Another Western-style reform is the introduction of state insurance schemes that citizens must contribute to in order to obtain services. The funds operate outside the control of ministries of health. Last year a scandal shook the Estonian insurance system when it was revealed that the directors of several funds had invested money abroad without proper accountability. In the midst of all this upheaval Western charities, equipment manufacturers and multinational donors have rushed in to provide medical aid. One observer commented wryly that hardly any plane lands in Moscow without a group of Western experts disembarking to tout their own vital product or a panacea for the health system.
Stories abound of countries being given pharmaceuticals past their sell-by date.
Equipment donated by Western companies often turns out to be a clever sales ploy, earning many times its original value from spare parts and maintenance over the years. The plight of Albanian and Romanian orphanages stirred public sensitivities abroad and led to an outpouring of aid. But many argue that such money has gone to prop up a discredited system for getting rid of unwanted children. The lack of co-ordination of this aid and the resentment that local inhabitants feel, when they see the living standards in these institutions far exceeding their own, raise further questions. Aid has had a beneficial impact as well, but there is resentment that Western largesse has been handed out in indiscriminate and unthinking ways.