Corruption is the very antithesis of patient centred care. Driven by greed, those in power divert crucial resources away from patients in need, which results in poor quality of care and worsening health outcomes. It is an international problem and no health system is free from it.

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Nature of Corruption in healthcare systems in India:

• Bribes and kickbacks:
  • The country’s doctors and medical institutions live in an ‘unvirtuous circle’ of referral and kickback that poisons their integrity and destroys any chance of a trusting relationship with their patients.
  • Given these practices, it is no surprise that investigations and procedures are abused as a means of milking patients.
• Theft and embezzlement:
  • This may  occur  as  theft  of  public  assets  and  goods,  such  as instruments  and  medicines,  by  individuals  for  sale,  personal use  or  use  in  for-profit  private 
  • The theft  of  government revenues,  such  as  patient  registration  fees,  and  the  payment of  salary  to  deceased  or  “ghost”  workers  are  other  forms  of corruption.
• Intentional damage to public goods for private gain:
  • Public assets and instruments in government hospitals may also be intentionally damaged so as to make them unavailable to patients, with the ultimate aim of ordering the services from private clinics in return for financial incentives or “commission.”
• Absenteeism:
  • Perceived somewhat   less   often   as   a   form   of   corruption, absenteeism  (not  attending  work  but  claiming  salary)  in  the health  sector  has  been  a  major  concern  in  some  developing countries.
• Informal payments:
  • In some countries, patients commonly make informal payments to healthcare professionals for better services. The  imposition of  such  a  “tax”  on  “free”  healthcare  services  has  a  negative impact on access to health services
• Use of human subjects for financial gain:
  • Clinical researchers  get  paid  by  the  biomedical  industry  for the  recruitment  of  poor  and  illiterate,  e.  Vulnerable, human subjects for clinical trials. 
  • Another way  in  which  hospitals and  physicians  use  patients  is  by  charging  uninsured  patients and  patients  with  other  health  plans  far  more  than  the  actual costs involved and what the health insurers pay.
• Institutionalised potential corruption:
  • In some    for-profit    hospitals,    physicians    have    contractual obligations to admit a fixed number of patients to allotted beds and prescribe a number of laboratory investigations (even if unnecessary) to generate revenues.

Impact of Corruption in Healthcare Sector in India:

No doubt, corruption has a severe impact on the society. It has not only affected the health industry and the economy as a whole, but also the people of the country, especially the poor and the common people. The results are evident:

• Low-quality healthcare facilities that do not fulfil our needs.
• Government hospitals and health centres in rural areas are in shabby conditions.
• Lack of access to medicines and other basic healthcare facilities for poor patients.
• Huge medical bills
• Incomplete treatment of patients
• Circulation of fake or inappropriate drugs, goods and equipment in the market
• Spread of diseases and no control of infectious diseases like dengue
• Death of patients for wrong treatment or inadequate services
• Unnecessary medical tests
• Unqualified and inefficient doctors
• Healthcare professionals in the vicious cycle of unethical practices
• Loss of faith in the system

Measures needed:

• Zero tolerance for unethical and corrupt practices in health:
  • Physicians, professional medical associations of diverse disciplines and the bioethics community should discuss possible anti-corruption measures and implement a publicly declared policy of zero tolerance for unethical and corrupt practices in the care of patients, clinical research and medical education.
• Whole-hearted support for anti-corruption measures:
  • Physicians and bioethicists should support, whole-heartedly and without reservation, the anti-corruption initiatives undertaken by the other sections of society and state, such as civil society, patient rights groups, voluntary health associations, nongovernmental organisations (NGOs), the judiciary, and the media.
  • This would help build good governance and a just society.
• Protection of whistle-blowers:
  • Physicians and bioethicists should provide moral support and legal help to members of their profession or discipline who have dared to expose serious wrong doing in any aspect of healthcare and medicine.
  • This is necessary because whistleblowers run the risk of facing harassment, if not harm, by vested interests.
• Legislation:
  • Physicians and bioethicists should play a more proactive role in pressing for the enactment and implementation of legislation and regulations for good governance, transparency and accountability in healthcare and medicine.
  • Anti-corruption laws are frequently breached because of inadequate regulation and monitoring, or the absence of effective penalties.
  • One solution could be to set up an office of ombudsman to deal with corruption (eg Lokpal) in every district, province and state capital.
  • The ombudsman should be equipped with adequate resources, infrastructure and real powers.
• Education:
  • The importance of (continuing) education can hardly be overemphasised. It is hard to believe that all young men and women join medicine only to make money out of people’s illness.
  • Education in ethics through the use of positive role models may reinforce moral values.
  • It would help present and future healthcare professionals not only to steer clear of fraud and abuse, but also to create a favourable ethical climate within the profession.

Conclusion:

It is time to acknowledge that corruption in healthcare entails crimes against humanity. There is no room for complacency- history will not forgive physicians and bioethicists if they fail in their moral duty to safeguard the cause of ethics in medicine when it is necessary.