Essays on corruption in healthcare

Parvanova, Iva (2024) Essays on corruption in healthcare. PhD thesis, London School of Economics and Political Science.

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Abstract

Corruption in healthcare is a widespread and costly phenomenon. A common form of petty corruption in the doctor-patient relationship is informal payments. These include exchanges such as bribery or gift-giving and exacerbate existing inequalities in treatment access and outcomes. In this thesis, I study issues related to the measurement and drivers of informal payments in health systems, with a particular focus on the role played by social norms. The first paper (Parvanova, 2024) explores the association between health system institutional characteristics, social norms and informal payments. I use nationally representative survey data from 33 countries in Europe and Central Asia to study the prevalence and drivers of these payments. Besides usual factors, I consider how hidden social norms make informal payments more likely and moderate the different types of informal payments. The study suggests updating anti-corruption policies to consider these underlying social norms. The second study explores the effect of framing questions about informal payments on respondents’ willingness to share their experiences. It compares two question wordings previously used in the Eurobarometer Survey – one using loaded words like “bribe” and the other - neutral terms, such as “additional payments and gifts”. Evidence from the Eurobarometer survey suggests that a neutral framing yields a significantly higher estimates of the prevalence of informal payments compared to a loaded framing, although this magnitude and significance of this gap varies between countries. To further explore this result, I design and implement a survey experiment in Bulgaria and the UK. Results confirm the positive effect of neutral framing on self-reported informal payments’ prevalence. Additional evidence suggests that this effect is driven by reported descriptive social norms about informal payments. In the third study I examine how bribery affects the allocation of scarce resources and explore the influence of fairness preferences and social norms. I design a novel allocation vignette experiment and implement it in online surveys fielded with representative samples in the UK and Bulgaria. Respondents are asked to act as a (public) service provider who decides how to distribute resources between a briber and a non-briber. I find that bribers get preferential treatment. This is not affected by inequalities between service recipients (mimicking inequalities in access to treatment) or inequalities between service providers (mimicking inequalities in remuneration). However, being in either of these treatment groups significantly increases the prevalence of briber punishment, i.e. allocating less resources to these recipients. I also use an incentivized elicitation method to understand participants’ descriptive norms about reciprocating bribery and favoritism, i.e. beliefs about the behavior of others in this situation. I find that exposing participants to inequality-related information leads to significant differences in the prevalence of such beliefs.

Item Type:	Thesis (PhD)
Additional Information:	© 2024 Iva Parvanova
Library of Congress subject classification:	H Social Sciences > HV Social pathology. Social and public welfare. Criminology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Sets:	Departments > Health Policy
Supervisor:	Lagarde, Mylene and Papanicolas, Irene
URI:	http://etheses.lse.ac.uk/id/eprint/4794

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