this question; the rest ones – 61.2% respondents showed that they themselves initiated corrupt actions [27].

A public opinion poll conducted by the Center “Democratic Initiatives” in Ukraine from September 18 to October 3, 2017 showed that medical institutions are leaders in everyday corruption practices. When asked if you paid medical workers, 16% of respondents replied that they do it regularly, 42% did it occasionally [19].

Due to the fact that public both as ordinary citizens and specialists whose professional interests are related to the sphere of medical care of population, are active participants in corruption processes, the fundamental task of the state anti-corruption policy is the radical transformation of public consciousness. This breakthrough will be witnessed by the formation of firm rejection climate of corruption in society. In Ukraine civil society, despite the growth of passionarity, patriotism is still at the stage of its formation. That is why the main subject of corruption prevention today, including in the field of medicine, is not society and public, but mostly criminal prosecution bodies that naturally react to corruption, but do not eliminate the problem roots. Therefore, it is erroneous to believe that corruption can only be curtailed by means of legal and administrative measures. These measures will provide support for anticorruption spirit in society, and not vice versa.

Thus, the provision of further means and methods, as well as preventive strategies that would help eradicate corruption practices in many areas of public life, including the health sector, is a priority task of domestic legal science. Such strategies should include at the same time three distinct links of corruption practices existence.

It is needed the solution and the issue of working out concrete measures for combating corruption in the medical sphere. At the same time, concrete measures to be taken in order to significantly reduce the corruption level in the public health sector can be modeled on the basis of an analysis of respondents’ responses on this issue. The majority of respondents from ordinary citizens consider that an effective measure of combating corruption is to bring the perpetrators of corruption into criminal responsibility while denying access to medical practice (92%). Many respondents argue that an important measure to counteract the corruption shameful facts in medicine will be wages increase for medical professionals and medical sector financing in necessary volumes. Another 12% of respondents rely on introduction of transparent health insurance schemes in the country, which is intended, in particular, to reduce the corruption level in the analyzed area. Regarding the anti-corruption measures proposed by healthcare professionals and pharmacists, among them, the following prevails: decent pay for their work and proper state policy to support the relevant sphere of society (87%); overcoming general disorder in the state (54%); fighting corrupt practices in bureaucratic apparatus (36%) (here refers to persons involved in state orders’ formation for drugs, medical equipment, machinery, etc.); introduction of full payment of medical services – 21%; introduction of compulsory health insurance system of Ukraine – 19%. And only 9% of the respondents indicated the necessity of bringing to justice the corrupted physicians.

A hypothesis is needed to prove that corruption in the medical sector is very difficult to regulate, since citizens are worried about their own health and their relatives’ health. Therefore, they all perceive any hint of a bribe from medical professionals very seriously, considering it to be a norm.

In addition to the aforementioned, the conducted research has shown that positive, in the opinion of a considerable number of respondents, is the phenomenon of integrity informing about corruption offenses. Thus, 45% consider such a possibility as a guarantee of counteraction to the specified criminal act; however, only 5% of them assume a personal message to anti-corruption authorities on a free or paid basis on the facts known to them about receiving unlawful benefits by medical professionals. In this regard, it is necessary to find out the reasons for such a low readiness of the population to expose the corruptors while performing the function of virtuous informant.

In order to find out the complete picture of corruption in the medical sphere in Ukraine, the results of regional study should be compared with relevant studies in other regions of Ukraine. In addition, such studies will turn problems into periodic ones, and their results should be brought to general public attention in order to create an atmosphere of acute rejection of any corruption facts in society.

CONCLUSIONS

Corruption is an extremely complex phenomenon. Therefore, solving this problem requires an integrated approach. It is impossible to overcome corruption in the medical sphere without paying serious attention to preventing corruption in other areas of public life. But in order to effectively implement certain anti-corruption strategies, one needs to have a clear idea of corruption state in the country. In this regard, a reliable tool for ascertaining this condition is the survey of ordinary citizens and doctors and pharmacists on anonymity conditions.

Health care of the nation, without a doubt, is priority area of the social policy of the Ukrainian state. The conducted poll on the sphere of medical practice of the country made it possible to structure the corruption problem, to see its various levels. Currently, there are clearly three levels of corruption practices in the field of medical care of the population of Ukraine: the first level, conventionally designated as corruption “from patient to doctor or other medical professional”; the second – “from an employee of medical institutions to hospital management” and, finally, the third – corruption at the level of state purchases of medical products and equipment.

The study of the reasons for corruption existence in the medical services’ sphere leads to the disappointing conclusion that the tradition of retaliation for medical aid to doctors, on the one hand, has deep historical roots, and, on the other one, is supported by the established psychology of a person seeking for such a help, which is not paying a doctor, you cannot receive a qualitative and timely medical service. Subsequently, this tradition based on the psychology of “gratitude” is transformed from the format of direct contact “patient – bribe physician” to the format of “thanks” of a patient in the form of charitable contributions to the hospital, but not all medical staff understands the further appointment of these funds, that is what needs they are going further. It is very likely to assume that this money is deposited in some doctors’ pockets. At the same time, numerous facts of enrichment at the expense of public funds in the healthcare sector have the most serious impact on the quality and accessibility of medical services in Ukraine, turning first and foremost into free-of-charge medical care on the predatory practice of withdrawal of funds from indigent citizens of our country.

Regarding the most likely and effective ways of overcoming corruption in the medical sphere, respondents from ordinary citizens are mainly in favor of repressive measures restricting corruption practices, and medical and pharmaceutical professionals are inclined to consider solving the problem of overcoming corruption practices in appropriate state support for the development and functioning of the medical sector.

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Authors’ contributions:

According to the order of the Authorship.

Conflict of interest:

The Authors declare no conflict of interest.

CORRESPONDING AUTHOR

Vladyslava Batyrgareieva

Аcademician Stashis Scientific Research Institute

for the Study of Crime Problems of the

National Academy of Law Sciences of Ukraine, Kharkiv, Ukraine

tel: +380505830788

e-mail: vladis2229@yandex.ru

Received: 08.06.2019

Accepted: 29.08.2019