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HENHENews How does corruption affect health care systems, and how

can regulation tackle it?

Source

Ensor T, Duran-Moreno A. Corruption as a challenge to effective

regulation in the health sector. In: Saltman R, Busse R, Mossialos E

(eds.) Regulating entrepreneurial behaviour in European health care

systems.

European Observatory on Health Care Systems Series. Accessed 7

April 2005.

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.

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Updated 04 May 2005 | Printer-friendly version