Corruption and performance in the Italian regional health care systems

Author/s Elisabetta Reginato, Isabella Fadda, Paola Paglietti, Aldo Pavan
Publishing Year 2019 Issue 2019/3
Language Italian Pages 24 P. 123-146 File size 354 KB
DOI 10.3280/MACO2019-003007
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

The present paper tries to assess to what extent corruption affects the different performance dimension of the Italian regional health care systems (RHSs). The Italian case is relevant because, in the European context, Italy presents the widest sub-national variation in both the levels of performance and corruption. The research focuses on petty corruption, measured using data from the European Quality of Government Index Survey. Italian RHSs' performance data are from the Meridiano Sanità, and are divided into three areas of analysis: a) population health status; b) equity and promptness to meet health needs; c) quality and responsiveness of the system. Taken together the results demonstrate that petty corruption is negatively associated to population health status and to the quality and responsiveness of the system. On the contrary, with reference to equity and promptness to meet health needs, a significant negative correlation was found only with reference to the Center-North regions.

Keywords: Health care systems, Corruption, Regions, Informal payments, Performance.

  1. Kaitelidou D.C., Tsirona C.S., Galanis P.A., Siskou O.C., Mladovsky P., Kouli E. G., Liaropoulos L.L. (2013). Informal payments for maternity health services in public hospitals in Greece, Health Policy, 109, 23-30.
  2. Kassirer J. (2006), The corrupting influence of money in medicine, Transparency International (eds), Global Corruption Report 2006: Special focus on corruption and health, London, Pluto Press, pp. 85-91.
  3. Kaufmann D., Kraay A., Mastruzzi M. (2006), Measuring corruption: myths and realities. World Bank paper, Washington, DC.
  4. Klomp J. and de Haan J. (2008), Effects of governance on health: a cross-national analysis of 101 countries, Kyklos, 61(4), 599-614.
  5. Knack S. (2006). Measuring corruption in Eastern Europe and Central Asia: A critique of the cross-country indicators. World Bank Policy Research Working Paper (3968).
  6. Ko, K. and A. Samajdar (2010). Evaluation of international corruption indexes: should we believe them or not?, The Social Science Journal, 47(3), 508-540.
  7. Kolstad I., & Wiig A. (2009). Is Transparency the Key to Reducing Corruption in Resource-Rich Countries? World Development, 37(3), 521-532.
  8. Kurtz M. J., & Schrank A. (2007). Growth and Governance: Models, Measures, and Mechanisms. Journal of Politics, 69(2), 538-554.
  9. Lambsdorff J. G. (2005). Consequences and causes of corruption: What do we know from a cross-section of countries?, Passauer Diskussionspapiere: Volkswirtschaftliche Reihe.
  10. Lantham S. (2001). Conflict of interest in medical practice, in David M., Stark A. (eds), Conflict of interest in the professions, New York, Oxford University Press, pp. 279-301.
  11. Lewis M. (2002), Informal Health Payments in Central and Eastern Europe and the Former Soviet Union: Issues, Trends and Policy Implications, in Funding Health Care: Options for Europe. Buckingham, Open University Press.
  12. Lewis M. (2006), Governance and corruption in public health care systems. Center for Global Development working paper n.78.
  13. Lewis M. (2007), Informal Payments and the Financing of Health Care in Developing and Transition Countries, Health Affairs, 26(4), 984-997.
  14. Allin S., Davaki K., Mossialos E. (2006), Paying for ‘free’ health care: The conundrum of informal payments in post-communist Europe, Transparency International (eds), Global Corruption Report 2006: Special focus on corruption and health, London, Pluto Press, pp. 62-75.
  15. Atanasova E., Pavlova M., Moutafova E., Rechel B., Groot W. (2014), Informal payments for health services: the experience of Bulgaria after 10 years of formal co-payments, European Journal of Public Health; 24(5), 733-739.
  16. Azfar O. (2005), Corruption and the delivery of health and education services, in Spector B. (ed.), Fighting corruption in developing countries: strategies and analysis, Bloomfield, CT, Kumarian Press, pp.181-212.
  17. Azfar O., Gurgur T. (2008), Does corruption affect health outcomes in the Philippines?, Economics of Governance, 9(3), 197-244.
  18. Baji P., Rubashkin N., Szebik I, Stoll K, Vedam S. (2017), Informal cash payments for birth in Hungary: Are women paying to secure a known provider, respect, or quality of care?, Social Science & Medicine, 189, 86-95.
  19. Balabanova D., McKee M. (2002), Understanding informal payments for health care: The example of Bulgaria, Health Policy, 62, 243-273.
  20. Belli P., Gotsadze G., Shahriari H. (2004), Out-of-pocket and informal payments in health sector: evidence from Georgia. Health Policy,70, 109-23.
  21. Bivona E. (2019), Sistema di Controllo Interno e prevenzione delle infiltrazioni della criminalità organizzata, Management Control, Suppl. 1, 51-68. DOI: 10.3280/MACO2019-SU1004
  22. Lewis M. (2000). Who Is Paying for Health care in Europe and Central Asia?, Human Development Sector Unit, Europe and Central Asia Region, Washington D.C., World Bank.
  23. Liaropoulos L.L., Siskou O., Kaitelidou D., Theodorou M., Katostaras T. (2008), Informal payments in public hospitals in Greece, Health Policy, 87(1), 72-81.
  24. Lindstedt C., Naurin D. (2010). Transparency is not enough: Making transparency effective in reducing corruption. International political science review, 31(3), 301-322.
  25. Mæstad O., Mwisongo A. (2011), Informal payments and the quality of health care: Mechanisms revealed by Tanzanian health workers, Health Policy, 99, 107-115.
  26. Marchi L., Greco G. (2016), Percorsi di integrazione tra auditing e controllo di gestione, Management Control, 3, 5-8. DOI: 10.3280/MACO2016-003001
  27. Marmot M. J. H. a. (2002). The influence of income on health: views of an epidemiologist, 21(2), 3, 1-46.
  28. Matsushima M. e Yamada H. (2016), Impacts of Bribery in Healthcare in Vietnam, The Journal of Development Studies, 52(10), 1479-1498. DOI: 10.1080/00220388.2015.1121241
  29. McPake B., Asiimwe D., Mwesigye F., Ofumbi M., Ortenblad L., Streefland P., Turinde A. (1999), Informal economic activities of public health workers in Uganda: implications for quality and accessibility of care, Social Science and Medicine, 49, 849-65.
  30. Campos, J. E., & Pradhan, S. (2007). The many faces of corruption: tracking vulnerabilities at the sector level, World Bank Publications.
  31. Charron N. (2013), European Perceptions of Quality of Government: A Survey of 24 Countries, in Alina Mungiu-Pippidi (editor), Controlling Corruption in Europe. The Anticorruption Report 1, Op,_laden, Barbara Budrich Publishers.
  32. Charron N., Dijkstra L. and Lapuente V. (2014), Regional governance matters: quality of government within European Union member states, Regional Studies 48(1), 68-90.
  33. Charron N., Dijkstra L. and Lapuente V. (2015), Mapping the Regional Divide in Europe: A Measure for Assessing Quality of Government in 206 European Regions, Social Indicators Research, 122, 315-346.
  34. Cherecheș R., Ungureanu M., Sandu P., Rus I. (2013), Defining informal payments in healthcare: a systematic review. Health Policy, 110(2‐3), 105‐114.
  35. Cockcroft A., Andersson N., Paredes-Solis S., Caldwell D., Mitchell S., Milne D. (2008), An inter-country comparison of unofficial payments: results of a health sector social audit in the Baltic States. BMC Health Services Research, 8-15. DOI: 10.1186/1472-6963-8-15
  36. Cohen N. (2012), Informal payments for health care – The phenomenon and its context. Health Economics, Policy and Law, 7, 285-308.
  37. Commissione Europea. (2014). Relazione della Commissione Europea al Consiglio e al Parlamento Europeo: Relazione dell’Unione sulla lotta alla corruzione.
  38. D’Onza G. (2008), Il sistema di controllo interno nella prospettiva del risk management, Milano, Giuffrè Editore.
  39. Del Vecchio M., Fenech L., Prenestini A. (2015), Private health care expenditure and quality in Beveridge systems: Cross-regional differences in the Italian NHS, Health Policy, 119(3), 356-366.
  40. Demicheli V., Ferrante L., Rivoiro C., Solfrini V. (2013), La ragnatela dell’illegalità, in Politiche sanitarie, 14(3), Luglio-Settembre, 118-126.
  41. Di Tella R., Savedoff W. (2001), Diagnosis corruption: fraud in Latin America’s public hospitals, Washington, DC, Inter-American Development Bank.
  42. Dirindin N. (eds) (2013), Illuminiamo la salute. Per non cadere nella ragnatela dell’illegalità, Coripe Piemonte, Libera, Avviso Pubblico e Gruppo Abele, Roma
  43. Donchev D. and G. Ujhelyi (2009), What do corruption indices measure? -- Retrieved from Social Science Research Network website:
  44. Ensor T. (2004), Informal payments for health care in transition economies, Social Science & Medicine, 58, 237-246.
  45. European Commission (2013), Study on Corruption in the Healthcare Sector, Luxembourg: Publications Office of the European Union.
  46. European Commission (2014) Special Eurobarometer 397/Wave EB79.1 (2013). Brussels, European Commission.
  47. Fagan C. (2010), The Anti-Corruption Catalyst: Realizing the MDGs by 2015, Transparency International, Berlin.
  48. Falkingham J. (2004), Poverty, out-of-pocket payments and access to health care: evidence from Tajikistan. Social Science and Medicine, 58, 247-58.
  49. Fattore G. (1999), Clarifying the scope of Italian NHS coverage. Is it feasible? It is desiderable?, Health Policy, 50, 123-42.
  50. Fattore G., Mariotti G., Rebba V. (2013), Italy, in Siciliani L., Borowitz M., Moran V. (eds.), Waiting Time Policies in the Health Sector: What Works? OECD Health Policy Studies, OECD Publishing. Doi.10.1787/9789264179080-en.
  51. Gaal P., McKee M. (2005), Fee-for-service or donation? Hungarian perspectives on informal payments for health care, Social Science and Medicine, 60, 1445-57.
  52. Gingerich D.W. (2013), Governance indicators and the level of analysis problem: empirical findings from South America, British Journal of Political Science, 43(3), 505-540.
  53. Golden M. A., Picci L. (2005). Proposal For A New Measure Of Corruption, Illustrated With Italian Data. Economics & Politics, 17(1), 37-75.
  54. Gupta S., Davoodi H.R., Tiongson E. (2001), Corruption and the provision of health care and education services, in Arvind K. Jain (Ed.), The political economy of corruption, London, Routledge.
  55. Habibov N., Cheung A (2017), Revisiting informal payments in 29 transitional countries: The scale and socio-economic correlates, Social Science & Medicine 178, 28-37.
  56. Hanf M., Nacher M., Guihenneuc C., Tubert-Bitter P. and Chavance M. (2013), Global determinants of mortality in under 5s: 10 year worldwide longitudinal study, BMJ, 347.
  57. Hanf, M., Van-Melle A., Fraisse F.,. Roger A, Carme B. and Nacher M. (2011), Corruption kills: Estimating the global impact of corruption on children deaths, PLoS One, 6(11).
  58. Holmberg S., Rothstein B. (2011), Dying of corruption, Health Economics, Policy and Law, 6(04), 529-47.
  59. Horodnic A.V., Williams C.C. (2018), Informal payments by patients for health services: prevalence and determinants, The Service Industries Journal, 38,11-12, 841-855,
  60. DOI: 10.1080/02642069.2018.1450870
  61. Horodnic A.V., Mazilu S., Oprea L. (2018), Drivers behind widespread informal payments in the Romanian public health care system: From tolerance to corruption to socio‐economic and spatial patterns. Int J Health Plann Mgmt., 33, e597-e611.
  62. Hussmann K. (2011), Vulnerabilities to corruption in the health sector: perspectives from Latin American sub-systems for the poor, United Nations Development Programme (UNDP).
  63. Meridiano Sanità (2015), Le coordinate della salute, Rapporto 2015, The European House-Ambrosetti S.p.A. --
  64. Moldovan A, Van de Walle S. (2013), Gifts or bribes? Attitudes on informal payments in Romanian healthcare. Public Integrity., 15(4), 385‐402.
  65. Montinola G. R., & Jackman R. W. (2002). Sources of Corruption: A Cross-Country Study, British Journal of Political Science, 32(1), 147-170.
  66. Muldoon K.A., Galway L.P., Nakajima M., Kanters S., Hogg R., Bendavid E. and Mills E.J. (2011), Health system determinants of infant, child and maternal mortality: A cross-sectional study of UN member countries, Globalization and Health, 7, 42.
  67. Mungiu-Pippidi A. (2016), For a New Generation of Objective Indicators in Governance and Corruption Studies, European Journal on Criminal Policy and Research, 22(3), 363-367.
  68. OECD/EU (2016), Health at a Glance: Europe 2016: State of Health in the EU Cycle, OECD Publishing, Paris.
  69. Pavolini E. and Vicarelli G. (2012), Is decentralization good for your health? Transformations in the Italian NHS, Current Sociology, 60(4), 472-488.
  70. Pickett K.E., Wilkinson R. G. (2015), Income inequality and health: a causal review, 128, 316-326.
  71. Rajkumar A. S., Swaroop V. (2008), Public spending and outcomes: Does governance matter? Journal of Development Economics, 86, 96-111.
  72. Rose R. (2006), Corruption is bad for your health: findings from Central and Eastern Europe, in Transparency International (ed.), Global corruption report 2006: special focus on corruption and health, London, Pluto Press, pp. 39-43.
  73. Savedoff W., Hussmann K. (2006), Why are health systems prone to corruption?, in Transparency International (ed.), Global Corruption Report 2006, London, Pluto Press, 4-16.
  74. Segato L., Del Monte D., Brassiolo M. T. (2014), La corruzione nella sanità italiana, in Libro bianco sulla corruption in sanità, ISPE Sanità.
  75. Segato L., Pinna A., Ceron M., Del Monte D., Sardella F. (2013), Corruzione e Sprechi in sanità, Milano, Transparency International Italia.
  76. Seligson M. A. (2006). The measurement and impact of corruption victimization: Survey evidence from Latin America. World Development, 34(2), 381-404.
  77. Stepurko T., Pavlova M., Gryga I., Murauskiene L. Groot W. (2015), Informal payments for health care services: The case of Lithuania, Poland and Ukraine, Journal of Eurasian Studies, 6, 46-58.
  78. Stepurko T., Pavlova M., Gryga I., Groot W. (2010), Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments, BMC Health Services Research, 10, 1-13.
  79. Szende A., Culyer A.J. (2006), The inequity of informal payments for health care: the case of Hungary, Health Policy, 75(3), 262-71.
  80. Tambor M., Pavlova M., Golinowska S., Sowada C., Groot W. (2013), The formal-informal patient payment mix in European countries. Governance, economics, culture or all of these?, Health Policy,113(3), 284-95.
  81. Tanzi V. (1998). Corruption around the world: Causes, consequences, scope, and cures. Staff Papers-International Monetary Fund, pp. 559-594.
  82. Thompson R. and Xavier A. (2002), Unofficial Payments for Acute State Hospital Care In Kazakhstan. A Model of Physician Behaviour with Price Discrimination and Vertical Service Differentiation, Discussion Paper 124/2002, Brussels: LICOS Centre for Transition Economics.
  83. Thompson R., Witter S. (2000), Informal payments in transitional economies: Implications for health sector reform, International Journal of Health Planning and Management, 15, 169-187.
  84. Toth F. (2014). How health care regionalisation in Italy is widening the North-South gap. Health Economics, Policy and Law, 9(3), 231-249.
  85. Treisman D. (2007). What Have We Learned About the Causes of Corruption from Ten Years of Cross-National Empirical Research?, Annual Review of Political Science, 10(1), 211-244.
  86. Vian T. (2006), Corruption in hospital administration, in Transparency International (eds), Global Corruption Report 2006: Special focus on corruption and health, London, Pluto Press, pp. 49-53
  87. Vian T. (2008), Review of corruption in the health sector: theory, methods and interventions, Health Policy and Planning, 23(2), 83-94.
  88. Vian T. (2015), How corruption distorts sector performance, OECD (2015), Consequences of Corruption at the Sector Level and Implications for Economic Growth and Development, Paris, OECD Publishing.
  89. Williams D. R. J. S. p. q. (1990), Socioeconomic differentials in health: A review and redirection, 53(2), 81-99.

  • The Role of Citizens in the Municipalities' Risk Management Process: An Overview in Italy Monia Castellini, Vincenzo Riso, in MANAGEMENT CONTROL 1/2023 pp.143
    DOI: 10.3280/MACO2023-001007

Elisabetta Reginato, Isabella Fadda, Paola Paglietti, Aldo Pavan, Corruzione e performance nei sistemi sanitari regionali italiani in "MANAGEMENT CONTROL" 3/2019, pp 123-146, DOI: 10.3280/MACO2019-003007