Corruption and waste in the health system

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18 // 06. THE CORRUPTION PHENOMENON

06.

THE CORRUPTION PHENOMENON

The reasons for the corruption On 17 February 1992 the president of a historic care institute for the elderly in Milan was caught in the act of pocketing a backhander of seven million lire paid by the owner of a small cleaning company (5 per cent out of a tender of 140 million for supplies to the rest home)28. This was the start of Mani Pulite, or the Clean Hands operation. During the interrogations, he confessed that he had taken the first bribe in 1974, aged 30, when he was head of the technical office of a hospital in Lombardy. After serving his sentence and returning to the world of work, in 2009 he was arrested again (as “Mister 10%”) for corruption in the waste disposal sector29 and in 2012 he was again involved in an inquest for corruption in the health sector30. Why would a person with a promising political career, prestigious position and a high level of well-being stoop to commit a series of acts of corruption and repeat them even after he had been sentenced for those crimes? Different methods can be applied to explain corruption in the health sector: the rational choice, sociological-cultural and neoinstitutionalist approaches31. Rational choice theory upholds that a potentially criminal person32 decides to commit a crime based on a choice in which they balance the interest/benefit and risks/costs connected to their criminal action. If the risk of being identified, sanctioned and condemned is lower than the expected benefit, it is more probable that the crime will come to pass. On the contrary, if the perceived risks outweigh the possible earnings, this becomes a deterrent. The rational approach includes the psychological factor but leaves out personal motivations (why one breaks the rules or ethics) because they are less influential on the final choice than the perceived risk factor. Rational choice can explain both grand and bureaucratic corruption as well as potential systemic risk, that is, the possibility that among the same people or different people participating in the same environment

many more episodes of corruption will follow on from a first occurrence. This is because the corruption is based on an agreement among several actors in whose interest it is, having embarked upon the corruption, to keep it up in order to minimise their own risks. Game theory explains that this illicit cooperation, in which individual interests are put before collective ones, can become structural in the absence of preventive forms of moral or ethical reprobation or in the absence of tools to keep check on it, because it strikes a strategic balance for the participants (Massarenti, 2012).33 Going back over the Tangentopoli experience, up to some recent scandals, corruption systems emerge that have solidified in time. They are systems which everyone had to adapt to, to obtain results that would otherwise have been denied.34 The Court of Bari speaks of systematic reiteration of crimes based on a “systematic logic of distortion in choosing the contracting party for supplies to the public administration and in the appointment of top managers and head physicians.”35 But the decision to subscribe to, reject, or report the corruptive setup pivots around the single person, who chooses on the basis of their own principles and values. The socio-cultural approach can give a better explanation as to why in the occasions and cases of vulnerability described in this report, some subjects decided to corrupt (or be corrupted) and others did not, but almost no one reported the fact. In this case, we can speak of the moral costs of corruption, that is, the price that a person has to pay to breach the ethical, social, professional and cultural values of their social and community context. There are numerous pieces of empirical evidence on the slightness of this cost in Italy: above all is the need to run special advocacy campaign36 or make regulatory provisions so that people condemned for corruption are not included in the electoral rolls, and people who might even be condemned for crimes against the public administration can peacefully reside in parliament. During this research, for example, it emerged how the figure of whistleblower, translated into Italian


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