Transparency International just released its yearly massive survey on corruption worldwide. The results are not pretty for health care and related sectors world wide and in the US. As expected, these results appear to be causing few echoes.
Global Results
Some useful summary statements found in the written version of the report:
Governments are not thought to be doing enough to hold the corrupt to account. The majority of people around the world believe that their government is ineffective at fighting corruption and corruption in their country is getting worse.
The democratic pillars of societies are viewed as the most corrupt. Around the world, political parties, the driving force of democracies, are perceived to be the most corrupt institution.
Personal connections are seen as corrupting the public administration. People surveyed regard corruption in their country as more than just paying bribes: almost two out of three people believe that personal contacts and relationships help to get things done in the public sector in their country.
Powerful groups rather than the public good are judged to be driving government action. More than one in two people (54 per cent) think their government is largely, or entirely run by groups acting in their own interests rather than for the benefit of the citizens.
The survey included questions about corruption in the health care sector. Globally, respondents perceived it was a major problem. On average, 17% said they or their family members had to pay bribes in connection with medical and health care. The average perception of corruption in medicine and health care across all countries was 3.2, where 1 = not at all corrupt, and 5 = extremely corrupt. (Scores for the media were 3.1, business sector, 3.3, education system, 3.1, public officials, 3.6, political parties, 3.8, and NGOs, 2.7)
US Results
While the US did not have the worst results, our numbers were not very good (see US specific results here). More than one-third (43%) of respondents thought that US health care is corrupt. Large numbers of people also thought that related sectors were corrupt (53% thought business in general was corrupt, 34% education, 58% the media, 55% public officials, 61% the legislature, 78% political parties.)
For comparison, the proportions of people who thought the health care sector is corrupt were 24% in Canada, 28% in France, 48% in Germany, 47% in Japan, and 19% in the United Kingdom
Also, more than half (60%) of respondents said corruption in the US has increased over the last 2 years, almost two-thirds (64%) thought that the US government is run by a few big interests.
Thus, this survey confirmed that health care corruption is a global problem, and that a large proportion of people in the US believe it is a major problem here.
The Media Shrug
This would seem to be major news. However, so far the Transparency International survey results have received little media attention in the US. Moreover, what attention they have received in the US makes corruption appear to be some other countries' problem. .
Most of the US media reports avoided mentioning any results that relate directly to the country. In particular, the New York Times, the Wall Street Journal, Fox News, CNN, NBC, and Reuters coverage said nothing about the US. Businessweek provided reports from Malaysia and Russia that focused on those countries' results. A brief report in the Los Angeles Times only noted a single US statistic, about the bribery rate, one area in which the US had relatively favorable results. Only a lonely Forbes blogger alluded to the US results in slightly more detail, (and then went on to summarize those from Brazil, Russia, India, and Mexico in detail).
In contrast, media reports from some other countries, like India, Ghana, and Israel, noted their own countries' poor results.
Summary
So once again we see how anechoic are the notions that health care corruption is a severe global problem, and that it affects all countries, including the most supposedly developed. Of course, the unwillingness to discuss global health care corruption, health care corruption in the US, and the relationship of health care corruption in the US to corruption in other sectors may arise from the fear, as stated by one person interviewed in Charles Ferguson's documentary Inside Job, that discussion could lead to investigation, and investigation could "find the culprits".
On Health Care Renewal, we try to discuss global health care corruption,. We were first inspired by the 2006 publication of Transparency International's Global Corruption Report which focused on health care, and documented how health care corruption is global, severe, and not restricted to the poorest countries (see post here).
This blog focuses on the US, and we now have in our archives some amazing stories that document various forms of health care corruption in the US, including numerous allegations of misbehavior by large health care organizations ending in legal settlements, and examples of outright fraud, bribery, kickbacks and other crimes. On the other hand, we have demonstrated again and again that bad and corrupt behavior by large health care organizations is a taboo topic. For example, we could find very few significant efforts to discuss, teach about, or research ways to fight corruption, or to promote accountability, integrity, transparency, honesty and ethics by academic health care institutions. (See this post for how difficult it was to find academic institutions' initiatives to resist conflicts of interest.) One can count the conferences, meetings, symposia, and courses on such topics on one's fingers. When I last looked, I could count only a single course on fighting corruption at any US medical or public health school (at Boston University, by Prof Taryn Vian).
Of course, if we really want to reform health care, in the little time we may have before our health care bubble bursts, 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.
ADDENDUM (16 July, 2013) - See comments by Dr Howard Brody on the Hooked: Ethics, Medicine and Pharma blog.
