The effect of institutional characteristics and social norms on corruption in healthcare

Corruption in healthcare is widespread and consequential. Informal payments (IPs) are a common form of petty corruption, especially in low- and middle-income countries. Using data from the Life in Transition Survey encompassing 33 countries across Europe and Central Asia, I analyze the prevalence and reasons behind IPs made to public health providers. In addition to individual- and system-level factors often used in literature, I also introduce a latent measure of social norms related to high levels of corruption. These are associated with a significantly higher prevalence of paying informally. This paper also bridges a gap between the corruption literature and health-related research by introducing a typology of IPs based on why they were made. I find that the association between health system characteristics and IPs prevalence differs based on the reason for payment. This difference is further exacerbated by the existence of corruption-related social norms. The results of this analysis highlight the need to revisit existing anti-corruption policies and align them to the underlying social norms.