Management in Health, Vol 13, No 1 (2009)

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Journalists Perception on the Corruption in the Romanian Health Administration

 

Dr. Val VLCU, lector, Universitatea Bucureşti, Bucharest University, Faculty of Journalism and Communication Sciences
Florin PUPĂZĂ,
PhD student, Deusto University, Bilbao, Spain

 

Abstract: We made a descriptive exploratory research, trying to analyse how journalists evaluate the health administrations performance. Mainly, their main complain is the lack of transparency. The authors prove that journalists dont analyze the performance in public management terms, but according to the institutions image. The structures which are able to receive informal payments are considered more influential than the health trade unions and professional associations. Media consider that the College of Physicians is responsible for hiding malpraxis cases, reflecting a problem of fair assignment of responsibilities. Another problem is related to the self-censorship generated by the expected reaction from the public.

Keywords: corruption, mass media, transparency, institution image, influential, self-censorship

 

MEDIA contributes in a high extent in establishing the public agenda. Cohen, quotated by McCombs, asserted that the press, even if can not make people see an issue in a certain way, it can always make them think at that issue (McCombs, 1972, p.177).

For those who are interested in the health management it is essential to know how journalists evaluate the administrations performance regarding the corruption in this field.

In this view we performed a descriptive exploratory research, (based on a questionnaire with closed questions), selecting a representative group for the media, interested in the analyzed phenomenon (quality type newspapers and televisions, with national distribution). The answers allow us to appreciate the media knowledge concerning the functioning of the health administration, which institutions are responsible for combating corruption in health and how many of them are considered of greater confidence on the part of journalists.

Thus were selected a number of 7 central newspapers and a number of 2 television channels with national coverage, 12 editors, reporters and chief editors answering, in October-November 2007, to 64 questions.

Questions concerned the most frequently practices involved in corruption. Thus, corruption is defined or identified as a type of behavior that deviate from official duties of a public office in order to fulfill some kind of pecuniary interests, or to acquire a higher status, or to violate some rules under the influence of certain types of private interests. This type of approach includes bribery, nepotism and illegal acquisition of goods (Heidenheimer, 1989, p. 966).

Factors that lead to corruption include lack of qualified personnel to manage auctions, legislative problems and the existence of powerful networks linking officials to the business interests. Authorities can develop some rules in order to facilitate corruption. Contracts can be fixed through an illegal agreement between providers and the preparation of the tender documents is made in such a manner in order to favor a particular contractor. Another widespread practice is that of the commission, a form of bribe considered normal even before the start of negotiations for acquisition. Sometimes, public employees increase the amount of commission, putting in front of companies two alternatives: either adapt to new levels of bribery, either to withdraw. Most of the companies that win the public auctions are those including among their shareholders officials from the public administration, or their relatives. (Open Society Institute, 2002, pp 169-171).

 

METHODOLOGY

Questionnaires with questions about the perception of fraud and corruption in the health sector have been completed by 12 journalists. Their selection was based on the frequency with which their media institutions analyzed phenomena related to corruption in health over the past three years (at least one inquiry per month, in newspapers, or news / IP television at every month). A number of 7 central newspapers and a number of 2 TV stations with national coverage were thus selected. Those who filled questionnaires were either reporters / editors who deal directly with health field or those working on inquiries and investigations on corruption in general, but who were involved in the investigation of cases related to health; there have been 2 cases in which the questionnaire was completed by the editor in chief of the newspaper. All institutions have their headquarters in Bucharest, most having territorial offices. Questionnaires were filled in October 15-November 15, 2007. The number of questionnaire is greater than the number of answering institutions because, there were cases in which more persons have answered in an institution, being specialized on corruption as we mentioned before.

 

Interpretation of responses was done by grouping the degree of intensity of the response scale as follows:

1-4 - low intensity;

5-7 - medium intensity;

8-10 - high intensity.

 

Interpretation was based on the specific answer for given question. On this basis, answers were grouped for each question, and in some cases the amount of answers can be bigger than 100% because one respondent could give several answers.

 

 

 

RESULTS

Journalists were asked, first, to answer a set of questions about how the providers could obtain contracts with public health (Ministry, NHIH, local health authorities, public hospitals, etc.), in the last three years (2005 - 2007).

 

The perception of 80% of respondents is that there were made adjustments to the terms of reference in favor of some competitors in the tender. In an even higher proportion, it was estimated that there bids submitted by competitors who had a previous understanding between them, at organizers`s demand. This proportion of answers is maintained concerning the problem of modifying the contractual terms during contract duration are amended, including increasing the value of the contract after its award.

 

The most common situation the media is suspecting is that the lack of transparency is seen as a rule in public contracts award.

The next question for the jour-nalists was to assess the public acquisitions proceedings in health administration institutions for the mentioned period (2005-2007), taking into consideration elements such as transparency, fair and open com-petition and lack of bureaucratic barriers artificially created, professionalism and fairness of organizers.

CONCLUSIONS

The lack of transparency is considered by the media a corruption mechanism, as well as a major obstacle.

All the mechanisms of corruption mentioned by the experts were iden-tified by journalists as being present in the process of public aquisition in health. Mainly, however, journalists complain about the lack of trans-parency. This is a practice specific to administrations that try to hide the facts of corruption, but also a major impediment in editorial activity. Complaints related to the administration transparency were expected, because the health system, as other high expertise systems, is difficult to be kept under control by the representatives of public opinion, who would need specific training in this regard. The journalist should have knowledge of medicine and be familiar with the health management. Journalists who are not trained in this field must rely on the experts opinion, but who are are part of decision makers in the field.

Further research could verify a hypothesis advanced in this exploratory investigation, that the institutions which ensure an increased level of trans-parency are perceived by journalists as being less corrupt than the opaque ones.

Journalists believe that the corruption level increases towards the pyramid bottom

The level of corruption increases, according to journalists, as the admi-nistrative level decrease: Ministry of Health is seen as having better quality acquisition procedures than the county authorities, and these, at their turn, have better procedures than hospitals. In this evaluation should be taken into account the followings: the assessment of quality wes pre/determined in the answers (trans-parency, lack of bureaucratic obsta-cles,organizers professionalism), the lack of transparency was the main corruption technique incriminated and that the interviewed journalists represent Bucharest media insti-tutions. They primarily receive information from the central struc-tures of government, which they know better, and which are more transparent and more interested in public communication.

Central structures are credited with more professionalism than the local ones. Therefore, journalists could have the impression that the procedures are followed rather at the top of the pyramid than to the bottom. They consider for example, the large number of contracts involved by the daily activity of a hospital, as being similar to the same number of acts of corruption. Even though the Ministry of Health, organizes few auctions, by undertaking high value contracts, has a considerable impact on the field. Note that most participants in this study believe that the most commonly used method of corruption is the pre/existent understanding between com-petitors in an auction, namely at the organizers demand. If this really happens, the likeliness to occur later misunderstandings, complaints and press scandals, is reduced in pro-portion to the number of small contracts and firms involved. Instead, hospitals or insurance county structu-res, which have many contracts, are often involved in press scandals.

In addition, the Ministry of Health which coordinates and controls the hospitals and Insurance Houses, is responsible for the way these struc-tures organize public auctions. Their lack of professionalism and transpa-rency should be charged to the Minis-try as well, but it seems that journalists consider them as autonomous structu-re, the liability being individualized. When questions are specific (about failed acquisitions conducted by the MoH or the assessment of health program) the perception that acts of corruption are involved predominate, but when assessments of procedures are made, in general, the Ministry is well positioned.

As for the effectiveness of public institutions, the Ministry has been better appreciated than the NHIH, which proves that journalists dont analyze the performance in public management terms, but according to the institution image. The NHIH is seen as an inefficient structure because it has not generated the expected financial resources. The Ministry of Health managed to transfer its negative image to the insurance system.

In terms of traditional public admi-nistration, efficiency should have been appreciated through the manner of the budget implementation is conducted (Păunescu, 2008, p. 39). This, however, is consistently lower in the case of Ministry of Health than in the National Health Insurance House, for the exa-mined period.

Another indicator of permeability to corruption is the capacity of influencing the decision. Journalists opinated that the companies and pharmacy chains have a higher capacity to influence decision than the College of Physicians. So, structures which are able to make informal payments or provide other material benefits are considered more influential than structures assimilated to professional associations and which put together experts in the field.

 

The College of Physicians, charged with responsibility for solving mal-praxis cases

Regarding correctness of health institutions in relation to the population, the lowest assessment degree is granted to the College of Physicians (and to a lower extent to the Insurance House, probably because of all the deficiencies in the system as well ). Thus, this position is expressed by the main part of media, which consider the College of Physicians responsible for hiding mal-praxis cases. There are not other critics in the press regarding the College. The result therefore reflects a problem of fair assignment of duties and responsibilities. In reality, the Ministry is the representative of the population and bears responsibility for the system`s performance. The College of Physicians is a professio-nal body, with responsibilities in the licensing, control and supervision of medical profession, according to the law. Moreover, the Ministry of Public Health watches the way the College of Physicians respects the legal provisions (Law 95/2006, art. 3).

As for the mentioned cases, at the time of this questionnaire, already a monitoring committee for cases malpraxis was operating, for the county public health authorities and Bucharest. The Ministry has the res-ponsibility, by law, of coordinating the quality control of medical ser-vices, conducted by local authorities for public health.

Negative feedback with respect to the College of Physicians are sur-prising in the absence of critical editorials about the experts who lead this institution (which are also the heads of universities or clinics and led until 2006, most hospitals). A possible explanation is the protection of sources of information. The infor-mation in the medical field has a high percentage in the news flow. Since the 80s, the Western media found that the news in science begin to be dominated by information from the biomedical field. Moreover, the style of news related to science adopted the rhetoric used by the news of bio-medicine: the information is perso-nalized, selecting cases, in particular emotional, makes reference to the risk and provides practical advice, enhanced by the expert authority (Bauer, 1998, p.732 ).

Thus, journalists need the pro-fessional leaders who are both sour-ces of expertise and casuistry. There-fore, this will lead institutions to tend to avoid assigning responsibilities, except those who are able to use also journalists independent of the field sources.


Self-censorship has tempered PNESSP critics

Another problem suggested by this exploratory research is related to the self-censorship generated by the ex-pected reaction from the public.

Although journalists consider PNESP as an image manipulation (i.e., even-tually, a form of corruption, the gover-nor get a help from the administrative act) and sending money to private laboratories, critical articles from the National Assessment of health Population Program were less numerous, where the predominant ones are the neutral information ones. Criticisms aimed especially failures in delivery of coupons for free analysis and less the efficiency with which considerable funds have been spent (200 millions euro). As a result of editorial experience, we can say that journalists expected that the population to appreciate that all this was free of charge, as with other benefits offered by the authorities, so they avoided issues that could annoy the public.

Surprisingly, the journalists consi-der the system to go in a good direc-tion, although they have a predomi-nantly negative view on the correct-ness of the persons who manages it and on the practices in the system. It is possible that feedback to be influenced by the general context: sustainable economic growth, integration into the European Union, increased allocation of resources in healthcare, enabling institutions and mechanisms to combat corruption at national level. As a result, although they had not confi-dence in the system administrators, journalists appreciate it will improve

References

1. BAUER, Martin, - The Medicalization of Science News. Social Science Information, SAGE Publications, Issue 37, 1998,
2. CHELCEA, Septimiu, - Sociological Research Methodology, Economic Publishing House, Bucharest, 2004,
3. HEIDENHEIMER, A. J. et all. - Political Corruption: A Handbook, N. J. Transaction Publishers, New Brunswick, 1989,
4. MAXWELL, E., McCOMBS, Donald, SHAW, L. - The aggenda-setting function of Mass-Media, The Public Opinion Quarterly,Vol.36, No.2, 1972,
5. OPEN SOCIETY INSTITUTE, 2002, the Monitoring the EU Accession: Corruption and policies to combat corruption, Budapest, 2002,
6. PĂUNESCU, Mihai (coordinator), - Public Management in Romania, Polirom Publishers, Iaşi, 2008.

 

 

 

 

 

 

 

 

 

 

 



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