The EconomistNovember 23rd 2019 Europe 491“W
e have higherwages, we do not
need bribes,” exclaims a poster
taped to a glass screen at Slatina County
Emergency Hospital in Romania. Five doc-
tors draped in stethoscopes smile encour-
agingly: “We let corruption suffer, we will
cure you!” Still, Romania’s health care con-
sistently ranks as the eu’s worst, according
to the Euro Health Consumer Index. De-
spite wages doubling in the past five years,
corruption, underinvestment and an exo-
dus of trained staff are still a plague.
The culture of expediting care with pet-
ty bribes is notoriously hard to root out.
Even more worrying, however, are the large
sums of money thought to be laundered
through heavily marked-up deals with pro-
viders of equipment and supplies. In a big
case in 2016, Hexi Pharma, a supplier of
antiseptics to 350 public hospitals, was
found to have diluted them significantly. A
report accused hospital directors of taking
a 30% cut on contracts.
Eurostat reckons Romania has the eu’s
lowest spending on health care, both per
head (a 13th of what Luxembourg, the front-
runner, spends) as well as by share of gdp.
No new government hospital has been
built since communism fell in 1989. The eu
has offered $170m to fund construction,
but no work has started. So the existing an-
cient buildings are biological time-bombs.
Last December 39 babies were infected with
an antibiotic-resistant superbug at one of
the country’s best maternity hospitals. Ro-
mania has Europe’s highest rate of hospi-
tal-acquired infections.
Though the country produces high
numbers of medical graduates, many do
not stay to practise. Since joining the euin
2007, Romania has haemorrhaged 15,000-
20,000 doctors, who move in search of bet-
ter pay. That leaves an estimated third of
hospital posts in the country vacant. Only
10% of doctors work in rural outposts that
are often understaffed and poorly
equipped. As a result, one in four Roma-
nians has insufficient access to essential
health care, admits the ministry of health.
The government is keen to show that
progress is being made. Medical salaries
are growing faster than those in other sec-
tors, rising from 88% to 122% of the nation-
al average in the past five years. As part of a
crackdown, doctors are being asked to sign
anti-corruption declarations. On July 15th
Romania’s then health minister an-
nounced that undercover patients are be-ingsentintostatehospitalsinordertoex-
pose corrupt staff. A day later, she
announcedherfirstcatch.
Butmuchmoremustchange.Adapting
oldhospitalstotoday’ssanitarystandards
mayprovemoreexpensivethanbuilding
newones,saysCristianVladescu,headof
the National School of Public Health,
thoughthatwillbepoliticallyhard.Root-
ingout corruptionwilltakeyears.Until
then,betternotgetillinRomania. 7The eu’s worst health-care system
struggles to reformRomanian medicineStill in critical
condition
RomanianrouletteI
n the summer eumember states squab-
bled over top European jobs. At least the
fighting was fairly brief. Not so the agonis-
ing deliberations over the eu’s seven-year
budget, or the “multi-annual financial
framework” (mff), which have been under
way for nearly two years. Officials had
hoped to agree a deal by the end of the year.
Though the budget was discussed again on
November 19th, its chances seem slim. The
European Commission has proposed
spending €1.1trn ($1.2trn), or 1.1% of the
combined national income of the eu27(ex-
cluding Britain) between 2021 and 2027.
Frugal governments in the north want to
spend no more than 1%. Some others,
meanwhile, want to decide the shopping
list before they agree on the bill.
A big, contentious item is agriculture,
which gobbles up 37% of spending in the
current mff. Once mocked for creating
mountains of butter and lakes of wine, the
common agricultural policy (cap)is lesswasteful than it used to be, and has shrunk
as a share of overall spending (see chart).
The commission wants to shift funds from
agriculture to research and technology.
That means, for the first time, a cut in abso-
lute terms—of around 5%, says Alan Mat-
thews of Trinity College, Dublin.
The cap’s champions, which include
France and Ireland as well as eastern Euro-
pean countries, want to maintain current
spending. In February Emmanuel Macron,
France’s president, told farmers that
spending should not shrink even by a euro.
But looking at the numbers a different way
might cause these countries to think again.
France is often assumed to be keen on
the cap because it gets the most cash. A bet-
ter measure, though, is to look at receipts
as a share of farmers’ income. This is what
the oecd, a club of mostly rich countries,
does—though it calculates figures only for
the eu as a whole. In a new paper, research-
ers from the Centre for Global Develop-
ment (cgd) work it out for each member.
They look at how much subsidy farmers re-
ceive and add an estimate of the protection
afforded by the eu’s tariffs, which shelter
home produce from foreign competition.
Seen in this way, the flow of money
looks rather different. Latvia does best: a
whopping one-third of its farm income
comes from eusupport. Greece and Esto-
nia also fare well. Although they champion
farm subsidies, France, Luxembourg and
Ireland fare only moderately well—as does
cap-hating Britain. At the bottom end,
Dutch farmers get a mere 7% of their in-
come from eusupport. Rather than reflect-
ing deliberate policy choices, these differ-
ences reflect the fact that subsidy rates
were often linked to historical values of
production, or set when a country joined
the eu, says Ian Mitchell of the cgd. This
might make politicians—and farmers—in
some countries more amenable to cuts that
make the level of support more uniform.
That would allow more time for politi-
cians to decide how to spend the money.
One question is whether funding should be
more closely tied to efforts to re-Farmers in some countries get much
more than othersFarm subsidiesMilking taxpayers
Not such a mountain
CAP expenditure, 2011 constant pricesSource:EuropeanCommission *Proposed1980 90 2000 27*2010806040200As % of EU expenditureTotal, €bn