Health Care Corruption as a Taboo Topic
Transparency International (TI) defines corruption as
Abuse of entrusted power for private gain
In 2006, TI published a report on health care corruption, which asserted that corruption is widespread throughout the world, serious, and causes severe harm to patients and society.
the scale of corruption is vast in both rich and poor countries.
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. But corruption in the richest parts of the world also has its costs.
The report did not get much attention. Since then, health care corruption has been nearly a taboo topic in the US. When health care corruption is discussed in English speaking developed countries, it is almost always in terms of a problem that affects benighted less developed countries. On Health Care Renewal, we have repeatedly asserted that health care corruption is a big problem in all countries, including the US, but the topic remains anechoic.
Yet somehow, a substantial minority of US citizens, 43%, seemed to believe that corruption is an important problem in US health care, according to a TI survey published in 2013 (look here). But that survey was largely ignored in the media and health care and medical scholarly literature in the developed world, and when it was discussed, it was again in terms of results in less developed countries. Health Care Renewal was practically the only source of coverage in the US of the survey's results.
The Transparency International Pharmaceuticals & Healthcare Programme
In June, 2016, Transparency International showed it was back in the fight against health care corruption. At that time, it published a report on corruption in the pharmaceutical sector. We discussed it here. Unfortunately, that report also got little notice in the media or in the medical or health care literature.
This report was actually one of the first efforts from a new Transparency International initaitive to address health care corruption, entitled the Transparency International Pharmaceuticals & Healthcare Programme. Its mission statement begins [italics added by me]:
Every day, all around the world, people suffer and die due to corruption in the pharmaceutical and healthcare sector. Our vision is a world where less corruption leads to improved global health and healthcare outcomes, leaving no one behind.
Building on twenty years of experience in this and other sectors, Transparency International’s Pharmaceuticals & Healthcare Programme is taking up the challenge of understanding, identifying and combatting corruption in this vital sector. The Programme wants to achieve genuine change in the pharmaceutical and healthcare sector through reducing corruption and promoting transparency, integrity and accountability.
On its new website is its next major report, Diagnosing Health Care Corruption. Its introduction updates the 2006 report, and begins with:
Every day, all around the world, people suffer and die due to corruption in the healthcare sector. It disproportionally affects vulnerable groups, who do not have the knowledge, money or connections to access the care or products they need. While corruption can occur in every area of a health system, corruption from the highest levels will trickle down to effect healthcare received by patients at local health care facilities.
There are several broad effects of corruption in healthcare. Distorted policy, legislative andclinical priorities; a loss of money from health systems; denied or delayed access to health care services and treatment; and a loss of trust in national health facilities, personnel and to a wider extent national governance as a whole.
However, the specific cost of corruption is almost impossible to measure. Like other forms of white-collar crime corruption is inherently hidden from sight and even when some forms of corruption are discovered it is hard to quantify their impact.
The report was motivated by the finding that:
individuals in the healthcare sector do not always understand what corruption is and how it may undermine their work. Conversely, anti-corruption specialists do not always understand and appreciate the complexity of the health care system. This map – a project that will be kept updated – attempts to bridge that gap by providing for the first time, a comprehensive and accessible guide to a health system and the types of corruption that may occur.
The report discussed how corruption affects eight different aspects of the health care system:
- health system governance
- health system regulation
- research and development
- product distribution and storage
- financial and workforce management
-delivery of healthcare services
For each aspect, it discusses specific types of corruption, 37 in all. An interactive map of the eight aspects of the health care system and 37 types of corruption affecting them starts on the main page of the website.
In the future, the Pharmaceuticals & Healthcare Programme
activities will be prioritised around five areas in health systems: research & development; manufacturing; procurement and distribution; marketing; and service delivery. These were identified following extensive stakeholder engagement and the programme’s foundational research.
The Pharmaceuticals & Healthcare Programme will target global, national and local interventions. Ongoing research and the lessons drawn from regional and national projects will be used to influence global policy to produce structural change within the health sector; promote global best practice standards to strengthen transparency and accountability; and support national and local interventions and solutions.
Transparency International's re-engagement with the problem of health care corruption argues for the importance and magnitude of this problem. I hope its new report is not as anechoic as Transparency International's previous efforts were, that it helps to end the taboo on even discussing health care corruption, much less addressing it. I dare to hope that the new initiative might actually lead to some action to reduce health care corruption.
As I have said before, and now once more with feeling... if we really want to reform health care, in the little time we may have before our health care bubble bursts, we will need to take strong action against health care corruption. Such action will really disturb the insiders within large health care organizations who have gotten rich from their organizations' misbehavior, and thus taking such action will require some courage. Yet such action cannot begin until we acknowledge and freely discuss the problem. The first step against health care corruption is to be able to say or write the words, health care corruption.