Topic Guide: Corruption in Health Services

Healthcare provision is extremely complex, with an intermingling of private and public actors, different government levels involved, weak and under-resourced regulatory systems, complicated health insurance systems, opaque relations between medical suppliers, healthcare providers and policy makers. Regulators, payers, healthcare providers, suppliers and consumers face a complex mix of incentives that pose major challenges for anti-corruption measures. In addition, health markets are often extremely volatile, leading to fluctuations in prices for pharmaceuticals and equipment which can make overpricing and accounting fraud easy to commit and difficult to detect. This exacerbates the challenge of generating and analysing information, and distinguishing between corruption, inefficiency and honest mistakes.[1]

The fact that healthcare needs and outbreaks of diseases can be difficult to anticipate also makes it challenging for policy makers to effectively plan, manage resources and design robust health insurance schemes. The risk of corruption is even higher in emergency situations such as humanitarian crises, when medical care is needed urgently and oversight mechanisms are often bypassed.[2] Similarly, at the level of individual patients, combatting corruption in healthcare is problematic due to the emergency nature of many healthcare interventions: in life or death situations, corruption may be the only option, and critically ill patients are rarely in a position to make formal complaints.[3]

Another challenge is related to the asymmetry of information between doctors and patients who know more about what ails patients than the patients themselves. Particularly in public-private partnerships where private providers are contracted by the state to offer healthcare, this can leave patients vulnerable to over-diagnosis and maltreatment in facilities which may be unaccountable and poorly regulated.[4] Likewise, pharmaceutical companies know more about their products than public officials responsible for purchasing them. Knowledge in these cases gives enormous power to medical professionals and pharmaceutical companies who can misuse their power and information for private gain.  

As healthcare provision is easily associated with issues of interpersonal trust, favouritism and patronage in the relationships between healthcare service providers and seekers, there may be many societal and cultural conditions under which transparency and corruption are not opposite poles. In countries where face-to-face and informal relations are the norm, it may be less important to promote anti-bribery and gift policies than to grant efficient and fair access to services among the population.[5]

Finally, the health sector in many countries is under-staffed and under-resourced. In India, where 47 per cent of children are underweight,[6] public spending on healthcare hovers around 1 per cent of GDP and the majority of this is typically on recurrent items like salaries, rather than capital investment in infrastructure or capacity building.[7] Doctors and healthcare professionals operate under poor and stressful working conditions and, in many cases, deal with delayed pay, no vacation days or long working hours. In many situations, corruption is a coping strategy for health professionals to supplement their meagre income or repay costly medical school bills.