Crossing the Global Quality Chasm Improving Health Care Worldwide (2018) / Chapter Skim
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6 The Critical Health Impacts of Corruption
6 The Critical Health Impacts of Corruption
Pages 203-226
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From page 203... ...
In fact, the quality of governance is a key media tor for whether public spending on health care influences health outcomes positively. • Many strategies exist for reducing corruption and making environments less conducive to malpractice, including remunerating health care workers ad equately, adequately financing the public health care system, ensuring social accountability, and strengthening institutions outside the health care sector.
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It then outlines some of the more common types of corruption found in the health care sector. Next, the chapter details the challenges to effective universal health coverage (UHC)
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From page 205... ...
. Corruption in the health sector has been found to take many forms in various areas, such as in health facility construction; equipment and supply purchasing; pharmaceutical distribution and use; health worker education; falsification of medical research; and perhaps most important for this report, the provision of health care services (Vian, 2008)
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These impacts can take the form of poor staffing at facilities and longer wait times due to absenteeism, less equitable care, poor quality or little availability of drugs, and unnecessary additional financial burden. As Hanf and colleagues (2011)
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Administration Paramedics and Clinical staff support staff Dual job-holding: shaving off hours, Unauthorized payments: absenteeism; use of public leverage for payments for commodities/services meant private practice to be provided for free in public facilities; Medico-legal impersonating doctors and Receiving unethical incentives illegal private practices from pharmaceutical firms and commission-based incentives from diagnostic facilities Pilferages from supply chains Receiving unethical incentives for forged reports Limited adherence to evidence-based guidelines FIGURE 6-1 Chain of malpractice in publicly owned health care facilities. FIGURE Nishtar, S
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However, it is problematic when a high percentage of OOP spending is directed toward informal payments. A study in Uganda, for example, found that health care workers embezzled 68–77 percent of user fees (McPake et al., 1999)
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Fraud can be committed by multiple actors within the health care system, including health care providers, government inspectors or regulators, payers (whether public or private) , and even suppliers of equipment and medicines (Transparency International, 2006)
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The resulting accumulation of unused medical donations in health care facilities around the world is denoted by the term "equipment graveyard." The World Health Organization (WHO) reports that as much as 80 percent of medical equipment in developing countries is donated (Bhadelia, 2016)
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From page 211... ...
CHALLENGES TO EFFECTIVE UNIVERSAL HEALTH COVERAGE POSED BY CORRUPTION The health care sector is unique because providers typically determine what services their customers (i.e., patients) should buy, whereas in most purchasing scenarios in other sectors, customers decide how they should spend their own money (Transparency International, 2006)
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212 FIGURE 6-2 Publications on different types of corruption, 2000 to 2018.
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The World Health Report 2010 notes that it is difficult to achieve UHC by limiting combined government and compulsory insurance expenditures to less than 5 to 6 percent of gross domestic product (GDP) , an amount required to decrease the proportion of OOP to less than 15 to 20 percent of total health care expenditures (WHO, 2010b)
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This practice violates the equity principle 2 Catastrophic health expenditure is defined as OOP spending on health care services that consumes a large portion of a household's available income, such that the household may be pushed into poverty as a result (WHO, 2005)
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. Lack of transparency Nepotism, cronyism, Clouding of business State capture and Unethical preferential treatment environment- selective benefits marketing practices Misappropriation of collusion in public talent procurements Inadequate public Unregulated burgeoning funding for health role of the private sector Absenteeism, shaving off hours, ghost workers in public facilities Inability to maintain and Flourishing Dual job diagnostics holding and deliberate undermining of in the care public equipment private provided in sector the private Paucity and poor quality sector of supplies Public Sector Private Sector Low quality of public services High cost of care Defeat the equity objective in Health FIGURE 6-3 The public–private nexus in institutionalizing corruption.
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found that quality of governance is a key mediator for whether public spending on health care effectively influences health outcomes. This finding is demonstrated by the changes the authors saw in child mortality rates: for each 1 percentage
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STRATEGIES FOR REDUCING CORRUPTION IN HEALTH CARE Many strategies exist for reforming health care systems to reduce corruption and make environments less conducive to malpractice. These include, among others, adequate remuneration of health care workers; adequate funding and management of the public health care system; community, public, and social accountability; and the strengthening of institutions outside the health care sector.
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From page 218... ...
. Thus, efforts to curb corrupt practices by health care workers need to be paired with similar reforms for health system management -- an area discussed in the next section.
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. Similar reform efforts in Ukraine have sought to increase transparency and instate reference pricing for the procurement of drugs, thereby addressing the state capture and collusion that plagued the pharmaceutical supply chain, which resulted in an annual loss of $100 million out of a $250 million pharmaceutical budget (Twigg, 2017)
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From page 220... ...
These malpractices lead to declining trust in governments and health care systems among citizens, as well as reduced quality of care and worsened health outcomes. Solutions lie in investments in health care infrastructure and payment of health care workers, coupled with accountability, public reporting, and strengthening of institutions outside the health care sector that may impact its practices, such as financing and regulation.
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From page 221... ...
Conclusion: It is critical for governments and societies to create bet ter governance structures that are accountable and transparent, build safeguards both within and outside of health care systems to decrease corruption, and improve health outcomes for populations. Until this is accomplished on a national scale for many countries, universal health care may be subverted to enrich the powerful and leave vulnerable populations without adequate care.
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2012. Corruption in the health care sector: A barrier to access of orthopaedic care and medical devices in Uganda.
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2012. Combating healthcare corruption and fraud with improved global health governance.
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2011. Effectiveness of medical equipment donations to improve health systems: How much medical equipment is broken in the developing world?
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2002. Corruption and the health care sector.
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