From Informal Exchanges to Dual Practices. The Shadows of the Romanian Health Care Reform

The current frailties of the Romanian health care system are often explained by resorting to the previous regime’s institutional framework, rarely accepting that they are also the product of post-1990 reforms and the neoliberal means of system reconfiguration. This paper provides an ethnographic account of the ways in which two “products” of these reforms actively contribute to the augmentation of private medical services and to the diminishing access to quality care in the public system: the bureaucratization of primary medicine and the “dual medical practice”. More specifically, I use the concept of “informal exchanges” in order to explore the variety of transactions that occur between patients and the health care staff and to document the means through which its main social actors understand, reproduce, legitimize or blame the very existence of these practices. Then, I analyze how referrals to private medical units increasingly replace informal payments, simultaneously laying even harder obstacles in the access to health care for those in need.