Small scale reforms can have a huge impact on reducing corruption in hospitals. While the majority of health care corruption discussions revolve around large scale reforms and inherent complications with the system, I believe that informal mechanisms are valuable solutions that deserve more attention. In addition to being cost-effective and easier to manage, they have proven to have a noteworthy impact on corruption.
For instance, a hospital in Kenya has devised an inventive way to ensure that hospitals are generating revenue and patient fees are used to cover health care costs. Prior to the implementation of the reform, hospital registers were not computerized. Therefore, it was difficult to determine how much money should have been in the register based on receipt records. Within a three year period after the implementation of the reform, hospital revenues increased by 400 percent.
Moreover, one hospital in Cambodia successfully reduced informal payments by formalizing the user fee system and creating hospital personnel accountability through incentive based contracts. By targeting these specific systemic flaws, health care costs were reduced and provided the opportunity for more people to seek treatment.
Furthermore, in order to combat bribes paid for reduced waiting times in Croatian hospitals, the Ministry of Health piloted a program that published the waiting lists online and made available at the hospital reception desk. The increased accountability and transparency of the public wait lists significantly reduced bribery.
There is no question that governments should ideally strive to achieve progress in rule of law, accountability in the civil servant sector, transparent health systems, reliable enforcement mechanisms, and effective tax systems. However, in order to bring about the greatest change, I believe that corruption discussions should focus on small scale reforms that are implemented in accordance with incentives and consequences tailored to the individual circumstances. Ultimately, informal solutions have proven to be effective and should be a bigger part of the health care system corruption discussion.