Medição do risco de corrupção na rede pública hospitalar: uma abordagem empírica baseada em índice
Conteúdo do artigo principal
Resumo
A corrupção, como uma força enraizada e sistêmica nos sistemas de saúde, é uma das barreiras mais significativas para o acesso e a garantia da qualidade dos serviços de saúde. O setor da saúde, em todas as suas formas e em todos os países, é particularmente vulnerável a abusos. A prevenção torna-se possível com o estabelecimento de um mecanismo institucional capaz de identificar transações com alto risco de corrupção. Este artigo apresenta uma abordagem inovadora para medir o risco de corrupção na rede pública hospitalar de um país em desenvolvimento. O artigo explora em que medida os indicadores de risco de corrupção podem servir como ferramentas eficazes de alerta precoce para o fortalecimento da transparência e da governança nos sistemas públicos de saúde. A metodologia propõe o uso de indicadores combinados em um índice capaz de avaliar o grau de exposição de um hospital público a práticas corruptas. Os indicadores mensuram o risco considerando processos-chave da gestão hospitalar: faturamento médico, gestão da dívida, alocação de recursos (gastos) e gestão de contratos. A análise mediu índices de risco de corrupção para 945 hospitais públicos colombianos (97% do total) ao longo de um período de três anos. A metodologia proposta destaca que o poder discricionário na alocação de contratos e na gestão da dívida são os principais determinantes do risco de corrupção. O estudo também encontrou uma correlação positiva entre o isolamento geográfico dos hospitais e a exposição ao risco de corrupção.
Downloads
Detalhes do artigo
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
A RAP compromete-se a contribuir com a proteção dos direitos intelectuais do autor. Nesse sentido:
- Adota a licença CC Attribution 4.0, que permite que os artigos sejam reutilizados e distribuídos sem restrição, desde que o trabalho original seja corretamente citado;
- Assegura os direitos morais e de uso do artigo a autores, conforme CC Attribution 4.0. Os autores mantêm os direitos autorais sob o artigo publicado e o periódico tem o direito de primeira publicação;
- Adota software de verificação de similaridade de conteúdo - plagiarismo (Crossref Similarity Check);
- Recomenda o uso dos critérios de autoria do CRediT (Contributor Roles Taxonomy);
- Adota ações de combate ao plagio e má conduta ética, alinhada às diretrizes do Committee on Publication Ethics (COPE);
- A revista se reserva o direito de efetuar nas originais alterações apenas de ordem normativa, ortográfica e gramatical com vistas a manter o padrão culto da língua e a padronização de layout, respeitando, contudo, o estilo dos autores. Posteriormente, os autores receberão as versões finais para aprovação antes da publicação.
Mais detalhes do Código de Ética adotado pela RAP podem ser visualizados em Normas Éticas e Código de Conduta.
Referências
Abadia, C. E., & Oviedo, D. G. (2009). Bureaucratic itineraries in Colombia: A theoretical and methodological tool to assess managed-care health care systems. Social Science & Medicine, 68(6), 1153-1160.
Akbar, H., & Vujić, V. (2014). Explaining corruption: The role of national culture and its implications for international management. Cross Cultural Management, 21(2), 191-218.
Álvarez-Díaz, M., Saisana, M., Montalto, V., & Moura, C. T. (2018). Corruption perceptions index 2017 statistical assessment. European Commission Joint Research Centre.
Azfar, O., Lee, Y., & Swamy, A. (2001). The causes and consequences of corruption. The Annals of the American Academy of Political and Social Science, 573(1), 42-56.
Biolcati-Rinaldi, F., Molteni, F., & Salini, S. (2018). Assessing the reliability and validity of Google Scholar indicators: The case of social sciences in Italy. In The evaluation of research in social sciences and humanities: Lessons from the Italian experience (pp. 295-319).
Birch, S., Eyles, J., & Newbold, K. B. (1996). Proxies for healthcare need among populations: Validation of alternatives—a study in Quebec. Journal of Epidemiology & Community Health, 50(5), 564-569.
Cappelli, L., Pisano, A., Iannucci, E., Papetti, P., D’Ascenzo, F., & Ruggieri, R. (2024). Digitalization and prevention of corruption: Opportunities and risks—Some evidence from the Italian university system. Business Strategy and the Environment, 33(1), 81-94.
Colombia Compra Eficiente. (2024). Manual of supervision and contractual oversight (v. 1). https://colombiacompra.gov.co
Cooley, A., & Sharman, J. C. (2017). Transnational corruption and the globalized individual. Perspectives on Politics, 15(3), 732-753.
Decarolis, F., & Giorgiantonio, C. (2022). Corruption red flags in public procurement: New evidence from Italian calls for tenders. EPJ Data Science, 11(1), 16. https://doi.org/10.1140/epjds/s13688-022-00325-x
Departamento Nacional de Planeación. (2022). SECOP I. https://www.colombiacompra.gov.co/secop/secop-i
Di Tella, R., & Savedoff, W. D. (2001). Diagnosis corruption: Fraud in Latin America’s public hospitals. Inter-American Development Bank.
Fazekas, M., & Kocsis, G. (2020). Uncovering high-level corruption: Cross-national objective corruption risk indicators using public procurement data. British Journal of Political Science, 50(1), 155-164.
Fazekas, M., & Tóth, I. J. (2016). From corruption to state capture: A new analytical framework with empirical applications from Hungary. Political Research Quarterly, 69(2), 320-334.
Fazekas, M., Cingolani, L., & Tóth, B. (2016). A comprehensive review of objective corruption proxies in public procurement: Risky actors, transactions, and vehicles of rent extraction (Working Paper Series No. GTI-WP/2016:03). Government Transparency Institute. https://doi.org/10.13140/RG.2.2.27430.11846
Felizzola, H., Gomez, C., Arrieta, N., Jerez, V., Erazo, Y., & Camacho, G. (2024). Enhancing transparency in public procurement: A data-driven analytics approach. Information Systems, 125, 102430.
Ferwerda, J., Deleanu, I., & Unger, B. (2017). Corruption in public procurement: Finding the right indicators. European Journal on Criminal Policy and Research, 23, 245-267.
García, P. J. (2019). Corruption in global health: The open secret. The Lancet, 394(10214), 2119-2124.
Gnaldi, M., & del Sarto, S. (2024a). Measuring corruption risk in public procurement over emergency periods. Social Indicators Research, 172(3), 859-877.
Gnaldi, M., & del Sarto, S. (2024b). Validating corruption risk measures: A key step to monitoring SDG progress. Social Indicators Research, 175(3), 1045-1071.
Golden, M. A., & Picci, L. (2005). Proposal for a new measure of corruption, illustrated with Italian data. Economics & Politics, 17(1), 37-75.
Hajdu, M., Pápay, B., Szántó, Z., & Tóth, I. J. (2018). Content analysis of corruption coverage: Cross-national differences and commonalities. European Journal of Communication, 33(1), 7-21.
Hutchinson, E., Balabanova, D., & McKee, M. (2019). We need to talk about corruption in health systems. International Journal of Health Policy and Management, 8(4), 191-194.
Johnsøn, J., & Mason, P. (2013). The proxy challenge: Why bespoke proxy indicators can help solve the anti-corruption measurement problem (U4 Brief 2013:2). U4 Anti-Corruption Resource Centre.
Kok, S., Rutherford, A. R., Gustafson, R., Barrios, R., Montaner, J. S. G., Vasarhelyi, K., & V. H. I. V. T. P. M. Group. (2015). Optimizing an HIV testing program using a system dynamics model of the continuum of care. Health Care Management Science, 18, 334-362.
Kos, M. (2019). Introduction to healthcare systems. In The pharmacist guide to implementing pharmaceutical care (pp. 437-441).
Langbein, L., & Sanabria, P. (2013). The shape of corruption: Colombia as a case study. Journal of Development Studies, 49(11), 1500-1513.
Lewis, J. (2017). Social impacts of corruption upon community resilience and poverty. Jàmbá: Journal of Disaster Risk Studies, 9(1), 1-8.
Lisciandra, M., Milani, R., & Millemaci, E. (2022). A corruption risk indicator for public procurement. European Journal of Political Economy, 73, 102141.
Mackey, T. K., & Cuomo, R. E. (2020). An interdisciplinary review of digital technologies to facilitate anti-corruption, transparency and accountability in medicines procurement. Global Health Action, 13(sup1), 1695241.
Malito, D. (2014). Measuring corruption indicators and indices (RSCAS Working Paper 2014/13). European University Institute.
Manna, R., & Palumbo, R. (2019). How to fight public corruption? Capturing evidence from a fixed effects model for Western European countries. International Journal of Organization Theory & Behavior, 22(4), 313-330.
Martínez, R., Pons, C., Rodríguez, R., & Vera, P. (2023). Quality study of open government data related to COVID-19 in Latin America. Revista Facultad de Ingeniería Universidad de Antioquia, 108, 18-32.
Mexican Institute for Competitiveness. (2023). Corruption risk index: Public procurement in Mexico, 2018-2022. https://imco.org.mx/riesgosdecorrupcion
Ministry of Health and Social Protection. (2022). Proposal for the redefinition of the operational characteristics of public hospitals [In Spanish]. https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PSA/estudiooferta-servicios-primarios-hospitales-publicos.pdf
Ministry of Health and Social Protection. (2023). Special Registry of Health Service Providers (REPS). https://www.paho.org/sites/default/files/2-presentacion-viceministro_0.pdf
Oberoi, R. (2014). Mapping the matrix of corruption: Tracking the empirical evidences and tailoring responses. Journal of Asian and African Studies, 49(2), 187-214.
Palacio Acosta, C. A. (2013). The crisis in the Colombian healthcare system. Revista Colombiana de Psiquiatría, 42(4), 303-312.
Panerai, R. (1998). Validation of indicators for health policy research. World Health Forum, 19(1), 6-11.
Pillay, S., & Dorasamy, N. (2010). Linking cultural dimensions with the nature of corruption: An institutional theory perspective. International Journal of Cross Cultural Management, 10(3), 363-378.
Previtali, P., & Cerchiello, P. (2018). The prevention of corruption as an unavoidable way to ensure healthcare system sustainability. Sustainability, 10(9), 3071.
Puaschunder, J. M. (2020). The future of artificial intelligence in international healthcare: Three indices for integrating technology, productivity, anti-corruption and healthcare interaction around the world (SSRN Scholarly Paper No. 3633951). Social Science Research Network. https://doi.org/10.2139/ssrn.3633951
Savedoff, W. D. (2007). Transparency and corruption in the health sector: A conceptual framework and ideas for action in Latin America and the Caribbean. Inter-American Development Bank.
Savedoff, W. D., & Hussmann, K. (2006). The causes of corruption in the health sector: A focus on health care systems. In Global corruption report (pp. 4-16). Transparency International.
Sequeira, S. (2012). Advances in measuring corruption in the field. In D. Serra & L. Wantchekon (Eds.), New advances in experimental research on corruption (pp. 145-175). Emerald.
Skolarus, L. E., Sánchez, B. N., Morgenstern, L. B., Garcia, N. M., Smith, M. A., Brown, D. L., & Lisabeth, L. D. (2010). Validity of proxies and correction for proxy use when evaluating social determinants of health in stroke patients. Stroke, 41(3), 510-515.
Slager, R. (2017). The discursive construction of corruption risk. Journal of Management Inquiry, 26(4), 366-382.
Smith, S. E. (1976). Neuromuscular blocking drugs in man. In E. Zaimis (Ed.), Neuromuscular junction (Handbook of experimental pharmacology, Vol. 42, pp. 593-660). Springer.
Sommer, J. M. (2020). Corruption and health expenditure: A cross-national analysis on infant and child mortality. The European Journal of Development Research, 32, 690-717.
Staffen, M. R. (2020). Transnational environmental corruption indicators: Opacity in international transparency. Brazilian Journal of International Law, 17, 352-372.
Stiernstedt, P. (2019). Some things are rarely discussed in public: On the discourse of corruption in healthcare—Comment on “We need to talk about corruption in health systems”. International Journal of Health Policy and Management, 8(9), 560-562.
Transparency for Colombia. (2016a). Departmental transparency index and comptrollers: Results April 2015-2016 (Vol. 18) [In Spanish]. https://transparenciacolombia.org.co/indice-transparencia-departamental-2015-2016/
Transparency for Colombia. (2016b). Municipal transparency index: Results April 2015-2016 (Vol. 17) [In Spanish]. https://transparenciacolombia.org.co/indice-transparencia-departamental-2015-2016-2/
United Nations Development Programme. (2005). Institutional arrangements to combat corruption: A comparative study. https://www.undp.org/asia-pacific/publications/institutional-arrangements-combat-corruption-comparative-study
Vian, T. (2008). Review of corruption in the health sector: Theory, methods and interventions. Health Policy and Planning, 23(2), 83-94.
World Bank. (2019). External assessment of quality of care in the health sector in Colombia. http://documents.worldbank.org/curated/en/719321564123515864
Zuleta, M. M., Ospina, S., & Caro, C. A. (2019). Índice de riesgo de corrupción en el sistema de compra pública colombiano a partir de una metodología desarrollada por el Instituto Mexicano para la Competitividad. Fedesarrollo. http://hdl.handle.net/11445/3872
Zyglidopoulos, S., Hirsch, P., de Holan, P., & Phillips, N. (2017). Expanding research on corporate corruption, management, and organizations. Journal of Management Inquiry, 26(3), 247-253.