Governments must ensure that individuals, companies and groups operating in a health system act honestly and fairly. A range of agencies and companies are responsible for maintaining the integrity and effectiveness of specific decision-making processes. For example, public bodies may accredit doctors and private companies that are often responsible for ensuring the safety of medical devices.
Corrupt practices can occur in these processes, from a supplier offering a regulator a bribe to approve a product, to an official having a financial interest in the health college they are inspecting. Corruption in regulation will impact health outcomes as dangerous products, untrained healthcare providers, and ill-equipped health facilities are allowed to flourish in the health system.
There are many ways of funding a health system. This can include public health services that are directly provided, private sector commercial insurance firms, and patients paying directly for services to providers (covered below as patients).
Likewise, there are multiple ways that other groups can defraud payers and each funding stream carries its own risks. For example, where there is a fee-for-service reimbursement, healthcare providers may bill for procedures that were never delivered, while in most systems there is a risk that officials may embezzle funds allocated for health facilities.
Companies and groups provide the products, services and facilities that are used by healthcare providers to diagnose, treat and advise patients. This includes pharmaceutical and medical technology companies and construction firms.
Suppliers may commit corruption in many ways to get their product or service on the market, purchased, and in use. This includes bribing officials to approve a product, rewarding doctors with holiday for prescribing a medicine, or making misleading claims about a product to patients. In contrast other individuals may seek to solicit payments from suppliers, particularly in countries with systemic corruption.
Healthcare professionals are responsible for providing healthcare services to patients. They are employed in the public and private sectors or may offer their services voluntarily.
Due to their central role in healthcare they can be involved in countless corruption types, in numerous areas of the corruption map. For example, in addition to providing healthcare services to patients, healthcare providers may conduct clinical trials to develop new medicines or sit on a hospital selection and procurement committee.
Every human has a right to the highest attainable standard of health, as enshrined in the WHO Constitution. A health system that provides timely, accessible and affordable health services is key to achieving this right. More and more countries are encouraging patient empowerment, placing patients at the heart of decision-making processes throughout the health system.
While patients may only be directly involved in some areas of a health system, they can suffer from corruption throughout the health system, as it impacts on the all of the services and treatments they receive. Patients can tackle corruption in healthcare by calling for more transparency and accountability in key processes such as procurement, and supporting community-monitoring initiatives.
However, patients themselves may also commit corruption, whether it is by underreporting their income, receiving subsidised care, or bribing healthcare providers to receive better care.