Taxi Firms as a Business Model for Russian Hospitals

Regular readers will be relieved to hear that Ms. Parallax Brief had her plaster removed last week. The visit to the hospital, the same pit of corruption and negligence she stayed in when the leg was first broken, was instructive.

During Ms. Parallax’s miserable week in traction in Room 101 ward 404 five weeks ago, the Parallax Brief’s views of the bribery and pared care pervasive in the hospital developed from seeing it as being a case of cheeky graft and apathy to be expected of low paid workers in a society where corruption is commonplace to viewing it as a brazen effort by wicked people to exploit for monetary gain their power of life and death, comfort and pain, and full recovery or chronic suffering.

The Parallax Brief felt obliged to play the game in the form of bars of chocolate, a bottle of bourbon and some hard currency while his good lady was under their care, but he now saw no reason to line the pockets of these racketeers for removing the plaster. If they assumed the foreigner in the shirt and tie would recompense them for a job well done because he slipped the odd bribe before, let them think that – no further services were needed, so disappointment for non-payment would not have repercussions.

But the plaster was removed, and farce ensued.

Ms Parallax Brief hobbled in on crutches, clearly upset that her leg was painful and angry looking and that she was still unable to walk. Meantime, the doctor stood over the Parallax Brief’s shoulder like a pending day, making no attempt to disguise his pavlovian expectation of a juicy payoff; Ms. Parallax stared the stare of a woman who wishes to communicate by facial expression alone the sentence “pay the man so we can get out of here or I’ll render you infertile”; and her father stood near, elbow nudging while muttering “he wants paying” several times under his breath.

About three minutes of this toe-curling purgatory was all it took to break the Parallax Brief, and against his better judgment he whipped out a thousand ruble note, handed it to the doctor and walked off in a self-loathing pique to hail a taxi.

But then the guards who control the entrance wouldn’t let the taxi into the main compound. Didn’t they understand, the Parallax Brief explained in the most forthright terms, that Ms. P is in the hospital on crutches, and it would be dangerous to negotiate the steps and ramps, which are covered in sheet ice? “Hospital policy. Under no circumstances can we break the rules.” But that’s absurd. It’s a hospital! How can you possibly have rules when patients who can’t walk have to come out all the time? “You don’t understand. It’s simply impossible. That’s the rules”.

200 rubles later, the rules had been broken and Ms. P was safely on her way home, but the experience provided the Parallax Brief with a lightning bolt revelation: the hospital’s business model is like that of a taxi firm.

Now, the Parallax Brief doesn’t know how taxi firms work elsewhere, but in the UK the taxi driver provides his own car, radio, etc, and every week pays the firm a certain amount of cash, but then gets to keep all the fares he receives. Likewise, the doctors in the hospital we went to provide their own medical expertise and time for negligible remuneration in exchange for being able to use the premises to extort bribes. Meantime, the guards sit and monitor the access gates for a measly salary, but get to keep whatever they can rustle from those who want to get private vehicles near an entrance door.

It’s the taxi firm business model working in a hospital.

Filed under: Russia, Corruption, Health Policy, Hospital, Medical Care, Russia