Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, México.
BMC Health Serv Res. 2011 Dec 21;11 Suppl 2(Suppl 2):S12. doi: 10.1186/1472-6963-11-S2-S12.
Unofficial payments in health services around the world are widespread and as varied as the health systems in which they occur. We reviewed the main lessons from social audits of petty corruption in health services in South Asia (Bangladesh, Pakistan), Africa (Uganda and South Africa) and Europe (Baltic States).
The social audits varied in purpose and scope. All covered representative sample communities and involved household interviews, focus group discussions, institutional reviews of health facilities, interviews with service providers and discussions with health authorities. Most audits questioned households about views on health services, perceived corruption in the services, and use of government and other health services. Questions to service users asked about making official and unofficial payments, amounts paid, service delivery indicators, and satisfaction with the service.
Contextual differences between the countries affected the forms of petty corruption and factors related to it. Most households in all countries held negative views about government health services and many perceived these services as corrupt. There was little evidence that better off service users were more likely to make an unofficial payment, or that making such a payment was associated with better or quicker service; those who paid unofficially to health care workers were not more satisfied with the service. In South Asia, where we conducted repeated social audits, only a minority of households chose to use government health services and their use declined over time in favour of other providers. Focus groups indicated that reasons for avoiding government health services included the need to pay for supposedly free services and the non-availability of medicines in facilities, often perceived as due to diversion of the supplied medicines.
Unofficial expenses for medical care represent a disproportionate cost for vulnerable families; the very people who need to make use of supposedly free government services, and are a barrier to the use of these services. Patient dissatisfaction due to petty corruption may contribute to abandonment of government health services. The social audits informed plans for tackling corruption in health services.
在全球范围内，卫生服务中的非官方支付现象普遍存在，且形式多样，与发生这些支付的卫生系统一样多样化。我们回顾了南亚（孟加拉国、巴基斯坦）、非洲（乌干达和南非）和欧洲（波罗的海国家）的卫生服务中小额腐败社会审计的主要经验教训。
社会审计的目的和范围各不相同。所有审计都涵盖了有代表性的社区样本，涉及家庭访谈、焦点小组讨论、卫生机构审查、服务提供者访谈和与卫生当局的讨论。大多数审计都询问了家庭对卫生服务的看法、对服务中腐败的看法以及对政府和其他卫生服务的使用情况。对服务使用者的问题包括是否支付了官方和非官方的款项、支付的金额、服务提供指标以及对服务的满意度。
各国之间的背景差异影响了小额腐败的形式和与之相关的因素。所有国家的大多数家庭对政府卫生服务持有负面看法，许多人认为这些服务存在腐败现象。几乎没有证据表明，较富裕的服务使用者更有可能支付非官方款项，或者支付这种款项与更好或更快的服务有关；向医疗保健工作者支付非官方款项的人对服务的满意度并没有更高。在我们进行了多次社会审计的南亚，只有少数家庭选择使用政府卫生服务，而且随着时间的推移，他们越来越倾向于选择其他提供者。焦点小组指出，避免使用政府卫生服务的原因包括需要为所谓的免费服务付费，以及医疗机构经常缺乏药品，这通常被认为是由于供应药品的挪用。
医疗保健的非官方费用对弱势家庭来说是不成比例的负担；这些人正是需要利用政府提供的免费服务的人，也是利用这些服务的障碍。由于小额腐败而导致的患者不满可能导致政府卫生服务的放弃。社会审计为解决卫生服务中的腐败问题提供了计划。
