How does corruption affect health care systems, and how can regulation tackle it?
The issue
There is a lot of corruption in governmental, private and quasi-private health care systems (the World Bank defines corruption as the “abuse of public office for private gain”). The use of power and influence by health practitioners, officials and organizations for self-enrichment conflicts with their public roles. Corruption can be divided into four main types: bribery, theft, bureaucratic or political corruption, and misinformation for private gain.
Findings
Corrupt activity in the health sector can have repercussions in three areas.
- Health and the health care system. Corrupt activity is likely to damage the ability of the health care system to deliver high quality, effective care to the people who can benefit most. There is growing evidence that high levels of corruption impoverish populations, increase inequality, and cause health status to deteriorate, especially among the most vulnerable population groups.
- Entrepreneurial activity. The presence of a substantial quasi-private system that operates corruptly within the public sector can be detrimental to the development of a strong private sector. It can often be more lucrative for private providers to exploit public facilities, with their supplies of medical equipment and patients, rather than to establish their own clinics and mechanisms for recruiting patients.
- Macro-economy. There is increasing evidence that corruption significantly reduces economic growth and private sector investment. As with other sectors, corruption in the health sector has spill over effects on the macro-economy.
Although corruption can be found in all countries, its effects are particularly devastating in low- and middle-income countries.
Policy considerations
Preventing health sector corruption is a complex and difficult task. A particularly important challenge is the development of a truly effective system of auditing and accountability that not only exposes corruption but acts on such revelations. All the processes of such a system need to be explicit and transparent, and anti-corruption laws and regulations need to be scrupulously enforced. One way to help measure the quality of public services is to publicize public perceptions of corruption in particular government departments and medical institutions. Patient rights should be clearly delineated, a system should make it easy to register and investigate complaints, and taking complaints through the courts should be simplified and made less costly.
Market incentives might also be used to regulate a health care system more effectively. The advantage of incentives is that, unlike regulatory procedures, they are universal and do not require that individual instances of corrupt behaviour be isolated. It must be noted, however, that such market incentives will only function fairly if they have been well designed in the context of the overall regulation of the health system and the economy.
A great deal can be done to reduce corruption, but it cannot be done alone. It has become increasingly apparent that all health system stakeholders – public authorities, payers, providers, professional associations, citizens etc. – need to be involved, and that international cooperation is also necessary.
The views expressed in this summary are based on a publication of a HEN Network member agency and do not necessarily represent the decisions or stated policy of WHO/Europe.
