Corruption is now a term that has become much more prevalent in the US media, particularly as a description of the actions of our new president elect, for example look here, here and here. So it is fitting that health care corruption may become a less taboo topic.
As we have discussed before, Transparency International (TI) defines corruption as
Abuse of entrusted power for private gain
In 2006, TI published a report on health care corruption, which asserted that corruption is widespread throughout the world, serious, and causes severe harm to patients and society.
the scale of corruption is vast in both rich and poor countries.
Also,
Corruption might mean the difference between life and death for those in need of urgent care. It is invariably the poor in society who are affected most by corruption because they often cannot afford bribes or private health care. But corruption in the richest parts of the world also has its costs.
The report did not get much attention. Since then, health care corruption has been nearly a taboo topic in the US. When health care corruption is discussed in English speaking developed countries, it is almost always in terms of a problem that affects benighted less developed countries. On Health Care Renewal, we have repeatedly asserted that health care corruption is a big problem in all countries, including the US, but the topic remains anechoic.
Yet somehow, a substantial minority of US citizens, 43%, seemed to believe that corruption is an important problem in US health care, according to a TI survey published in 2013 (look here). But that survey was largely ignored in the media and health care and medical scholarly literature in the developed world, and when it was discussed, it was again in terms of results in less developed countries. Health Care Renewal was practically the only source of coverage in the US of the survey's results.
But the message that health care corruption is an important problem is gradually leaking past the barriers meant to contain such uppity talk. Earlier this year, Transparency International's new Pharmaceuticals and Healthcare Programme came out with two reports, one on corruption in the pharmaceutical sector, and one on diagnosing health care corruption.
The Symposium on Combating Corruption in Health Care and Pharmaceuticals
This week, I was fortunate to be able to attend a symposium on Combating Corruption in Health Care and Pharmaceuticals (look here) put on by the WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector. That was the first meeting expressly and exclusively on health care corruption that I had ever heard about (although the center did put on an earlier meeting on Corruption in the Pharmaceutical and Healthcare Sector: Global Policy and Structural Issues, look here, which I missed.)
The slides from the meeting presentations will hopefully soon be available online, but let me present a few important ideas from some of the speakers that relate to some things we have posted here, but enlarge upon them.
Jillian Clare Kohler, director of the WHO Collaborating Centre, provided a brief introduction to the field. She noted, as we have, that health care corruption has largely been a taboo topic. In fact, those at the WHO who are concerned about corruption found that public discussion of the solutions to corruption, particularly, the notions of good governance (a term used somewhat differently in global health circles than it is here in the US, look here), particularly including transparency and accountability may be allowable as long as corruption as the need for these solutions is just implied.
Marc-Andre Gagnon addressed "Tackling the Corruption of Pharmaceutical Markets," and made the following points:
- Markets, which are systems (socially, politically) constructed rules may not align with the public good.
- Markets are distorted by ghost management, which is meant to shape narratives to increase corporate revenue, even as it encourages the production of ignorance.
- Pharmaceutical, and by implication, other health care corporations do better when they promote the "right" medical discourse rather than the (often minimal) effectiveness of their products.
- Health care markets are subject to various kinds of "capture," not just regulatory capture, but scientific, professional, technological, market, media, and civil society capture.
Conclusions
As I have said before, and now once more with feeling... if we really want to reform health care, in the very little time we may have before our health care bubble bursts (which appears imminent in the US), we will need to take strong action against health care corruption. Such action will really disturb the insiders within large health care organizations who have gotten rich from their organizations' misbehavior, and thus taking such action will require some courage. Yet such action cannot begin until we acknowledge and freely discuss the problem. The first step against health care corruption is to be able to say or write the words, health care corruption.
ADDENDUM (12 December, 2016) - the slides from most of the presentations are now available. Specifically, the slides for the presentation by Prof Gagnon as discussed above are available here.