Corruption in Europe’s health services is surprisingly common

EUROPEAN HEALTH CARE is in a sickly state. In Britain more than 6.5m people are on waiting lists for treatment, up by more than 50% since 2019. Patients in Spain wait an average of 123 days for an operation, the most in 18 years. The pandemic bears most of the blame. Disruptions to essential treatments created backlogs and strained services. But even before covid-19, health care in Europe was in trouble. Waiting lists had been creeping higher across much of the continent. It should perhaps be no surprise that a study published on September 6th by researchers at Imperial College London finds that patients are being asked to grease their practitioners’ palms to secure treatment (see chart).

The study, by Giulia Dallera and her colleagues, used surveys carried out in 2013, 2017 and 2019 by Eurobarometer, the EU’s polling organisation. Each survey asked more than 27,000 people from 28 EU countries (before Britain left the bloc) whether they had been asked to make unofficial payments or give valuable gifts to nurses, doctors or hospitals to secure treatment in the past year. In the most recent survey almost 4% of Europeans who used such services reported that they were asked to make an informal payment. This represented an increase of around 14% since 2013, despite public perceptions that corruption in health care is becoming less common.

Eastern Europe had the highest prevalence of bribes: 5.5% of the population was asked to make an informal payment in 2019. But the situation there is improving. Requests for such payments have fallen by around 8% since 2013, with the biggest drops coming from Lithuania, Romania and Slovakia. The more worrying trend is farther west. The surveys show that western Europe is seeing the largest increase in bribery, with every country except Germany reporting an increase between 2013 and 2019. Respondents in the west were 1.5 percentage points more likely to have been asked for unofficial payments by medical professionals than those in southern Europe, where the figure stands at 2.5%. Austria had the highest bribery rate of any European country in 2019; more than one person in nine was pressured by heath-care professionals. Belgium, Germany and Luxembourg all had rates above 5%.

The cause is still unclear. Bribes are often a symptom of poor governance in health-care systems, where doctors lack adequate supervision and oversight. Previous studies have shown that such mismanagement brings medical as well as moral risks: patients may be likelier to develop chronic diseases and resistance to antibiotics. And added pressure from covid could make the already grim situation worse.