Abstract
The paper explores the relationship between corruption and performance dimensions of the Italian regional health care systems (RHSs). In Europe, Italy shows the widest sub-national in performance and corruption levels. The research focuses on petty corruption in health care. So-called informal payments are the most common form and were measured using data from the European Quality of Government Index Survey. The performance of Italian RHSs was assessed using key indicators divided into three analytical dimensions: health status; access to care; and quality of care. OECD Health Data was used as source data for health status and access to care. As a proxy for quality of care, the study used avoidable mortality, with data drawn from the Italian National Institute of Statistics (ISTAT). The study formulated a research hypothesises that petty corruption has a negative influence on RHS performance. The findings showed considerable regional differences. The results did not confirm the research hypotheses. However, informal payments did show an adverse effect on renunciations to specialist medical examinations due to costs.
Highlights
The health care sector, more than other areas in Western society, is prone to corruption
When considering the regions with a GDP not lower than the national average, the results show tha Experienced corruption (EC) is positively associated with Under five mortality rates (UFM) – r = 0.451 p = 0.012 – and medical examinations skipped due to costs (MtsC) – r = 0.568 p = 0.001, while it is negatively associated with medical examinations skipped due to waiting times (MtsW) –r = −0.344 p = 0.063
Many studies show that corruption has a corrosive impact on the population's health status, as measured by indicators such as child and maternal mortality rates and life expectancy from birth (Azfar, 2005; Gupta, Davoodi & Tiongson, 2001; Hanf, Van-Melle, Fraisse, Roger, Carme & Nacher, 2011; Hanf, Nacher, Guihenneuc, Tubert-Bitter & Chavance, 2013; Lewis 2006; Muldoon et al, 2011; Rose, 2006)
Summary
The health care sector, more than other areas in Western society, is prone to corruption. Factors include uncertainty surrounding the demand for health care services; large numbers of dispersed actors; and asymmetric information available to them (Savedoff & Hussmann, 2006; Holmberg & Rothstein, 2011; Vian, 2015; Koheler, 2019) This sector is vulnerable to abuse because so much public money is allocated to health spending in many countries, and private actors are entrusted with important public roles. A sub-national analysis offers unique measurement challenges, when health service performance and corruption present vast regional differences (Charron, Dijkstra & Lapuente, 2015; Charron, Dijkstra & Lapuente, 2014; Charron, 2013). The paper is structured as follows: Section 2 provides the literature background on corruption in the health care sector; Section 3 describes the corruption phenomenon in the Italian NHS; Section 4 illustrates the research question and method; Section 5 presents the data analysis; Section 6 provides the discussion of results and offers conclusions and implications for future research in this field
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