One doctor said a patient recently offered him a free shopping trip to Dubai, an offer he declined.

The issue of health care corruption gained national attention in January when a 63-year-old man, Mihai Constantinescu, died of a heart attack in the waiting room of a hospital in Slatina, in southern Romania. Mihaela Ionita, the nurse who wheeled him from room to room trying to get a doctor to treat him, said in an interview that she believed he had been refused care “because he appeared poor and could not afford a bribe.” The hospital said Mr. Constantinescu had not seemed an emergency case.

Dr. Vasile Astarastoae, a biomedical ethicist who is president of the Romanian College of Physicians, which represents 47,000 doctors, blamed a pitifully low average monthly wage of about $510 for doctors for the bribe-taking.

“Patients don’t want to go to a doctor who is distracted thinking, ‘How will I feed my kids or pay the rent?’ ” Dr. Astarastoae said. “So there is a conspiracy between the doctor and the patient to pay a bribe.”

He said that unlike in many Western countries, where doctors are respected and handsomely rewarded for years of hard study, the medical profession here had been denigrated under Communist leaders who made workers in factories the country’s heroes.

A 2005 study conducted by the World Bank for the Romanian Ministry of Health concluded that so-called informal payments amounted to $360 million annually. When an illness requires hospitalization, patients typically pay bribes equivalent to three-quarters of a family’s monthly income, the study showed.

Some doctors say that the bribery culture is so endemic that when they refuse bribes, some patients become distraught and mistakenly conclude it is a sign that their illnesses are incurable.

Doctors and patients say the bribery follows a set of unwritten rules. The cost of bribes depends on the treatment, ranging from $127 for a straightforward appendix-removal operation to up to more than $6,370 for brain surgery. The suggested bribery prices are passed on by word of mouth, and are publicized on blogs and Web sites.