Sir, The FT’s coverage of the British immigration debate and the status of Romanian citizens has been both balanced and nuanced. As a Romanian expat who follows debates on this topic closely, I can tell you that this is very rare.
The analysis on the role of the brain drain in the depletion of the Romanian health sector, which has lost a third of its doctors in two years (“Romanians despair that wealthy Britain is taking all their doctors”, January 15), was particularly insightful. Large swaths of the Romanian medical profession saw their income nearly halved after government cuts in 2010 and were told that more than a third of public hospitals would be shut down.
Yet the doctors’ mass migration is not all about their low wages. An overlooked issue is that Romanian doctors work in a system whose very existence is in question as a result of misguided structural reforms. Widespread anti-state ideology, combined with demoralising income policies for public sector workers, has gradually eviscerated the government’s capacity to exercise basic oversight over public clinics and hospitals. The result was widespread cronyism in hiring practices, informal payments, more mismanagement and a disheartening collapse of basic standards.
The decentralisation of healthcare initiated by the World Bank has compounded the problem. The reform created a new reality in which impoverished municipalities were unable to foot the bill for what were now “their” hospitals. A proposed new reform will make things worse by enabling local politicians to divert healthcare funds to private hospitals contributing to their campaign finances. To top it all off, malpractice stories are covered in the media as morality tales that stigmatise the medical profession and skirt the more demanding task of analysing the systemic causes of the healthcare crisis. For any youngish doctor the incentives to leave all this behind are overwhelming.
Romania has to start by paying its doctors a lot better. The argument that the country can’t afford it is false. If the government could become as good at collecting taxes as Slovenia, let alone Denmark, health sector wages could go up significantly. But the country’s elite also has to decide that they want a decent public healthcare system that can make doctors feel that their vocation is respected and that their careers will evolve in a predictable fashion. Turning this system into nothing but a subsidised avenue for high-skill emigration or jobs in the private hospitals of the local wealthy is not the inevitable consequence of being a peripheral European economy. It is a political choice, and one that the Romanian government and its international advisers truly cannot afford.
Cornel Ban, Assistant Professor, Dept of International Relations, Boston University, MA, US
Copyright The Financial Times Limited 2014
