Corruption, public trust and medical autonomy in the public health sector of Montenegro: Taking stock of the COVID-19 influence.

In this paper, we analyze the influence of corruption perception, experiences of corruptive behavior, and healthcare autonomy on the public trust in Montenegrin healthcare, by surveying the general population before and after the global COVID-19 pandemic. By providing a quasi-replication of a previous empirical study of corruption and trust in the Croatian public healthcare sector, we introduce the COVID-19 pandemic as a new research context. Before the pandemic, we found a consistent and significant negative influence of the corruptive practices and the generally perceived level of corruption (corruption salience) on the trust in public healthcare. The emergence of COVID-19 had mixed effects: while there is a slightly higher effect of corruption salience to the preference of public healthcare, corruptive experiences still matter but are tolerated much higher than before the pandemic. Public assessment of the autonomy of the health system increases preference for public healthcare, both before and after the pandemic, although the emergence of COVID-19 somewhat lowers this effect. The obtained results point to the most significant challenges of the 'post-COVID-19' social context to public health policymaking and management of public healthcare institutions. These include focusing the public healthcare reforms on corruption, reducing waiting times for different diagnostics and medical procedures in the public healthcare system, and regulating the 'dual practice' (simultaneous work in public and private healthcare institutions).