Introduction

Health is a major global industry, a key responsibility and budget expense for governments and businesses; but more than that, it is a global human right. Corruption deprives people of access to health care and is one reason why so often increased spending does not correlate with improved health outcomes. Corruption in the healthcare sector can erode public trust in the medical profession.

Every year, the world spends more than US $3 trillion on health services, most of which is financed by taxpayers. The diversity of health systems worldwide, the multiplicity of parties involved, the paucity of good record keeping in many countries, and the complexity in distinguishing among corruption, inefficiency and honest mistakes make it difficult to determine the overall costs of corruption in this sector around the globe. But a growing body of evidence shows that scale of corruption is vast in both rich and poor countries.

In the United States, which spends more on health care – 15.3 per cent of its GDP – than any other industrialised nation, the two largest US public health care programmes, Medicare and Medicaid, estimate that 5–10 per cent of their budget is lost to ‘overpayment’. In Cambodia, health practitioners estimate that more than 5 per cent of the health budget is lost to corruption before it even leaves central government.

There is no blueprint for tackling corruption in the health sector, but relatively simple tools such as giving patients access to greater information about how the sector is funded and regulated, can improve the situation. Many people around the world are carrying out the difficult work of trying to understand where and how corruption in health occurs and what can be done to prevent it. Transparency International looks at the health sector from various angles: as part of a programme looking at corruption and poverty; as a sector in need of greater access to information; and from the supply side, urging pharmaceutical companies to implement an anti-bribery framework and calling on governments to procure medicines and hospital equipment through open, competitive processes.