Research Paper on Corruption in the Healthcare Sector

Introduction

Access to affordable and transparent healthcare services is a critical part of any country with the developmental goal of ensuring quality healthcare for its citizens. However, the health sector is affected by a myriad of challenges that hinder services and operations to be conducted appropriately. One of the primary issues that affect the healthcare sector globally is corruption. Corruption has permeated the industry, and its prevalence is more common in contemporary society. Healthcare managers and other relevant stakeholders in this sector significantly engage in practices that are deemed as the abuse of power. The greed of the top officials in the healthcare sector ignores the delivery of services to the patients and result in poor quality in service delivery. There are countless examples of actions in the healthcare system that illustrates fraud and corruption. The consequences of such actions are adverse and affect the whole industry, directly and indirectly causing a lot of damage to the health of the citizens and economy of the nation. Fraud and corruption negatively impact the resources available for healthcare.

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The Vulnerability of the Health Sector

Officials have been successful in engaging in corrupt activities because of the complexity of the healthcare system. The complexity of the system is evident in all healthcare facilities around the globe. According to Toebes (2011), the uncertainty in the health sector makes it difficult for the institutions to allocate the necessary resources and the consumers to make the right choices regarding their health. The presence of uncertainties such as who will fall ill, the time of illness to occur, and the types of diseases that the population will contract, renders the health sector vulnerable to inefficiencies, which creates opportunities for corruption. The health sector is also unusual in the extent to which private providers are entrusted with the responsibility to undertake particular public roles (Vian, 2008).

Another significant aspect that exposes the health sector to corruption is the presence of asymmetric information (Toebes, 2011). Information in the health sector is not shared equally among the relevant health actors who are the pharmaceutical companies, the health care providers, health insurers, and the consumers. The pharmaceutical companies know more information about their products than the healthcare providers. The healthcare providers may understand more about the services they deliver than their patients. On the other hand, the health insurers may know more information regarding the status of their clients than healthcare providers and patients do; and, the patients may fail to disclose relevant information regarding their health status to the insurers and the healthcare providers. This lack of equal dissemination of information creates loopholes in the sector that enable fraudulent individuals to carry out their activities. Moreover, the presence of multiple actors who engage each other in different activities regarding healthcare may hamper the adequate generation and spread of information, and the promotion of transparency within the healthcare system. Moreover, Vian (2008) argues that the availability of expensive hospital construction, high-tech equipment, and the increasing number of drugs in the market coupled with a powerful market of vendors and pharmaceuticals, exposes the healthcare sector to instances of bribery and conflict of health interests.

Equally important, the health finance systems in the health sector are more vulnerable to corruption in procurement abuses that undermine the quality of services. According to the Chr. Michelsen Institute (2006), a system that relies on billing an insurance institution is more vulnerable to corruption by diverting funds to unplanned areas. Financing the healthcare sector through taxes exposes the institutions to large-scale diversion of public funds, increased risk of illegal payments, corruption in procurement, and abuses that undermine the quality of the services being offered.

A Brief Definition of Corruption in the Healthcare Sector

Corruption is arguably a complex phenomenon and a severe problem. Its deep roots in the social, cultural, economic, political, legal, and ethical value systems of individuals, cultures, and countries make it even more complicated. In the past years, corruption was not given much attention because it was considered a mere issue of development. Currently, corruption in the health sector has raised significant concerns among researchers and policymakers. According to Vian (2008), corruption can be defined as the misuse of entrusted power for individual gain. Chattopadhyay (2013) further explains that the private gain aspect in the definition of corruption can be categorized into either actual (immediately), potential (to be realized in the future), financial, or political.

The Forms of Corruption and their Consequences in Healthcare and Medicine

Corruption in the health sector is carried out during different activities in the institution such as construction, procurement of health equipment, the supply of medicines and equipment, appointment of healthcare professionals among others (Chattopadhyay, 2013). The common forms of corruption include bribes and kickbacks, theft and embezzlement, absenteeism, informal payments, intentional damage to public resources for personal gain, potential institutionalized corruption, and use of human subjects for private benefit. Bribes and kickbacks are typically issued by individuals and firms who want to procure government contracts and leases. Such individuals and firms prefix and rig the bidding process involved in tenders. They manipulate and falsify records to win the bids, contracts, and leases, and they speed up the procedure of permission to carry out legal activities (Chattopadhyay, 2013). Theft and embezzlement is the type of corruption that occurs when some individuals in the health sector steal public assets and goods. Instruments, medicines, and theft of government revenues are some of the things taken by greedy to individuals to satisfy their needs. The intentional damage of public goods for personal gain involves the destruction of certain facilities in the health system to make them unavailable to the public, with the ultimate goal of ordering the services from private clinics to benefit from the revenue or commissions collected (Chattopadhyay, 2013). The use of human subjects for financial gain occurs when health institutions charge exorbitant fees to uninsured patients. It also happens when clinical researchers receive payment from the biomedical industry for the recruitment of poor and illiterate human subjects to be used for clinical trials.

When bribes and kickbacks are utilized during the construction and rehabilitation of the health services, such actions result in high cost, low-quality facilities, and construction. Other consequences include biased distribution of infrastructure by favoring urban and elite-focused services (Vian, 2008). In the purchase of equipment and supplies especially drugs, engaging in bribes and kickbacks results in delivery of sub-standard equipment and medicines, inequities due to inadequate funds reserved to provide for all their needs; and delivery of high cost and duplicative drugs. In the area of distribution and use of drugs and supplies in the service delivery, theft and embezzlement result in incomplete treatment, which results in the development of antimicrobial resistance. Theft and fraud also force the patients to make informal payments to access the required drugs (Vian, 2008). Bribes to speed the process of legal activities in the area of regulation of quality in products and services brings about sub-therapeutic medications in the market, increased incidence of food poisoning, the spread of infectious and communicable diseases, and incompetent professionals in practice. Equally important, absenteeism by the health professionals results in the inadequate serving of patients in the hospital setting, lower volume of services and unmet needs, and higher unit costs for health services delivered.

Overall, on a macroeconomic level, corruption limits economic growth in a country because private firms begin to shift their focus to less corrupt countries. The low economic growth results in lower revenue collection by the administration, which is always diverted to developmental projects. Corruption also affects government choice on how to invest the revenue collected. In the health sector, fraud may result in the procurement of high-tech materials instead of focusing on simple and helpful programs such as immunization and family planning (Chr. Michelsen Institute, 2006). The draining of resources from the health budgets through theft and procurement fraud results in less funding, which is supposed to be directed toward payment of health worker salaries. The lack of regular payments leads to the staff being demotivated, and they begin providing low-quality services to the patients. Scholarly works from researchers have indicated that corruption had adverse effects on various health indicators such as infant and child mortality (Chr. Michelsen Institute, 2006). Research from Eastern Europe and Asia found that bribery reduces access to services and caused delays in care-seeking behaviors especially for the poor. In a region such as Azerbaijan, studies have indicated that thirty-five percent of childbirths in rural areas occur at homes due to the high charges imposed on medical services, which were supposed to be free (Chr. Michelsen Institute, 2006). Families are forced to sell livestock and other essential goods and borrow money from family friends and the community to pay for the informal payments requested by the hospitals.

The Reasons why Physicians and Bioethicists should be Concerned about Corruption in the Health Sector

It is essential for physicians and bioethicists to care about corruption in the health sector because the vice results in adverse effects. Physicians should be worried about instances of corruption because it kills. Corruption determines good health and suffering life and death. In this scenario, the poor suffer the most. Corruption in the health sector also prevents countries from achieving millennial development goals. Corruption increases further the consequences of a natural disaster. For instance, the increased death toll witnessed in the Haiti earthquake was fueled by corruption (Chattopadhyay, 2013). If the effects of corruption concern physicians in the health system, then they should discuss the matter and take a stand against the vice.

Physicians and bioethicists should be worried about corruption and do something about it because it fosters ill health and extends suffering. According to Chattopadhyay (2013), a transnational study found that good governance resulted in high life expectancy and lower mortality rates for children and mothers. If doctors and the relevant stakeholders take a stand against corruption and support appropriate anti-corruption campaigns and programs, the healthcare professionals may create opportunities for good governance that will better the health outcomes of the population. Additionally, corruption in the health sector undermines the patients trust on the system. Patients would not prefer to share their health status with a doctor they do not believe; for this case, taking a stand against corruption, physicians and bioethicists can rebuild their trust with the patients. Physicians should be concerned about corruption because it destroys the moral...