Of the more than $3 trillion dollars per year spent worldwide on health services, an untold amount is drained through corruption, according to the non-governmental anticorruption watchdog Transparency International. Albert Fisher, M.D., comments on the sources of corruption and proposed remedies in the winter issue of the Journal of American Physicians and Surgeons. Dr. Fisher, a family physician in Oshkosh, Wis., is the immediate past president of the Association of American Physicians and Surgeons (AAPS).

Read full article by Dr. Fisher http://www.jpands.org/vol23no4/fisher.pdf

Evidence on the effectiveness of ways to reduce corruption is scanty, Dr. Fisher notes. The huge flow of money invites abuse. Having more than one provider of service, instead of monopolies, may reduce incentives for corruption.

The Cochrane review of related studies did not even consider the role of patients in detecting corruption when they are responsible for paying the bills. One of Dr. Fisher’s patients, upon receiving a $100,000 bill for a hysterectomy, called the hospital billing office, and the charge for the robot—a $68,000 “mistake”?—was immediately removed.

Conflicts of interest certainly play a role, as when guidelines writers, who are recipients of research grants and consulting fees, recommend against a long-established drug like theophylline (a bronchodilator) and promote newer, far more expensive drugs. Architects of big government programs, like those established by the Affordable Care Act, have deep ties to interlocking individuals and organizations that benefit.

Anticorruption interventions often target doctors as scapegoats. Tools designed to fight violent crimes and drug dealers have been used to imprison physicians who had no idea that they were engaging in any activity that could remotely be considered unlawful.

“Fighting corruption is a complex challenge,” Dr. Fisher writes. “Big government health programs invite corruption on a broad scale.” He urges physicians to opt out of corrupt schemes, and to reaffirm their commitment to the “primary mission of the medical profession—taking care of patients.”

The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.