Brown envelopes. Would you hand one over to your Doctor?
By katerina
@thea09 (18305)
Greece
August 12, 2009 9:47am CST
The term brown envelopes refers to handing over a bribe and is rife in certain areas in this country but most generally accepted as a given when dealing with some Doctors. A good friend of mine is debating the merits of proceeding with surgery at the moment as a quick solution to a critical condition. His other option involves a recovery time of six months. As the operation is risky he is debating this but of course has been encouraged to go ahead with it by certain doctors. Some of them have named the specific amount, round about 2000 euros, they expect to receive for operating desptite no need for payment within the system. My friend takes the attitude of 'not doing brown envelopes' although payment of the bribe is affordable to him, rather he questions the motives of the Dr's pushing for surgery. Will it be in his best interests first, or in the interests of the Dr first, he rightly thinks.
Would you hand over a brown envelope to a Doctor or not?
6 people like this
12 responses
@Hatley (163772)
• Garden Grove, California
12 Aug 09
oh my no never. I had never heard of the term but here in the U
S I dont think doctors take bribes,at least mine doesnt and he does take all us hmo p atients.he is a really great doctor and he would never take a bribe.if it is done here in the US I sure dont know about it . I think that is outrageous. I would never do that with a doctor. they get paid by my insurance and they sure get no bribes from me.
1 person likes this
@thea09 (18305)
• Greece
12 Aug 09
Hello Hatley, as I said to Joy above, this is a widespread thing in this country and often families ponder on whether they will need to do it or not as of course not all doctors do this and some would be offended by the offer whilst others expect it as a matter of course, usually to have the surgery needed brought forward. I agree with you that it is an unacceptable practice, and in this particular case all the costs are carried by the insurance anyway, so the doctor is asking for nothing but an out and out bribe.
@JoyfulOne (6231)
• United States
12 Aug 09
Never heard of that term before, but I've heard of people doing that. I would not do that. I also would not trust a Dr who would ask for such a payment, that's cheating the system and lining their pockets with bribe money. If a Dr is willing to do that, what else are they willing to cheat on?! And if a person's NOT willing to give that payment, would they still do a quality job of the surgery and all, or worse, would they not take the patients best interests in heart because they didn't fork over extra money? I don't know what country you're from, but I think in the US here they'd be reported for dishonesty and malpractice. I wish your friend good luck and better health.
1 person likes this
@thea09 (18305)
• Greece
12 Aug 09
Hello JoyfulOne, I live in Greece and this practice maybe illegal but is widespread and usually a family will hand over a brown envelope of cash to speed up the system. If there are twenty people waiting for an operation then the one with the biggest envelope will be seen first. Not all Dr's work like this I hasten to add, and not usually the ones who have worked abroad, but everyone knows it goes on.
@GardenGerty (169449)
• United States
17 Aug 09
Yours is a timely discussion, with so many people pushing for healthcare reform in my country and for universal health care. Your friend already knows his moral standing on the topic of brown envelopes. He needs to see if he can find a doctor who does not expect a bribe and see what the verdict about surgery is then. He can also work from the idea of pros and cons and lists about the surgery. Not knowing the specific condition, I will comment that sometimes the quick fix is also the solution that unravels quickly, but a process that requires a long time to establish can then be counted on to stand for a long time.
@thea09 (18305)
• Greece
18 Aug 09
Hi Golden Gerty, yes my friend would not for a moment consider paying a bribe for this but the less well educated and poorer people are used to giving in to this sort of thing. My friend will be going to see various specialists in Athens on Friday and have further tests but lots of people are so used to the paying the brown envelope that they would not for a moment challenge the doctor on his mediacal opinions. It is often true here that the type of people who won't pay bribes would also trust more a Doctor who has worked abroad and thus less likely to be embroiled in the little corruptions here. In this case the quick fix ought to be permanent
@scarlet_woman (23463)
• United States
13 Aug 09
wow.
our doctors would be keelhauled if they pulled that.
but then,they charge so much for any service,they really don't need to ask for it.
they're already getting it in a way.
@scarlet_woman (23463)
• United States
16 Aug 09
that,i bet would work here.
i'm sure they'd be more than happy to jump somebody up with an envelope.
the appointment setter would anyway 
@thea09 (18305)
• Greece
16 Aug 09
Ah, so now you see how the brown envelopes can be worked! We have to know when a kind of nepotism is actually more prevalent, I must admit to being a beneficiary of the latter myself in queue jumping, the family ties reach far into many places and are pulled out all the time. Basically Greece is dominated by the 'who you know' element and I don't think that that will ever go away, and it's free unlike the brown envelopes.
@thea09 (18305)
• Greece
14 Aug 09
Hi scarlet woman, well the doctors here are also being paid for the job they do but many of them have used the brown envelope system for so long they are just used to it now, and expect it. I must stress again that not all doctors expect it or will accept it, even though the tradition is so entrenched in the culture that often the patient offers the bribe before the doctor can accept it. In the cafenion culture much general debate goes on as to how much should go in the brown envelope to get the surgery needed more quickly.
I heard yesterday of someone trying to jump the queue at the local hospital just to get in to see the doctor, which can be a huge wait even with an appoinment, as the first to book in with admin on arrival with an appointment for that day goes to the front of the queue. Anyway this hopeful queue jumper turned up late to admin and tried to hand over a brown envelope to be seen first and was flatly refused by admin. She should have known that queue jumping for your appointment only works if you know someone who works in the hospital who will take you in in front of the queue.
1 person likes this
@ANTIQUELADY (36440)
• United States
12 Aug 09
I'm not famaliar w/that custom & know nothing about it so would be hard for me to say i would or wouldn't but right off the top of my head i will say no, i wouldn't do that.
@ANTIQUELADY (36440)
• United States
12 Aug 09
I think that is awful that they are getting by w/doing that. Has it been going on a long time. That should be againist the law. I DON'T KNOW WHAT DOCTORE MAKE THERE BUT HERE THEY ARE OUTRAGEOUS. If they started tacking on extra noone could afford them. The last time i went to the dr. i was in there less than 30 minutes & his office visit was $129.
@thea09 (18305)
• Greece
12 Aug 09
Hi Jo, yes it is a pretty standard practice here, I don't know if it illegal or not
but it wouldn't make any difference, that kind of thing is just how it is. A visit here to a general practioner who is private would be about 35 euros which include follow up visits for the same condition. Our local clinic is free and an appointment with a hospital doctor is a standard 3 euro admin fee, so we come in much cheaper than you generally. It only appears to be surgeons who do this and of course they control when operations are scheduled. My friend will be meeting new doctors in Athens next week where hopefully the practice of brown envelopes is not so common.
1 person likes this
@thea09 (18305)
• Greece
12 Aug 09
Hi Jo, I'm getting the idea that this does not happen stateside but it is an ongoing thing here which hopefully will phase itself out as a younger generation of doctors rise through the ranks. I think the thing that irked me most about my friend was when he was also told the anethiatist would also require a brown envelope of 500 euros. And apart from dispensing out medications nursing is non existent here anyway, it is done by the family, and if they can't cope with it they need to hire in a private nurse.
1 person likes this
@zhuhuifen46 (3483)
• China
14 Sep 09
In our place, there are doctors who hint for the brown envelope, no matter how the authorities are guiding for a cleaner profession atmosphere.
In my case, I would rather give some gifts afterwards to express my gratitude or appreciation, but not in cash. But the issue is cash is quite often more expected, not the gifts.
@thea09 (18305)
• Greece
14 Sep 09
Hi zhuhuifen, I've heard now that this practice is rife in India but I hadn't realised it had reached China too, thanks for the information. Actually it's really surpised me, I thought this would be a major offence there. What does the envelope achieve there, faster attention? Even gifts shouldn't be necessary to doctors. And I presume that as this will fade out here in Greece gradually as people become more educated then it is just starting in China?
@sudiptacallingu (10879)
• India
13 Aug 09
Well, the term brown envelope is new to me but I can just understand how it works coz in India, at least in my state, it’s rather the norm than the exception. We have this chain of medical and equipment companies who are visiting doctors and promoting their products. Till this point it was OK…but in cases where surgery is an option, they push really hard so that the doctor makes it look to the patient as if there is no alternative to surgery. Now surgery, if done at Govt hospitals, costs minimum but the equipments, like pacemaker, or steel plates or joint replacements, cost a fortune for ordinary people…yet the doctors will force these just because they (the doctors) get a substantial cut money from the manufacturers of these equipments. So if I am being forced to buy equipments worth Rs 10,000 for a surgery which could have been avoided (though I don’t know that), the doctor gets at least Rs 1,000 for his ‘share’…so in this case, the patient is not paying the brown envelope to the doctors directly, but indirectly definitely so. Right now, we are facing the same with my FIL…he has a minor fracture on his knee which would have been plastered and left before, but now doctors have insisted that he needs an operation to tie the two bones together with a steel twine…now we have no option but to agree simply coz the doctor supposedly knows the best. So is the case with your friend I guess…he can of course opt out of surgery but before that he’ll have to ensure neutrally that its not going to create any complications in the future. In our case, we could not ensure coz most doctors have their own opinion and we got more confused.
@thea09 (18305)
• Greece
13 Aug 09
Hello celanith, I think the problem here is that because it has become an accepted practice in many areas the people who are most susceptible to feeling the need to hand over the envelope are those who have accepted this as the norm and are generally less educated and less able to travel further for other options.
@kykidd (6812)
• United States
13 Aug 09
Wow, this seems very odd. I'm not sure if I understand, but it doesn't seem like there are any benefits to him paying the 2000 since the doctors are pushing for him to have the surgery done anyway. I don't think that I would pay it. And like the one person said, I may even have to switch to a different doctor if they are asking for this on top of their regular pay.
@thea09 (18305)
• Greece
14 Aug 09
Hi kykidd, in the case I mentioned my friend, along with many other more modern thinking people who are better educated, would never use the brown envelope system. He has the option to travel further afield to find other opinions on the best course foward. For others though perhaps with the same condition they may be influenced by the doctor to have the surgery which is only one of two options. If the person is used to handing over brown envelopes and thinks of the doctor as knowing best, they will hand over the money and take the surgery. The surgeon will then be the one to benefit whereas it might not have been the best option for the patient. Unfortuantely so many are so used to the brown envelope system that they just go along with it and do not seek other opinions. One if five Greeks hand over a brown envelope each year and the average amount inside is 800 euros.
@3SnuggleBunnies (16374)
• United States
12 Aug 09
I've not heard of that term exactly. However when it comes to celebrities with addictions I've heard that's how it works.... basically they end up owning the Dr by telling them that they pay them good money to prescribe them XYZ meds & if they want thier money they'll continue to do it. I bet that's why they take months and months to investigate their deaths & clean out the Dr's offices & their records.
I could not afford to hand over a brown envelope whatsoever. But I agree if so many have their hands out maybe it would be in your friends best interest to find a truly reputatible Dr, not someone who may not be advising in your friends best interest rather their wallets.
@thedailyclick (3017)
•
12 Aug 09
Well the practice definitely doesn’t go on in the UK and any Doctor caught practising such methods would be struck of immediately. Although you could say that by going Private in the UK is the legitimate equivalent of brown envelopes as you pay for your operations rather than going through the NHS. The thing with going private is that the doctor who recommends surgery won’t benefit financially from your decision.
Personally I wouldn’t be willing to do it because if a Doctor is willing to accept a bribe then in my opinion he will also push unneeded operation on you just to feed his own pocket. It all sounds a little too risky for me.
@dlr297 (5409)
• United States
12 Aug 09
I do not think that i would pay a bribe to a doctor for medical treatment. and i think that any doctor that accepts such a thing should lose his licience to practice medicine. It is that type of thing that is destroying the health care for people, it just defeats the purpose of having health insurance that pays for the sugary.
@thea09 (18305)
• Greece
12 Aug 09
Hi dlr, most of the responses here have been from Americans and you all seem to deplore the system. However here it is an accepted practice, along with nepotism. It definitely goes against the grain of how we perceive doctors but I think its been going on here for so long that many just accept it. The one time I needed to be in hospital I didn't know if I should be offering one or not but my surgeon did not operate that way having worked in Canada and Sweeden.
