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How Does Corruption Damage Health-care Systems, And What Can Be Done About It Through Regulation?

In governmental, private, and quasi-private health-care systems, there is a lot of corruption (the World Bank defines corruption as “abuse of public office for private gain”). Health practitioners, politicians, and organizations abusing their authority and influence for personal gain contradicts their public roles. Bribery, theft, bureaucratic or political corruption, and misinformation for private gain are the four basic types of corruption.

 

Corrupt behaviour in the health-care sector can have three types of consequences.

The state of health and the health-care system Corrupt behaviour is likely to wreak havoc on the health-care system’s ability to provide high-quality, cost-effective care to those who need it most. There is mounting evidence that high levels of corruption impoverish people, create inequality, and degrade health, particularly among the most vulnerable people.

Entrepreneurship is a type of business activity. The presence of a significant quasi-private system operating corruptly within the public sector can stifle the growth of a strong private sector. It is sometimes more profitable for private providers to take advantage of public facilities, which have supply of medical equipment and patients, rather than opening their own clinics and recruiting mechanisms.

Macroeconomics is the study of the economy as a whole. There is mounting evidence that corruption stifles economic growth and investment in the private sector. Corruption in the health sector, like corruption in other industries, has macroeconomic consequences.

While corruption exists in all countries, its consequences are especially severe in low- and middle-income countries.

 

Considerations for policy

Preventing corruption in the health-care sector is a complex and challenging endeavor. The development of a truly effective system of auditing and accountability that not only exposes corruption but also acts on it is a major problem. Anti-corruption laws and regulations must be strictly enforced, and all processes in such a system must be explicit and transparent. Publicizing public perceptions of corruption in certain government departments and medical facilities is one technique to assist gauge the quality of public services. Patient rights should be clearly defined, a system should be in place to make it simple to register and investigate concerns, and the process of filing complaints with the courts should be simplified and made less expensive.

Market incentives could also be utilized to better govern a health-care system. Incentives have the advantage of being universal, unlike regulatory procedures, and do not require particular cases of corrupt behavior to be isolated. It is important to stress, however, that market incentives will only work equitably if they are well-designed in the context of broader health-care and economic regulation.

 There is a lot that can be done to reduce corruption, but it will not be enough. It is becoming increasingly clear that all players in the health-care system — governments, payers, providers, professional groups, people, and so on – must be involved, as well as international cooperation.

The opinions presented in this summary are based on a HEN Network member agency’s publication and do not necessarily reflect WHO/decisions Europe’s or declared policy.