( r the table out of wages averaging $48...)Russian Health Care Marred by Corruption,Health

r the table, out of wages averaging $480 a month. The poll had a margin of error of 2.6 percentage points.

Panfilova also said medical and pharmaceutical companies routinely bribe health officials so that hospitals buy their equipment and medicines, even though their quality is often not the best.

Kirill Danishevsky, a health researcher with the Russian Academy of Sciences' Open Health Institute, has estimated that up to 35 percent of money spent on health care consists of under-the-table payments.

At the Dzhanelidze Emergencies Institute where Papiyants was treated, spokesman Vadim Stozharov denied that doctors refused to provide free care. But he conceded the hospital has received so many similar complaints it set up a hot line to deal with them.

The Health and Social Development Ministry declined to comment on the bribery allegations. But Galina Lavrishcheva, the top health official in Stupino, an industrial town in the Moscow region, acknowledged that health care workers sometimes demand payoffs.

Overspecialization, a legacy of the Soviet era, is a big problem because patients are shuttled from one narrowly focused specialist to another. Meanwhile, no physician generally takes responsibility for their overall state of health.

But critics say these changes are no substitute for radical change -- just a high profile way of spending the country's oil-driven wealth in an election year. They insist the reform does not address bribe-taking by emergency health care providers and medical specialists.


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