The effect of institutional characteristics and social norms on corruption in healthcare

Abstract

Corruption in healthcare is widespread and consequential. Informal payments (IPs) are a common form of petty corruption, especially in low‐ and middle‐income countries. Using data from the Life in Transition Survey encompassing 33 countries across Europe and Central Asia, I analyze the prevalence and reasons behind IPs made to public health providers. In addition to individual‐ and system‐level factors often used in literature, I also introduce a latent measure of social norms related to high levels of corruption. These are associated with a significantly higher prevalence of paying informally. This paper also bridges a gap between the corruption literature and health‐related research by introducing a typology of IPs based on why they were made. I find that the association between health system characteristics and IPs prevalence differs based on the reason for payment. This difference is further exacerbated by the existence of corruption‐related social norms. The results of this analysis highlight the need to revisit existing anti‐corruption policies and align them to the underlying social norms.