Doctor’s dirty secret

David Berger’s experience of the Indian health system highlights how corrupt practices can steadily erode the trust and respect with which doctors were previously regarded.

Published on:June 30, 2014 12:02 am

By: Anita Jain, S. Nundy and Kamran Abbasi

Healthcare is a high-risk sector for corruption. Best estimates are that between 10 per cent and 25 per cent of global spend on public procurement of health is lost through corruption. This is big bucks. Total global spend on healthcare is more than $7 trillion each year. Corruption takes many forms, depending on the country’s level of development and health financing system. The US, for example, lost between $82 billion and $272bn in 2011 to medical embezzlement, mostly related to its health insurance system. No country is exempt from corruption. Patients everywhere are harmed when money is diverted to doctors’ pockets and away from priority services. Yet this complex challenge is one that medical professionals have failed to deal with. Transparency International (TI), a watchdog on these matters, defines corruption as the abuse of entrusted power for private gain, which in healthcare encompasses bribery of regulators and medical professionals, manipulation of information on drug trials, diversion of medicines and supplies, corruption in procurement, and overbilling of insurance companies. This is no dirty little secret. It is one of the biggest open sores in medicine.
India, with rampant corruption at all levels, is prominent in this international field, with a survey by TI in 2013 finding the practice of paying bribes for services in India to be double that found globally.

Resistance is often not an option for those working within corrupt systems. David Berger’s experience of the Indian health system highlights how corrupt practices can steadily erode the trust and respect with which doctors were previously regarded. As in China, attacks on doctors may become a more common consequence of perceived corruption in the medical system.

When devising effective solutions, it is important to identify the possible drivers of corruption. India has a lack of external accountability and oversight of both public and private health sectors. Most doctors work in the underfunded and inefficient public sector because it is a secure job with time-bound promotions and little supervision. However, those in much better paid private-sector jobs are incentivised to generate business for their employers by over-investigation and over-treatment of patients who are at their mercy both medically and financially. Private medicine has flourished in India because of a weak regulatory climate with no standards to monitor quality or ethics. Using a theoretical framework, [Taryn] Vian suggests that three factors are at play here: opportunity to engage in corrupt practices by dint of being in a position of power in a system with inadequate oversight; financial, peer or personal pressures felt by officials; and a culture that rationalises and accepts corruption. It is therefore a difficult task to weed out corruption from the health system, and it requires action at all levels. Indeed, how is it possible to practise medicine free of corruption in an overwhelmingly corrupt society?

Good governance, transparency, and zero tolerance must form the basis of any anti-corruption strategy. Changes must be implemented in society at large for reform to be sustained. Better governance requires …continued »

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