I can pardon everybody’s mistakes except my own. Marcus Cato

Many patients have experienced the seamy side of commercial medical practice today.

* Surgeons demanding large cash payments before they will operate in an emergency

* Pediatricians peddling unnecessary vaccines by playing on the fears of parents

* Doctors writing prescriptions for unnecessary, expensive medicines because of the incentives that drug companies lure them with

* Specialists ordering expensive tests in order to get kickbacks from diagnostic centers With the privatization of medical colleges, we have reached a deplorable state of affairs in which medical education is seen to be a business expenditure, and the doctor’s professional fees are regarded as his return on this investment in his training. This is why patients no longer have any faith in the profession’s ability to regulate itself – or in an external authority doing it either.

Corruption is rampant

However, the roots of medical corruption and fraud run much deeper than this, and cause far more extensive harm. Forms of corruption in healthcare and medicine include:

* Bribes and kickbacks

* Theft and embezzlement

* Absenteeism (where doctors and healthcare workers do not attend work , but claim their salary)

* Informal payments or “speed money” which the patient has to give the medical staff to expedite their care

* Institutionalized corruption (in some for-profit hospitals, revenue targets are set by the management, and physicians are obliged to admit at least a minimum number of patients every month , even if the hospitalization is unnecessary, if they don’t want to be sacked) While the damage a crooked doctor does is limited to his patients, the elephant in the room is the far more extensive damage wrought by a corrupt pubic healthcare system. The Govt of India pumps money to try to provide safe and affordable healthcare for the poor, but most of this gets wasted and diverted. This has been extensively documented many times, but nothing seems to have changed over the years. For example, in 2012, India’s Comptroller and Auditor General (CAG) reported that the UP State Health Mission failed to fulfill its mandate and was responsible for an unaccounted loss of Rs 5754 crores out of the total amount of Rs 8657 crores. They described this as “organized looting of) government funds.”

According to the Central Bureau of Investigation (CBI), “Large-scale bungling took place in the implementation of NRHM ( National Rural Health Mission).” The modus operandi for siphoning off state wealth included overpricing, fake supply of medicines and hospital equipment by fictitious firms as well as huge kickbacks in construction activity to improve health services in government-run primary health centers in rural areas.

The cover-up

The truth is that what is visible is only the tip of the iceberg; the bottom of the “iceberg” of corruption is almost untraceable. Sadly, the art of healing has turned into a science of stealing and the conspiracy to cover up has introduced criminality into medicine. No public health program can succeed in a setting in which scarce resources are siphoned off, depriving the disadvantaged and poor of essential healthcare. Safe care cannot be provided by a healthcare delivery system in which kickbacks and bribery are a part of life.

It’s high time we stopped turning a blind eye to the cancer of corruption that has corroded the heart of our healthcare system. As individuals, we often feel that we are powerless to make a difference in a system that seems so set in its ways. However, if we work together, as doctors, patients and concerned citizens, we can help to fix the problem by speaking up against it. By keeping quiet (which is what most of us do) and because of our lackadaisical attitude, we become part of the problem.