Now arrives the years of investigation. Here in the US, a new majority in the US House of Representatives promises multi-pronged investigations of, among other topics, the corruption that now seems pervasive at the highest reaches of the US government, corruption that has badly affected efforts to truly reform US health care (look here). Meanwhile, similar investigations are likely to get underway in various US states. We can only hope that this flurry of activity will end up with some positive steps to reduce US health care corruption, an enduring problem about which we often write.
As we wrote in August, 2017, 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 got little attention. Health care corruption has been nearly a taboo topic in the US, anechoic, presumably because its discussion would offend the people it makes rich and powerful. As suggested by the recent Transparency International report on corruption in the pharmaceutical industry,
However, strong control over key processes combined with huge resources and big profits to be made make the pharmaceutical industry particularly vulnerable to corruption. Pharmaceutical companies have the opportunity to use their influence and resources to exploit weak governance structures and divert policy and institutions away from public health objectives and towards their own profit maximising interests.
Presumably the leaders of other kinds of corrupt organizations can do the same.
When health care corruption is discussed in English speaking developed countries, it is almost always in terms of a problem that affects some other places, mainly presumably benighted less developed countries. At best, the corruption in developed countries that gets discussed is at low levels. In the US, frequent examples are the "pill mills" and various cheating of government and private insurance programs by practitioners and patients. Lately these have gotten even more attention as they are decried as a cause of the narcotics (opioids) crisis (e.g., look here). In contrast, the US government has been less inclined to address the activities of the leaders of the pharmaceutical companies who have pushed legal narcotics (e.g., see this post).
However, Health Care Renewal has stressed "grand corruption," or the corruption of health care leaders. We have noted the continuing impunity of top health care corporate managers. Health care corporations have allegedly used kickbacks and fraud to enhance their revenue, but at best such corporations have been able to make legal settlements that result in fines that small relative to their multi-billion revenues without admitting guilt. Almost never are top corporate managers subject to any negative consequences.
We have been posting about this for years at Health Care Renewal, while seeing little progress on this issue.
Things only seem to be getting worse given the increasing evidence that the Trump administration is corrupt at the highest levels. In January, 2018, we first raised the question about how health care corruption could be pursued under a corrupt regime. We noted sources that summarized Trump's. the Trump family's, and the Trump administration's corruption.. These included a website, entitled "Tracking Trump's Conflicts of Interest" published by the Sunlight Foundation, and two articles published in the Washington Monthly in January, 2018. "Commander-in-Thief," categorized Mr Trump's conflicted and corrupt behavior. A Year in Trump Corruption," was a catalog of the most salient cases in these categories in 2017.
In July, 2018, we addressed the Trump regime's corruption again By then, more summaries of Trump et al corruption had appeared. In April, 2018, New York Magazine published "501 Days in Swampland," a time-line of starting just after the 2016 presidential election. In June, 2018, ProPublica reviewed questionable spending amounting to $16.1 million since the beginning of Trump's candidacy for president at Trump properties by the US government, and by Trump's campaign, and by state and local governments. Meanwhile, Public Citizen released a report on money spent at Trump's hospitality properties. Meanwhile, the voluminous Tracking Corruption and Conflicts of Interest in the Trump Administration summary appearing in the Global Anti-Corruption Blog has grown and grown.
So the driver of US health care corruption may now be the executive branch of government and its relationship with the Trump family and cronies, trumping even the influence of health care corporate corruption.
However, in our work we have been heartened to find some useful resources (although unfortunately none specifically targeted at health care corruption in the US). To inspire others to join the fight against health care corruption and related ills, I take this opportunity to post an idiosyncratic list of some of the most helpful resources I have found (including one very new one). In alphabetical order:
Basel Institute on Governance
Located in Basel, Switzerland,
an independent not-for-profit competence centre working around the world with the public and private sectors to counter corruption and other financial crimes and to improve the quality of governance.
The Institute does not have a specific health care focus, but focuses on broad issues with applicability to health care: asset recovery, public governance, corporate governance and compliance, collective action, and public finance management.
This is a new website staffed by anti-corruption experts mainly based in the UK, meant
to appeal widely to people who want to take action to reduce corruption within their sector of society, and/or within their organisation. This includes Members of Parliament, the private sector, civil society organisations, professional associations, the media and the judiciary.
However, their main focus now are politicians and public officials.
The website includes sector specific resources, including a very extensive review document on the health sector.
Global Anti-Corruption Blog
A multi-author US based blog
devoted to promoting analysis and discussion of the problem of corruption around the world. This blog is intended to provide a forum for exchanging information and ideas across disciplinary and professional boundaries, and to foster rigorous, vigorous, and constructive debate about corruption’s causes, consequences, and potential remedies.
It includes an extensive list of international anti-corruption resources (much bigger than this idiosyncratic list), but which tellingly has no organization specifically focused on health care, and no organization specifically focused on US corruption.
Perhaps the best known international anti-corruption NGO (non-governmental organization), based in Berlin, Germany. It proclaims
From villages in rural India to the corridors of power in Brussels, Transparency International gives voice to the victims and witnesses of corruption. We work together with governments, businesses and citizens to stop the abuse of power, bribery and secret deals.
As a global movement with one vision, we want a world free of corruption. Through chapters in more than 100 countries and an international secretariat in Berlin, we are leading the fight against corruption to turn this vision into reality.
Its website is extensive. It hosts more or less biannual International Anti-Corruption Conferences. It provides many resources, including a well known annual international survey of corruption perceptions. It has chapters in multiple countries (although, tellingly, its US chapter was dis-accredited in 2017, look here).
The TI UK chapter has a specific health care initiative focusing on the pharmaceutical industry.
U4 Anti-Corruption Resource Centre
Located in Bergen, Norway,
U4 is a permanent centre at the Chr. Michelsen Institute (CMI) in Norway. CMI is a non-profit, multi-disciplinary research institute with social scientists specialising in development studies.
Its introductory statement
At U4, we work to reduce the harmful impact of corruption on society. We share research and evidence to help international development actors get sustainable results.
U4 provides publications and resources for various sectors, including health care.
Corruption in health care is a daunting problem, but 2018 showed us in the US that when people get upset enough about problems, things happen (albeit, not always great things). So we urge all concerned about health care corruption to make things happen. The resources above may help them do so.