When I was in Poland last month, someone there remarked how Poland had been one of the ‘disability capitals’ of Europe. The numbers of people claiming to be unable to work through illness were apparently enormous. Today I had a conversation which perhaps helped explain why.
A Polish man told me how it had been very normal for a backhander payment to be paid to a doctor in order to get extra days of being certified unable to work. You went to the doctor with your national insurance book which showed that you were to be treated under the national insurance scheme. Inside the book you put, say 100 zlotys. You placed the book on the table before you went into the cubicle to be examined for whatever illness you were supposed to have.
The doctor came in and it was agreed that you would need an extra three days of being off sick and then you would probably be ‘cured’. You would go out and, on the way, collect your national insurance book which no longer contained the 100 zlotys.
My Polish contact does not know how much the prevalence of this has changed in the post-Communist days. He says though that because of the efforts of special anti-corruption police, it now tends to be done through a third party. You make a deal with a friend of the doctor, let’s call him Robert, and you give him some money. You then go to the doctor and remark, ‘by the way, I saw Robert yesterday and he sends you his best wishes’. You then get the certification that you want.
My same source told me about how himself was treated in a Polish government hospital about five years ago. He was in a bad way but there were no beds available and he was left in the corridor and not treated well. His partner went to see the doctor in charge of his treatment. She said, “I live in England now. I don’t know how I should do this. My partner needs to be in a bed and he needs to be back in Britain within two weeks. I will give you £500.”
The doctor said ‘no’.
She said, “OK” but put the cash under a magazine and left the room.
When she returned the cash had gone. Her partner got a bed and was able to leave within two weeks as she had asked.
How much is now the going rate to get an extra three days of sick leave? According to a colleague of my source who still spends a lot of time in Poland, it is ‘at least 100 zlotys’.
And what conclusions should be draw from all this?
I am not sure. Obviously we can conclude that the truth about how welfare systems work is not always to be found in policy documents, government declarations or academic studies. Important things are going on that are hard to measure and which many people prefer to pretend do not exist.
Even more important, though, is the point that systems should be designed to minimise these sorts of things. The incentives need to be aligned with good behaviour, not bad, corrupt or wasteful behaviour.
Which reminds me of another corrupt practice my Polish source mentioned. He instanced a doctor in Poland saying that a patient he is seeing privately needs some tests. There is a long wait for such tests. But the doctor gets the person into his national health hospital the very next week and has the tests done. He then charges the individual extra for having got the tests done. But neither of them actually paid the cost of the tests. The individual effectively paid money to jump the national health queue.