Common corruption risks in the health sector
Key takeaways of this simplified differentiation between the two types of health systems:
First, corruption tends to be found where money is to be made. Therefore, the financing of health services is critical to understand and address. A system’s mechanisms greatly impact its vulnerability to corruption.
Second, healthcare systems are complex structures. It is therefore vital to gain a thorough understanding of an individual healthcare system in order to design adequate anti-corruption measures.
Table 2.1 Relation between the different financing mechanisms and the risk of corruption
| Financing (46) | Characteristics | Corruption risk |
| Taxes | Normally associated with free or almost free service deliveries | Large-scale diversions of public funds at ministerial level. High risk of informal or illegal payments. Corruption in procurement. Abuses that undermine the quality of services. |
| Social insurance | Compulsory, not every citizen elegible for coverage, premiums and benefits described in social contracts (laws or regulations). Only applicable for formal employees. | Most common abuses include excessive medical treatment, fraud in billing, and diversion of funds. |
| Private insurance | Buyer voluntarily purchases insurance (can be done on individual or group basis). | Problem of risk selection (selecting healthy people). Same as for public insurance schemes. |
| Out-of-pocket payments | When patients pay providers directly out of their own pockets for goods and services. Costs are not reimbursable. | No guarantee that all health services are of value to those buying them. With weak regulatory capacity there is a high risk of overcharging and inappropriate use of services. |
Source (accessed August 6th, 2012). EC 2013: 26 (also Vian/Nordberg 2008, taken from Savedoff 2003).
For instance, the above table, Relation between the different financing mechanisms and the risk of corruption, provides a more detailed illustration of financing mechanisms and their impact on corruption.