"Romanians spend €300m to €400m on bribing doctors, and just €150m on private healthcare", says Rainer Schoenberg, head of the East European division of healthcare insurer Signal Iduna.

He says that this demonstrates the real pent-up demand for timely, quality healthcare. Undaunted by the level of corruption, Signal Iduna launches one of the first private healthcare policies in Romania this month.

As well as a policy for adults, covering non-acute care, Signal Iduna is launching an acute policy aimed at children. Schoenberg says the policy is only available for children, in order to stop adults with serious conditions selecting it in their droves. "We know the likelihood of children between 2 and 16 claiming," he says.

Children with acute problems will be flown, with a parent, to facilities in either Greece or Germany, in an agreement with big German healthcare provider Asklepios, which also owns 30% of Athens Medical Centre. Schoenberg claims: "There are only four private hospitals in Romania, and the largest has just 40 beds."

Our Analysis: The presence of a significant black market works both ways. Yes, it spells competition for legitimate private operators, who face incremental competitors in the form of public sector specialists, who, for a small bribe, will offer preferential treatment. But it is also a measure of demand for services.

It perhaps helps to explain the extraordinarily high profitability achieveable in Romania, where we hear that pre-tax profit margins can be as high as 60%. Black market levels remain very high across Eastern Europe. Indeed, we are told that even Greece has a substantial black market!