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Corruption ruins the doctor-patient relationship in India

BMJ 2014; 348 doi: (Published 08 May 2014) Cite this as: BMJ 2014;348:g3169
  1. David Berger, district medical officer, emergency medicine
  1. 1Broome Hospital, Robinson Road, Broome, WA 6725, Australia
  1. daveberger{at}

Kickbacks and bribes oil every part of the country’s healthcare machinery, writes David Berger. If India’s authorities cannot make improvements, international agencies should act

“The corruption strangles everything, Sir. It’s like a cancer.” Accompanied by apologetic shrugs and half smiles, statements like this are commonly heard in India. I knew this was the case before I went to work as a volunteer physician in a small charitable hospital in the Himalayas, but what I didn’t realise was how far the corruption permeates the world of medicine and the corrosive effect it has on the doctor-patient relationship.

Although the causes and effects of corruption are complex, a few strands can be teased out. The healthcare system itself is a model of inequity; it is one of the most privatised in the world, with out of pocket expenditure on healthcare at more than 70%, far higher even than in the United States.1 This phenomenon is at least partly the result of the neoliberal World Bank policies of the 1990s, which mandated a reduction in public financing of healthcare, fuelling growth of the private sector.2 The latest in technological medicine is available to people who can pay, albeit at a high price, but the vast underclass, 800 million people or more, has little or no access to healthcare, and what access it does have is mostly to limited substandard government care or to quacks, who seem to operate with near impunity. There is one leveller, however: corruption is rife at all levels, from the richest to the poorest.

One day in the outpatient department I was writing a request …

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