Investigating the relationship between corruption and health system outcomes in Central and Eastern Europe.

Corruption in the health sector wastes precious resources and threatens progress to universal health coverage (UHC). Countries of Central and Eastern Europe (CEE) have undertaken extensive health system reforms, many including measures to tackle informal payments and other forms of corruption. We asked whether there is evidence linking perceived corruption in twelve CEE countries between 2012 and 2020 with two health system-related outcomes, out-of-pocket payments and avoidable mortality. We analyse panel data and adjust for national characteristics in the political, economic, and social domains. We find a significant association between perceived corruption and health system outcomes after accounting for time-variant and in-variant factors using fixed-effects analysis. The political, economic, and social determinants of health, including quality of government, public health expenditure, national income, inequality, and urbanisation have stronger associations with each health system outcome. The results suggest that while corruption is detrimental to population health, it is one of a number of political and economic factors that must be addressed to accelerate progress towards equitable and universal health coverage. The direct and indirect effects of corruption on factors outside the health system that impact health outcomes cannot be ignored. Intersectional and global anti-corruption, accountability, and transparency initiatives remain a critical priority for achieving UHC in CEE and ensuring health systems keep pace with economic growth and population expectations.