Service delivery and client interface

In many developing countries, corruption at the point of service delivery takes the form of extortive bribery, where doctors and nurses charge small informal payments to patients to supplement incomes, especially in countries where wages are below living standards. They may demand bribes for medication or services which should be free such as beds, bandages or anaesthetics.  

There have been documented instances of collusive bribery between patients and healthcare professionals. Under the table payments can be made to medical staff for preferential treatment, timely care, better drugs and so on. Patients may bribe health professionals to obtain drugs that were not prescribed to them or to “skip the line” in operation or organ donation lists. The use of fraudulent prescriptions is an important factor in the illegal commerce of prescription drugs.[1]

However, corruption at the point of service delivery does not always involve any monetary transfer between medical professionals and patients. Physicians may provide preferential treatment to family members and friends, treating them first or in a better manner than those patients that need the service most. For severe conditions that require organ transplant, for example, this practice can mean the difference between life and death.

Corruption in payment systems is also an area of concern in many countries, including waiving fees or falsifying insurance documents for particular patients or using hospital budgets to benefit favoured individuals. Risks also include the illegal billing of insurance companies, government or patients for services that are not covered or carried out, as well as the falsification of invoice records, receipt books or utilisation records, or creation of “ghost” patients.[2]

Doctors may perform unnecessary medical interventions to maximise fee revenue. Illegal referral of patients to specific private pharmacies to purchase prescribed medicines that are not on the supply list of the public facility is common practice, resulting from unethical arrangements between pharmacies/pharmaceutical companies and doctors. Some pharmaceutical companies use aggressive marketing practices and gift-giving to influence individual doctors to favour their company's drugs at the time of prescription. In countries such as the US, some doctors are practically paid by pharmaceutical companies to prescribe their drugs, sometimes on a commission basis.[3] This type of influence may not always illegal, but it may significantly influence the quality of healthcare provided and the types of drugs available to patients.[4]

It is also common for doctors in developing countries to run their own private practices while on the public health system payroll as a coping strategy to supplement their wages. Doctors are then likely to refer their public patients to their own private clinics, depriving the poorer clients of quality treatment and fuelling inequalities in access to healthcare.



Iñaki Albisu Ardigó; Marie Chêne


Matthew Jenkins

Contributing experts:

Umrbek Allakulov (Water Integrity Network)

Shaazka Beyerle (US Institute of Peace)

Simone Bloem (Center for Applied Policy)

Claire Grandadam (Water Integrity Network)

Jacques Hallak (Jules Verne University – Amiens)

Mihaylo Milovanovitch (Centre For Applied Policy)

Muriel Poisson (International Institute for Educational Planning (IIEP-UNESCO)

Juanita Riano (Inter-American Development Bank)

Marc Y. Tassé (Canadian Centre of Excellence for Anti-Corruption)

Vítězslav Titl (University of Siegen)

Davide Torsello (Central European University Business School)

Patty Zakaria (Royal Roads University)



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