Monday, March 20, 2006

A Perspective from Transparency International's 2006 Global Report on Health Care Corruption

To put the various examples of mismanagement, conflicts of interest, and corruption afflicting health care organizations discussed in Health Care Renewal in perspective, I strongly advocate reading Transparency International's Global Corruption Report 2006, which focuses on health care. (We had previously noted the release of the report here, and a Lancet editorial inspired by it, here.)

To get the flavor, I have assembled some key quotes from the beginning of the report.

Corruption - alongside poverty, inequity, civil conflict, discrimination and violence - is a major issue that has not been adequately addressed.... It leads to the skewing of health spending priorities and the leaching of health budgets, resulting in the neglect of diseases and those communities affected by them; it also means that poor people often decide against life-saving treatment, because they cannot afford the fees charged for health services that should be free. Corruption in the health care sector affects people all over the world.

Corruption might mean the difference between life and death for those in need of urgent care. It is invariably the poor in society who are affected most by corruption because they often cannot afford bribes or private health care.
[Executive Summary]
But the scale of corruption is vast in both rich and poor countries.
Corruption deprives people of access to health care and can lead to the wrong treatments being administered. Corruption in the pharmaceutical chain can prove deadly.... The poor are disproportionately affected by corruption in the health sector, as they are less able to afford small bribes for health services that are supposed to be free, or to pay for private alternatives where corruption has depleted the public services.
Corruption affects health policy and spending priorities.
[The Causes of Corruption in the Health Sector: a Focus on Health Care Systems]

Corruption in the health sector is not exclusive to any kind of health system. It occurs in systems whether they are predominantly public or private, well funded or poorly funded, and technically simple or sophisticated.
No other sector has the specific mix of uncertainty, asymmetric information and large numbers of dispersed actors that characterise the health sector. As a result, susceptibility to corruption is a systemic feature of health systems, and controlling it requires policies that address the sector as a whole.
The forms of abuse may differ depending on how funds are mobilised, managed and paid.
The evidence available on corruption in health care systems with direct public provision [of care] is largely focused on informal, or illegal payments for services in developing or transitional economies. This form of corruption has a particularly negative impact on access to care for the poor when they cannot afford these payments.
When public financing is separated from provision, the character of abuses is likely to change, focusing on ways to divert the flow of payments and reimbursements. One central aspect influencing the type of abuse is the payment mechanism....
When remedies are put in place to remedy these problems, efforts to influence regulators becomes a new potential source of corruption. Powerful interest groups, including suppliers, payers and health providers, may ‘capture’ regulators in order to evade their responsibilities, or further their interests at public expense.
Consumers generally lack the organisation and power to discipline other actors by voicing criticism or choosing different health care providers. In addition, abuses can be hidden behind simple administrative inefficiencies....

I would strongly suggest, as they say in the blogsphere, "read the whole thing."

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