Unnecessary referrals and procedures

A healthcare worker may be incentivised in multiple ways to provide excessive diagnosis or more treatment than is necessary to a patient. A doctor in a private hospital may be encouraged to generate business for their employer, or indeed themselves. A doctor could receive payments from a hospital in return for referring patients there. Or a doctor may have a financial stake in a private laboratory to which they send patients for diagnostic tests. In some countries it is illegal for doctors to receive kickbacks for referring patients.

As well as increasing the costs that patients must pay, this type of corruption can impact on patient safety if they undergo unnecessary treatments. In the most severe cases patients have died from unnecessary procedures. This diminishes the trust that patients have in healthcare providers and, in countries where corruption is already systemic, trust in the health system more generally.

The corruption type false treatment reimbursement claims in the financial and workforce management category also covers this issue. However, in contrast to this corruption type, it focuses on the process of a healthcare provider making a false claim to a payer for unnecessary procedures, as well as procedures that were undelivered or overcharged.