Common corruption risks in the health sector
Ad 2) Separation between financing and provision
The second category, “separation between financing and provision,” refers to a system in which the entity that finances health services is different from that providing those services (e.g. Germany, France, Canada). This separation between public financing and provision is rare in low-income countries, but common in high-income countries and in the middle-income countries of Latin America and Asia.
When public financing is separated from provision, methods of abuse are likely to focus on diverting the flow of payments and reimbursements.
Medical professionals who are reimbursed on a fee-for-service basis may be tempted to overcharge for services, bill for services that were not provided, or order tests and procedures that are not medically necessary. To motivate providers to focus more on preventive rather than curative care in such a system, capitation based payments can be used. Yet, this payment system may drive dishonest providers to neglect necessary care or reduce quality below acceptable standards.