This group is comprised of the entire population and is therefore quite heterogeneous in terms of resources and needs. Illiterate patients in rural areas and upper class citizens in metropolitan areas are both part of this group. While the former is more susceptible to being a victim of corruption, the latter can take part in corrupt interactions by abusing the system, such as through gifts to doctors for treatments they are not entitled to.
This group is comprised of medical personnel and their respective institutions – hospitals, private practices, etc. This group can engage in a diverse array of corrupt practices, such as abuses during the delivery of services, administrative and financial crimes involving payment for services, or corrupt dealings with the private sector involving procurement, research and marketing activities.
In the health sector, the payer is usually not the direct recipient of the health service. Depending on the system, service providers are paid by an insurance company (private or public), or services are provided free of charge to the end user in public facilities financed through public funds. As corruption follows the money, the method of financing and paying for services greatly impacts the types of corruption risks in the health system.
The private sector plays a vital role. Big international pharmaceutical and medical equipment companies conduct research, develop drugs and equipment, and license and market their products. In this sector, research and development costs have a significant impact on the budget, yet they are difficult to verify, which complicates the issue of intellectual property. Combined with the inherent uncertainty of drug effectiveness, additional issues arise related to generic and counterfeit drugs, licensing and marketing, etc.
Large amounts of money are invested in the non-medical sphere of the sector, such as for construction of facilities (hospitals, etc.) and procurement of non-medical equipment (office equipment, etc.). While these issues are considered vital, they are not addressed in this course. For additional information, please refer to the available literature – a good starting point are the websites of TI and U4 referenced above (theme sites: private sector, public procurement, etc.).
The inspection of health facilities and licensing of drugs are important and complex tasks that a government regulator (Ministry of Health) must carry out in order to guarantee the quality of services provided. Depending on the system, the ministry can manage and run publicly owned facilities, staff employment, etc. (direct public provision).
