Friday, February 17, 2006

"Corruption in Health Care Costs Lives"

Last week's Lancet lead editorial was insprired by the Global Corruption Report 2006, which focussed on health care, by Transparency International. (The link is here, but requires subscription.) [1]

This is a significant development (and a reminder that anyone interested in the issues discussed on Health Care Renewal should read the Global Corruption Report 2006).

Here are some important quotes.
In recent years, newspaper business pages have been full of examples of corruption and criminal business practices that led to the enrichment of a few greedy individuals.

Yet, one enormous business affecting everyone's life, the health-care sector, which is worth an estimated US$3 trillion per year worldwide and which is mostly funded by taxpayers' money, is strangely exempt from close scrutiny. Very little is known about the extent to which corruption affects health-care systems and providers. The word corruption—abuse of entrusted power for private gain—rarely enters health professionals' vocabulary and is frequently softened to unethical or unprofessional behaviour.

In its annual Global Corruption Report 2006, released on Feb 1, the non-governmental organisation Transparency International shines a spotlight on the health-care sector and concludes that corruption permeates the provision of health care at all levels and in all countries. The health sector is particularly prone to corruption, argues the report, as it constitutes a maze of complex and opaque systems that provide a fertile ground for malfeasance. Transparency International's focus on health is a welcome wake-up call for both developed countries, which are grappling with spiralling health-care costs and increasingly impossible budget control, and for developing countries, which are ravaged by preventable and treatable diseases. Corruption, argue the report's authors, is one of the main reasons why the global community is off target to achieve the health-related Millennium Development Goals.

What is the scale of the problem? In terms of financial costs, it is impossible to state an exact figure, but the estimate goes into tens of billions of dollars per year. The spectrum of corruption ranges from physicians with conflicts of interest advocating a particular treatment for the wrong reasons to aggressive marketing strategies by pharmaceutical companies; from underpaid health workers accepting small bribes from patients to the provision of ineffective counterfeit drugs; from large-scale embezzlement of public-health funds to massive distortions of health policy and funding by corrupt government officials.

Any cure should start with maximum transparency. Donor and recipient governments need to grant easy access to information on health-related projects, budgets, and policies to allow independent and public audits. Codes of conduct need to be adopted by health workers and private sector companies. In this context, the recommendation goes as far as prohibiting physicians from advocating drugs or devices they have a financial interest in and from taking part in speakers' bureaus funded by pharmaceutical companies. Public-health policies should be independently monitored at national and international level and these reports need to be publicly available. Procurement processes should be competitive and transparent. Any transgressions have to be rigorously prosecuted. Whistleblowers from all sectors should be protected.
The Lancet editors have recognized the importance of health care corruption, and particularly that it pervades all countries, that it permeates the leadership of health care organization, rather than just be restricted to low-level employees and invidual practitioners.

It is also important that the Lancet have recognized what we have called on Health Care Renewal "the anechoic effect," that before the Transparency International report, almost nobody in the health care or in health care policy arenas seemed willing to talk about health care corruption other than that perpetrated by low-level employees and individual practitioners. As I noted in my two, but relatively obscure articles,[2-3] numerous cases of conflicts of interest and outright corruption afflicting the leadership of health care organizations have appeared in local media, but never mentioned beyond the local areas affected.

The Transparency International Report and now the Lancet editorial are important steps on the road to increasing awareness of concentration and abuse of power in health care. But we have only just begun.

1. The Lancet. Corruption in health care costs lives. Lancet 2006; 367: 447.
2. Poses RM. A cautionary tale: The dysfunction of American health care. Eur J Int Med 2003; 14: 123-130.
3. Poses RM. The US health care system: dysfunction and hope. Lancet Oncology 2004; 5: 454-455.

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