Untangling the corruption maze: exploring the complexity of corruption in the health sector.

BACKGROUND: Healthcare corruption poses a significant threat to individuals, institutions, sectors, and states. Combating corruption is paramount for protecting patients, maintaining the healthcare system's integrity, and preserving public trust. As corruption evolves, takes new forms, and adapts to changing socio-political landscapes, understanding its manifestations is critical to developing effective anti-corruption strategies at individual and institutional levels. OBJECTIVE: The aim was to comprehensively collate the manifestations of different types of corruption in healthcare to illustrate prevailing patterns and trends and to provide policymakers, practitioners, and researchers with practical insights to inform research agendas, regulatory and governance strategies, and accountability measures. METHOD: We conducted a narrative review of scientific articles published between 2013 and 2022 using keyword searches in SCOPUS and EBSCO. We utilized the corruption typology proposed by the European Union and Thompson's Institutional Corruption Framework to systematically identify manifestations across different corruption types. The Prisma scheme was employed to document the selection process and ensure reproducibility. FINDINGS: Bribery in medical service provision was the most frequently investigated form of corruption, revealing rather uniform manifestations. Misuse of high-level positions and networks and institutional corruption also received considerable attention, with a wide range of misconduct identified in institutional corruption. Extending the analysis to institutional corruption also deepened the understanding of misconduct in the context of improper marketing relations and highlighted the involvement of various stakeholders, including academia. The pandemic exacerbated the vulnerability of the healthcare sector to procurement corruption. Also, it fostered new types of misconduct related to the misuse of high-level positions and networks and fraud and embezzlement of medical drugs, devices, and services. CONCLUSIONS: The review spotlights criminal actions by individuals and networks and marks a notable shift towards systemic misconduct within specific types of corruption. The findings highlight the necessity of customized anti-corruption strategies throughout the healthcare sector. These insights are crucial for policymakers, practitioners, and researchers in guiding the formulation of legal frameworks at local and global levels, governance strategies, and research priorities.

Why Resilience in Health Care Systems is More than Coping with Disasters: Implications for Health Care Policy.

Health care systems need to be resilient to deal with disasters like the global spread of the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) on top of serving the changing needs of a multi-morbid, ageing and often dispersed population. This paper identifies, discusses and augments critical dimensions of resilience retrieved from the academic literature. It pulls together an integrated concept of resilience characterised by organisational capabilities. Our concept does not focus on the micro-level like most resilience literature in health care but addresses the system level with many stakeholders involved. Distinguishing exogenous shocks to the health care system into adverse events and planned innovations provides the basis for our conclusions and insights. It becomes apparent only when dealing with planned interventions that transformative capabilities are indispensable to cope with sudden increases in health care pressures. Due to the current focus on absorptive and adaptive resilience, organisations over-rely on management capabilities that cannot generate a lasting increase in functionality. Therefore, reducing the resilience discussion to bouncing back from adverse events could deceive organisations into cultivating a suboptimal mix of organisational capabilities lacking transformative capabilities, which pave the way for a structural change that aims at a sustainably higher functionality.

Central European journal of operations research (CJOR) "operations research applied to health services (ORAHS) in Europe: general trends and ORAHS 2020 conference in Vienna, Austria".

This articles provides a short summary of the research topics and latest research results of the European Working Group "Operations Research Applied to Health Services" (ORAHS) organized as an e-conference in Juli 2020 at the University of Vienna, Austria (https://orahs2020.univie.ac.at/). Furthermore, challenges for OR in health care including application areas, decision support systems, general trends, and modelling techniques are briefly illustrated from an European and international perspective by providing selected essential literature reviews.

Implementing a Clinical Research Department to Support Pediatric Studies: A SWOT Analysis.

The safety, tolerability, pharmacokinetics and efficacy of most drugs used in pediatrics have not been studied in different age groups and are administered "off-label use". Clinical pediatric drug trials require specific and stringent compliance with laws, regulations, guidelines, and patient/parent/public involvement, which in turn increases resource use and makes support useful from a medical, qualitative, economic, and system perspective. We examined the strengths, weaknesses, opportunities and threats of implementing a Research Department for the Support of Pediatric Studies (RDPS) in Vienna. We used the SWOT ("strengths", "weaknesses", "opportunities", and "threats") analysis to collect comprehensive data and facts on the internal strengths, weaknesses (company analysis), and external opportunities and threats (environmental analysis). The company analysis revealed a productivity gain, due to a highly specialized team and standardized processes. The environmental analysis outlined a considerable 360-degree potential for a qualitative and quantitative medical- and social-scientific expansion of the service portfolio. The establishment of a RDPS leads to the centralization of pediatric studies by bundling tasks and concentration of specialist knowledge, which enables the exploitation of synergies, the standardization of processes, the promotion of professionalism, flexibility, innovations and the reduction of inefficiencies in the form of duplication of tasks. RDPS offers tailored advice and support for different types of pediatric studies.

Determinants of soft budget constraints: How public debt affects hospital performance in Austria.

Soft budget constraints (SBCs) undermine reforms to increase hospital service efficiency when hospital management can count on being bailed out by (subnational) governments in case of deficits. Using cost accounting data on publicly financed, non-profit hospitals in Austria from 2002 to 2015, we analyse the association between SBCs and hospital efficiency change in a setting with negligible risk of hospital closure in a two-stage study design based on bias-corrected non-radial input-oriented data envelopment analysis and ordinary least squares regression. We find that the European debt crisis altered the pattern of hospital efficiency development: after the economic crisis, hospitals in low-debt states had a 1.1 percentage point lower annual efficiency change compared to hospitals in high-debt states. No such systematic difference is found before the economic crisis. The results suggest that sudden exogenous shocks to public finances can increase the budgetary pressure on publicly financed institutions, thereby counteracting a pre-existing SBC.

Distribution of Health Care Resources in Austria - Inequality Assessment of Different Health Care Resources at Different Points in Time.

A major objective of health policy in many countries is to avoid inequality in the distribution of health care resources. Our goal is to provide initial insight into the inequality in the regional distribution of different health care resources per capita and the variation of the inequality over time in Austria to provide starting points for policy recommendations and international comparisons. We also aim to examine whether the type of inequality measure and need-adjustment has an impact on the results. The findings reveal that inequality in the distribution of GPs with contracts with social health insurance is comparably small, but we observe an increase in inequality from 2002 to 2014. In general, there is a clear trend toward private physicians, of whom private specialists preferably open their practices in densely populated areas. Despite considerable reductions in public hospital beds between 2002 and 2014, the distribution across regions remains almost constant. The use of different inequality measures and need-adjustment provides additional insights so that custom-made policies to reduce inequalities can be developed.

Individual and Institutional Corruption in European and US Healthcare: Overview and Link of Various Corruption Typologies.

In recent years, the fight against healthcare corruption has intensified. Estimates from the European Healthcare Fraud and Corruption Network calculate an approximate €56 billion annual loss to Europe as a result of corruption. To promote understanding of the complexity and interconnection of corrupt activities, we aim to present healthcare-related corruption typologies of the European Union and European Healthcare Fraud and Corruption Network. We subsequently link them to the typology of individual and institutional corruption introduced by Dennis Thompson in the context of investigating misconduct of US Congressional members. According to Thompson, individual corruption is the personal gain of individuals performing duties within an institution in exchange for nurturing private interests, while institutional corruption pertains to the failure of the institution in directing the individual's behaviour towards the achievement of the institution's primary purpose because the institutional design promotes the pursuit of individual goals. Effective anti-corruption activities not only require the enactment of anti-corruption laws but also the monitoring and, where appropriate, revision of institutional frameworks to prevent the undermining of the primary purposes of health systems or institutions. To gain further understanding of the similarities and differences of the three typologies, prime examples of corrupt activities in the health sector in the European Union and USA (along with their potential remedies) are provided. Linking corruption cases to Thompson's typology revealed that many corrupt activities may show elements of both individual and institutional corruption because they are intertwined, partly overlap and may occur jointly. Hence, sanctioning individual actors only does not target the problem.

Hospital physician payment mechanisms in Austria: do they provide gateways to institutional corruption?

Institutional corruption in the health care sector has gained considerable attention during recent years, as it acknowledges the fact that service providers who are acting in accordance with the institutional and environmental settings can nevertheless undermine a health care system's purposes as a result of the (financial) conflicts of interest to which the service providers are exposed. The present analysis aims to contribute to the examination of institutional corruption in the health sector by analyzing whether the current payment mechanism of separately remunerating salaried hospital physicians for treating supplementary insured patients in public hospitals, in combination with the public hospital physician's possibility of taking up dual practice as a self-employed physician with a private practice and/or as an attending physician in private hospitals, has the potential to undermine the primary purposes of the Austrian public health care system. Based on the analysis of the institutional design of the Austrian public hospital sector, legal provisions and directives have been identified, which have the potential to promote conduct on the part of the public hospital physician that systematically undermines the achievement of the Austrian public health system's primary purposes.

The Austrian Tobacco Act in practice--analysing the effectiveness of partial smoking bans in Austrian restaurants and bars.

The purpose of this study is to examine the effectiveness of partial smoking bans in restaurants and bars, such as those currently in place in Austria, by evaluating adherence to the relevant regulations and assessing the satisfaction levels of those affected by these regulations. To evaluate adherence, 127 randomly selected restaurants and bars were observed using a form of structured observation. In order to evaluate their level of satisfaction with the regulations, 342 randomly selected customers and 29 restaurant owners were interviewed using standardized questionnaires. The customers widely adhered to the partial smoking bans, but many of them were dissatisfied with the fragmented Austrian solution. Most restaurant owners showed neither adherence to the relevant regulations nor satisfaction with the partial smoking bans. The present study reveals that partial bans on smoking are an ineffective solution. The presumed advantages of these regulations, such as still allowing smoking in restaurants provided a spatial separation of smoking and non-smoking areas is guaranteed, cannot be confirmed; adherence to the partial bans is rather inadequate, especially among restaurant owners, and the level of satisfaction with the Austrian solution is poor as well, not only among smoking and non-smoking customers, but also restaurant owners.

Monitoring political decision-making and its impact in Austria.

The range of services provided by the Austrian health care system has been greatly extended over the last few decades. The accompanying measures for long-term care bring the situation closer to the ideal concept of a 'seamless web' between primary, secondary and tertiary care. Due to the expansion in services it has become increasingly difficult to ensure the balance between the financing and degree of usage of the services. The reiterated political aim has been to achieve balanced financing via legally fixed social health insurance (SHI) contributions and taxation. A steadily expanding part is contributed by the private sector. In the 1980s, measures for SHI expenditure containment were implemented; in 1997 a new hospital financing system based on flat rates was introduced. In order to guarantee hospital financing, the historical financing shares of the SHI for the hospitals were introduced in the form of valorised global budgets. The contradictory incentives arising from the flat rates and global budgets lead hospitals to shift services to the primary and tertiary care sector, causing additional expenditure for SHI. Currently, attempts are being made to secure the financing by increasing the SHI contribution rates and patients' co-payments.

Co-payments in the Austrian social health insurance system. Analysing patient behaviour and patients' views on the effects of co-payments.

Austrian health politicians constantly claim that patients have to be the focus of interest when providing health care services. However, due to increasing demand, scarce resources and insufficient guidance for health care provision at the national level, Austrian patients have been confronted with a variety of health care reforms during recent years. These reforms include the introduction of additional, mainly lump sum co-payments and the increase of existing (lump sum) co-payments. Using a sample of 378 socially-insured patients, the aim of this study is to analyse patients' attitudes towards co-payments, their views on the effects of co-payments on health care demand and their actual behaviour in response to co-payments. The study is descriptive rather than hypothesis testing due to the limited data. The results of this survey indicate that co-payments have no major guiding effect on health care demand. This is confirmed by what the patients indicate as regards their actual behaviour.