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Sommersguter-Reichmann M, Reichmann G. Untangling the corruption maze: exploring the complexity of corruption in the health sector. HEALTH ECONOMICS REVIEW 2024; 14:50. [PMID: 38995456 PMCID: PMC11241952 DOI: 10.1186/s13561-024-00530-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Healthcare corruption poses a significant threat to individuals, institutions, sectors, and states. Combating corruption is paramount for protecting patients, maintaining the healthcare system's integrity, and preserving public trust. As corruption evolves, takes new forms, and adapts to changing socio-political landscapes, understanding its manifestations is critical to developing effective anti-corruption strategies at individual and institutional levels. OBJECTIVE The aim was to comprehensively collate the manifestations of different types of corruption in healthcare to illustrate prevailing patterns and trends and to provide policymakers, practitioners, and researchers with practical insights to inform research agendas, regulatory and governance strategies, and accountability measures. METHOD We conducted a narrative review of scientific articles published between 2013 and 2022 using keyword searches in SCOPUS and EBSCO. We utilized the corruption typology proposed by the European Union and Thompson's Institutional Corruption Framework to systematically identify manifestations across different corruption types. The Prisma scheme was employed to document the selection process and ensure reproducibility. FINDINGS Bribery in medical service provision was the most frequently investigated form of corruption, revealing rather uniform manifestations. Misuse of high-level positions and networks and institutional corruption also received considerable attention, with a wide range of misconduct identified in institutional corruption. Extending the analysis to institutional corruption also deepened the understanding of misconduct in the context of improper marketing relations and highlighted the involvement of various stakeholders, including academia. The pandemic exacerbated the vulnerability of the healthcare sector to procurement corruption. Also, it fostered new types of misconduct related to the misuse of high-level positions and networks and fraud and embezzlement of medical drugs, devices, and services. CONCLUSIONS The review spotlights criminal actions by individuals and networks and marks a notable shift towards systemic misconduct within specific types of corruption. The findings highlight the necessity of customized anti-corruption strategies throughout the healthcare sector. These insights are crucial for policymakers, practitioners, and researchers in guiding the formulation of legal frameworks at local and global levels, governance strategies, and research priorities.
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Affiliation(s)
| | - Gerhard Reichmann
- Department of Operations and Information Systems, University of Graz, Graz, Austria
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2
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Varbanova V, Hens N, Beutels P. Determinants of life-expectancy and disability-adjusted life years (DALYs) in European and Organisation for Economic Co-operation and Development (OECD) countries: A longitudinal analysis (1990-2019). SSM Popul Health 2023; 24:101484. [PMID: 37680998 PMCID: PMC10480329 DOI: 10.1016/j.ssmph.2023.101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/05/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023] Open
Abstract
•We relate 68 factors to population health observed in 61 countries over 30 years.•Using random forests, multiple imputation and generalized estimating equations.•GDP per capita and demographics are key; income inequality is not.•Health and social expenditure are more influential than freedom and corruption.•On the macro-level, life-style effects appear to be mediated by cultural context.
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Affiliation(s)
- Vladimira Varbanova
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken (D.S. 243), Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Niel Hens
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken (D.S. 243), Universiteitsplein 1, 2610, Antwerp, Belgium
- Interuniversity Institute of Biostatistics and Statistical Bioinformatics (I-BioStat), Data Science Institute, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken (D.S. 243), Universiteitsplein 1, 2610, Antwerp, Belgium
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3
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Noor MN, Rahman-Shepherd A, Siddiqui AR, Aftab W, Shakoor S, Hasan R, Khan M. Socioecological factors linked with pharmaceutical incentive-driven prescribing in Pakistan. BMJ Glob Health 2023; 6:bmjgh-2022-010853. [PMID: 36731921 PMCID: PMC10175940 DOI: 10.1136/bmjgh-2022-010853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/02/2022] [Indexed: 02/04/2023] Open
Abstract
Pharmaceutical marketing through financial incentivisation to general practitioners (GPs) is a poorly studied health system problem in Pakistan. Pharmaceutical incentivisation is seen to be distorting GPs prescribing behaviour that can compromise the health and well-being of patients. We draw on a conceptual framework outlined in the ecological system theory to identify multiple factors linked with pharmaceutical incentivisation to GPs in Pakistan. We conducted qualitative interviews with 28 policy actors to seek their views on the health system dynamics, how they sustain pharmaceutical incentivisation and their effect on the quality of care. Our analysis revealed four interlinked factors operating at different levels and how they collectively contribute to pharmaceutical incentivisation. In addition to influences such as the increasing family needs and peers' financial success, sometimes GPs may naturally be inclined to maximise incomes by engaging in pharmaceutical incentivisation. On other hand, the pharmaceutical market dynamics that involve that competition underpinned by a profit-maximisation mindset enable pharmaceutical companies to meet GPs' desires/needs in return for prescribing their products. Inadequate monitoring and health regulations may further permit the pharmaceutical industry and GPs to sustain the incentive-driven relationship. Our findings have important implications for potential health reforms such as introducing regulatory controls, and appropriate monitoring and regulation of the private health sector, required to address pharmaceutical incentivisation to GPs.
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Affiliation(s)
- Muhammad Naveed Noor
- Pathology and Laboratory Medicine, Aga Khan University, Karachi, Sindh, Pakistan.,Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Afifah Rahman-Shepherd
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Wafa Aftab
- Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sadia Shakoor
- Pathology and Laboratory Medicine, Aga Khan University, Karachi, Sindh, Pakistan
| | - Rumina Hasan
- Pathology and Laboratory Medicine, Aga Khan University, Karachi, Sindh, Pakistan.,Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Mishal Khan
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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4
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Dragos SL, Mare C, Dragos CM, Muresan GM, Purcel AA. Does voluntary health insurance improve health and longevity? Evidence from European OECD countries. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1397-1411. [PMID: 35124741 DOI: 10.1007/s10198-022-01439-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
The financing structure of the healthcare system and, particularly, the voluntary health insurance (VHI) constituent, has been a vital pillar in improving the overall quality of life. Consequently, this study aims to shed light on the effect of VHI on the population's health and longevity in a sample of 26 European OECD countries. The methodology employed covers both hierarchical clustering and the novel dynamic panel threshold technique. First, the descriptive cluster analysis unveils a delimitation of the countries into four main groups with respect to a broad set of health status indicators. Second, the estimates show that VHI is a significant determinant of health and longevity. More specifically, we find that the relationship between variables is characterized by a threshold effect, whose estimated value is roughly 6.3% of the total healthcare financing. Also, the heterogeneity analysis unveils consistent differences regarding the impact of VHI on health and longevity for the supplementary and complementary types of VHI. Overall, results are strongly robust, the signs and the significance of the coefficients being preserved in the presence of several additional control factors. From a policy perspective, the study's findings can be used nationwide to stimulate regulatory policies to encourage the achievement of a satisfactory level of private health insurance.
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Affiliation(s)
- Simona Laura Dragos
- Department of Finance, Faculty of Economics and Business Administration, Babeș-Bolyai University, 58-60, Teodor Mihali str., 400591, Cluj-Napoca, Romania
| | - Codruta Mare
- Department of Statistics-Forecasts-Mathematics, Faculty of Economics and Business Administration, Babeș-Bolyai University, 58-60, Teodor Mihali str., 400591, Cluj-Napoca, Romania.
- Interdisciplinary Centre for Data Science, Babeș-Bolyai University, 68, Avram Iancu str., 4th floor, 400083, Cluj-Napoca, Romania.
| | - Cristian Mihai Dragos
- Department of Statistics-Forecasts-Mathematics, Faculty of Economics and Business Administration, Babeș-Bolyai University, 58-60, Teodor Mihali str., 400591, Cluj-Napoca, Romania
| | - Gabriela Mihaela Muresan
- Department of Finance, Faculty of Economics and Business Administration, Babeș-Bolyai University, 58-60, Teodor Mihali str., 400591, Cluj-Napoca, Romania
| | - Alexandra-Anca Purcel
- Department of Statistics-Forecasts-Mathematics, Faculty of Economics and Business Administration, Babeș-Bolyai University, 58-60, Teodor Mihali str., 400591, Cluj-Napoca, Romania
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5
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Vogler S, Bauer E, Habimana K. Centralised Pharmaceutical Procurement: Learnings from Six European Countries. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:637-650. [PMID: 35513686 DOI: 10.1007/s40258-022-00729-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
Several European countries have introduced centralised procurement for all or some medicines. This article comparatively describes key features of national centralised pharmaceutical procurement (CPP) systems of six European countries (Cyprus, Denmark, Estonia, Italy, Norway and Portugal). Additionally, it aims to identify benefits, challenges and prerequisites for successful CPP, with a view to offering learnings for other countries. Information was collected based on literature and interviews with national procurement experts. While all countries studied established a designated procurement entity, other institutional and organisational features of the CPP systems vary across the countries. All CPP systems apply a mix of procurement procedures depending on the type of medicine (mainly tendering and negotiations). Reported benefits of CPP include lower purchase prices, stronger bargaining power of the public purchasers, enhanced transparency and governance, improved equity, and eventually improved access to medicines. Challenges that are to be met particularly in the starting phase are opposition of some users and the management of stakeholders with different expectations. Issues such as limited competition and non-availability of medicines may continue in the CPP setting. Compliance with good procurement principles is indispensable for any procurement, including CPP. Further prerequisites for successful CPP include a consistent, comprehensive and regularly updated procurement strategy, sufficient funding and appropriate staffing of the procurement entity, efficient processes including contract management and logistics, data collection and monitoring as well as interaction with users and suppliers.
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Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (Austrian National Public Health Institute/GÖG), Vienna, Austria.
| | - Eveli Bauer
- Pharmaceuticals and Medical Devices Department, Estonian Health Insurance Fund, Tallin, Estonia
| | - Katharina Habimana
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (Austrian National Public Health Institute/GÖG), Vienna, Austria
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6
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Timofeyev Y, Jakovljevic M. Editorial: Fraud and Corruption in Healthcare. Front Public Health 2022; 10:921254. [PMID: 35719660 PMCID: PMC9204141 DOI: 10.3389/fpubh.2022.921254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Mihajlo Jakovljevic
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia.,Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan.,Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
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7
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Smith SM, Parkash V. Impeded Delivery of Pathology and Laboratory Medicine Services by Corruption Is Not Unique to Resource-Limited Settings. Am J Clin Pathol 2022; 158:443. [PMID: 35599544 DOI: 10.1093/ajcp/aqac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephen M Smith
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Canada
| | - Vinita Parkash
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
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8
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Makhinson M, Seshia SS, Young GB, Smith PA, Stobart K, Guha IN. The iatrogenic opioid crisis: An example of 'institutional corruption of pharmaceuticals'? J Eval Clin Pract 2021; 27:1033-1043. [PMID: 33760335 DOI: 10.1111/jep.13566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/28/2022]
Abstract
RATIONALE Prescribed opioids are major contributors to the international public health opioid crisis. Such widespread iatrogenic harms usually result from collective decision failures of healthcare organizations rather than solely of individual organizations or professionals. Findings from a system-wide safety analysis of the iatrogenic opioid crisis that includes roles of pertinent healthcare organizations may help avoid or mitigate similar future iatrogenic consequences. In this retrospective exploratory study, we report such an analysis. METHODS The study population encompassed the entire age spectrum and included those in whom opioids prescribed for chronic pain (unrelated to malignancy) were associated with death or morbidity. Root cause analysis, incorporating recent suggestions for improvement, was used to identify possible contributory factors from the literature. Based on their mandated roles and potential influences to prevent or mitigate the iatrogenic crisis, relevant organizations were grouped and stratified from most to least influential. RESULTS The analysis identified a chain of multiple interrelated causal factors within and between organizations. The most influential organizations were pharmaceutical, political, and drug regulatory; next: experts and their related societies, and publications. Less influential: accreditation, professional licensing and regulatory, academic and healthcare funding bodies. Collectively, their views and decisions influenced prescribing practices of frontline healthcare professionals and advocacy groups. Financial associations between pharmaceutical and most other organizations/groups were common. Ultimately, patients were adversely affected. There was a complex association with psychosocial variables. LIMITATIONS The analysis suggests associations not causality. CONCLUSION The iatrogenic crisis has multiple intricately linked roots. The major catalyst: pervasive pharma-linked financial conflicts of interest (CoIs) involving most other healthcare organizations. These extensive financial CoIs were likely triggers for a cascade of erroneous decisions and actions that adversely affected patients. The actions and decisions of pharma ranged from unethical to illegal. The iatrogenic opioid crisis may exemplify 'institutional corruption of pharmaceuticals'.
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Affiliation(s)
- Michael Makhinson
- Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine at the University of California, Los Angeles, California, USA.,Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Shashi S Seshia
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gordon Bryan Young
- Clinical Neurological Sciences and Medicine (Critical Care), Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.,Grey Bruce Health Services, Owen Sound, Ontario, Canada
| | - Preston A Smith
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kent Stobart
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Indra Neil Guha
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
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9
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Maresova P, Rezny L, Peter L, Hajek L, Lefley F. Do Regulatory Changes Seriously Affect the Medical Devices Industry? Evidence From the Czech Republic. Front Public Health 2021; 9:666453. [PMID: 33996732 PMCID: PMC8113379 DOI: 10.3389/fpubh.2021.666453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Within the EU, some of the challenges and perceived risks now facing medical device (MD) developers result from changes in the regulatory framework, emphasizing safety. Therefore, medical technology companies must adopt stricter quality assurance measures so that individual devices can be speedily tracked and retrieved in emergency situations. Objectives: We highlight the challenges and risks faced by the European medical devices industry, particularly those faced by SMEs in the Czech Republic. We address two important research questions: Q1. Do advantages from increased regulation outweigh the additional expenses? Q2. As many MD developers are SMEs, will the new regulatory regime result in some of those companies going out of business and therefore impede future innovation? Methods: The paper focuses on a single case study, with the situation and outcomes discussed in the context of the financial results of a further 50 medical device manufacturers marketing in the Czech Republic. Results: Our findings suggest that the new legislation will result in improved safety, facilitate product recalls, but the cost and administrative burden may be high. The evidence also indicates that some SMEs may be forced to diversify to “non-medical” products, with the inevitable loss of innovative MDs being made available to patients and healthcare providers.
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Affiliation(s)
- Petra Maresova
- Department of Economics, University of Hradec Kralove, Hradec Kralove, Czechia
| | - Lukas Rezny
- Department of Economics, University of Hradec Kralove, Hradec Kralove, Czechia
| | - Lukas Peter
- Department of Cybernetics and Biomedical Engineering, Technical University of Ostrava, Ostrava, Czechia
| | - Ladislav Hajek
- Department of Economics, University of Hradec Kralove, Hradec Kralove, Czechia
| | - Frank Lefley
- Department of Economics, University of Hradec Kralove, Hradec Kralove, Czechia
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10
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Vian T. Anti-corruption, transparency and accountability in health: concepts, frameworks, and approaches. Glob Health Action 2020; 13:1694744. [PMID: 32194010 PMCID: PMC7170369 DOI: 10.1080/16549716.2019.1694744] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: As called for by the Sustainable Development Goals, governments, development partners and civil society are working on anti-corruption, transparency and accountability approaches to control corruption and advance Universal Health Coverage. Objectives: The objective of this review is to summarize concepts, frameworks, and approaches used to identify corruption risks and consequences of corruption on health systems and outcomes. We also inventory interventions to fight corruption and increase transparency and accountability. Methods: We performed a critical review based on a systematic search of literature in PubMed and Web of Science and reviewed background papers and presentations from two international technical meetings on the topic of anti-corruption and health. We identified concepts, frameworks and approaches and summarized updated evidence of types and causes corruption in the health sector. Results: Corruption, or the abuse of power for private gain, in health systems includes bribes and kickbacks, embezzlement, fraud, political influence/nepotism and informal payments, among other behaviors. Drivers of corruption include individual and systems level factors such as financial pressures, poorly managed conflicts of interest, and weak regulatory and enforcement systems. We identify six typologies and frameworks that model relationships influencing the scope and seriousness of corruption, and show how anti-corruption strategies such as transparency, accountability, and civic participation can affect corruption risk. Little research exists on the effectiveness of anti-corruption measures; however, interventions such as community monitoring and insurance fraud control programs show promise. Conclusions: Corruption undermines the capacity of health systems to contribute to better health, economic growth and development. Interventions and resources on prevention and control of corruption are essential components of health system strengthening for Universal Health Coverage.
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Affiliation(s)
- Taryn Vian
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
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Pharmacy Internal Controls: A Call for Greater Vigilance during the COVID-19 Pandemic. PHARMACY 2020; 8:pharmacy8040216. [PMID: 33203152 PMCID: PMC7712955 DOI: 10.3390/pharmacy8040216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 12/03/2022] Open
Abstract
For businesses that store physical goods, managing product inventories and financial cost accounting controls are critical. Pharmacies are under considerable scrutiny, due to the nature of their merchandise, making internal controls even more vital. Due to the emergence of COVID-19 and government mitigation strategies, the US economy has seen significant macro- and microeconomic effects. COVID-19 has changed the pharmacy working environment, which could theoretically increase rates of employee drug diversion. Therefore, better inventory management could reduce the misuse of pharmaceutical drugs from fraudulent and drug diversion activities. The author explored secondary findings to create a multidisciplinary conceptual analysis of the reasons why internal controls executed with greater diligence may be needed to avoid damaging financial, legal, and health outcomes. The author also provides a review of available internal control methods that can be used to mitigate diversion.
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Abstract
During college and medical school, the author's summer employment acquainted him with members of organized crime families. After a full career as a primary care clinician and geriatrician with research on improving health care delivery, the author opines that several insights from organized crime should be of interest to health care professionals: (1) don't damage the host; (2) protect the brand; and (3) lead necessary adaption. From these insights, the author presents symptoms of failure evidenced by the US health care system, followed by several adaptations that would reduce the system's costs, improve its image, and address future challenges.
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13
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Radanović I, Likić R. Opportunities for Use of Blockchain Technology in Medicine. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:583-590. [PMID: 30022440 DOI: 10.1007/s40258-018-0412-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Blockchain technology is a decentralized database that stores a registry of assets and transactions across a peer-to-peer computer network, which is secured through cryptography, and over time, its history gets locked in blocks of data that are cryptographically linked together and secured. So far, there have been use cases of this technology for cryptocurrencies, digital contracts, financial and public records, and property ownership. It is expected that future uses will expand into medicine, science, education, intellectual property, and supply chain management. Likely applications in the field of medicine could include electronic health records, health insurance, biomedical research, drug supply and procurement processes, and medical education. Utilization of blockchain is not without its weaknesses and currently, this technology is extremely immature and lacks public or even expert knowledge, making it hard to have a clear strategic vision of its true future potential. Presently, there are issues with scalability, security of smart contracts, and user adoption. Nevertheless, with capital investments into blockchain technology projected to reach US$400 million in 2019, health professionals and decision makers should be aware of the transformative potential that blockchain technology offers for healthcare organizations and medical practice.
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Affiliation(s)
- Igor Radanović
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Robert Likić
- School of Medicine, University of Zagreb, Zagreb, Croatia.
- Unit of Clinical Pharmacology, Department of Internal Medicine, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.
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Bion J, Antonelli M, Blanch LL, Curtis JR, Druml C, Du B, Machado FR, Gomersall C, Hartog C, Levy M, Myburgh J, Rubenfeld G, Sprung C. White paper: statement on conflicts of interest. Intensive Care Med 2018; 44:1657-1668. [PMID: 30191294 DOI: 10.1007/s00134-018-5349-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/14/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Conflicts of interest are a normal part of human social intercourse. They become problematic when there is a power differential between participants in the setting of relationships requiring a high degree of trust, as in healthcare. In this white paper we consider how these conflicts may be detected and mitigated. METHODS Following Medline search and reference chaining, we undertook a narrative review of the literature with iterative discussion. RESULTS Conflicts of interest may be financial, professional or personal, and may operate at the level of the individual or the organisation. Unmanaged, they become a source of bias which places the interests of the professional or the organisation before those of the patient. Reported with increasing frequency, conflicts damage trust, harm patients, and defraud the health system. We make 15 recommendations for minimising conflicts of interest. CONCLUSIONS Nationally funded open-access registries should be established to permit complete disclosure of financial, professional, and personal relationships with the potential for driving bias in research, clinical practice, or health management. Governance of disclosure should be the responsibility of employing organisations through annual staff appraisals, audited by national research integrity committees. Research fraud should incur suspension of the license to practice. Organisations should monitor staff perceptions of ethical climate to enhance awareness of staff behaviours and the potential for misconduct driven by academic pressures. Clear separation of advisory and voting roles is needed in best practice guideline panels. Professional societies and scientific journals should display conflict of interest policies for their own staff and officers as well as for speakers and authors. Undergraduates should not be exposed to pharmaceutical promotions masquerading as education. Undergraduate and postgraduate training programmes should include teaching about managing conflicts of interest and identifying research misconduct.
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Affiliation(s)
- Julian Bion
- University Department of Intensive Care Medicine, University of Birmingham, Ground Floor East Wing, Queen Elizabeth Hospital (Heritage Site), Birmingham, B15 2GW, UK.
| | - Massimo Antonelli
- Department of Intensive Care Medicine, Anesthesiology and Emergency Medicine, Fondazione Policlicnico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - LLuis Blanch
- Parc Tauli University Hospital, CIBER Enfermedades Respiratorias, Institut de Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence at UW Medicine, A. Bruce Montgomery-American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA, 98104, USA
| | - Christiane Druml
- UNESCO Chair on Bioethics of the Medical University of Vienna, Ethics, Collections and History of Medicine, Waehringerstrasse 25, 1090, Vienna, Austria
| | - Bin Du
- Medical Intensive Care Unit, Peking Union Medicine College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, China
| | - Flavia R Machado
- Anesthesiology, Pain, and Intensive Care Department, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Charles Gomersall
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Christiane Hartog
- Department of Anaesthesiology and Intensive Care Medicine, Centre for Sepsis Care and Control, Jena University Hospital, 07747, Jena, Germany
| | - Mitchell Levy
- Pulmonary and Critical Care Medicine Alpert Medical School of Brown University, Rhode Island Hospital, Providence, USA
| | - John Myburgh
- The George Institute for Global Health, Level 5, 1 King St, Newtown, NSW, 2042, Australia
| | - Gordon Rubenfeld
- Interdepartmental Division of Critical Care Medicine, University of Toronto, 2075 Bayview Avenue, Room D108c, Toronto, ON, M4N 3M5, Canada
| | - Charles Sprung
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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