Waste and corruption in health care

The challenges that await, in the near future, the universalistic health systems will present more and more problems that are related to the necessary resources to guarantee equal access to services to all citizens. Universal coverage requires that all people who reside in a given country may have access to quality health services when they need them, without the risk of incurring severe financial problems due to the necessity to pay for care. Lack of resources should not deter people from seeking or continuing to use the health services they need. Health care provision depends on efficiently combining financial and human resources, and delivering services throughout a country. This requires a system that processes information and motivates appropriate behaviour by individuals, health care professionals and administrators (Lewis, 2006). In health care, good governance is a critical factor and implies that health care systems work correctly, effectively and efficiently. In this light, efficiency and effectiveness should be the main goals for health policymakers. In particular, the notion of efficiency shows whether health care resources are being used to get the best value for money (Williams, 1988). Instead, adopting the criterion of effectiveness implies that society makes choices which maximise the health outcomes gained from the resources allocated to health care (Weinstein and Stason, 1977). There is a situation characterised by low efficiency and effectiveness when the resources could be reallocated in a way in which health outcomes may increase (Palmer and Torgerson, 1999). Indeed,good care leads to better outcomes, such as the reduction of morbidity and mortality and the prevention of non-communicable and chronic diseases; the selling of the right products and medical equipment at a fair price; and the alignment of financial means with objectives. Unfortunately, across the world, these objectives are far from being obtained and among the main reasons is corruption. Corruption is so pervasive within health care systems that it has become a well-known phenomenon. Recently, the UN special rapporteur for the right to health stated that health care is among the most corrupted sectors (United Nations, 2017). Corruption negatively affects the financial resources available for health care; out-of-pocket payments, including bribes, have ‘a particularly negative effect on the poor in society, as they are often unable to pay the bribes necessary for a certain service’ (United Nations, 2017). Furthermore, corruption in the health care sector undermines efforts to achieve the objective of universal health coverage by eroding financial protection efforts. The next sections are aimed at providing a definition of fraud and corruption related to health care, examining, even using some examples, how they have been treated in the relevant literature and in international reports. The chapter contains, in the conclusions, some considerations of an economic and policy nature.