Alcázar, L., y Andrade, R. (2000). Transparencia y rendición de cuentas en los hospitales públicos: el caso peruano (Documentos de Trabajo R-383). Washington, DC: BID.

This study analyses the problem of corruption in public hospitals from an institutional perspective. The specific objectives were: i) to analyse the influence of the different institutional structures of the organisations providing health services on the type and degree of corruption; and ii) to make policy recommendations to combat these problems based on the causal relationships identified.

The study focuses on two types of corruption: absenteeism or hours paid to doctors that are not worked, and the relationship between medical effort expended and ‘technically appropriate’. To achieve these objectives, the study involved four hospitals in the country characterised by different institutional arrangements.

In Peru, the main types of health organisations can be summarised in three, according to their ownership regime: i) public hospitals belonging to MINSA; ii) public hospitals belonging to EsSalud; and iii) private clinics. The study has involved two hospitals belonging to MINSA (one of which is participating in the pilot phase of the PAAG), one hospital belonging to EsSalud and one private clinic.

Empirical evidence for the study was collected through surveys of doctors, nurses and patients (both outpatients and inpatients) in each of the hospitals participating in the study, as well as interviews with hospital staff. For the analysis of the relationship between effort expended and ‘technically appropriate’, data were collected from the medical records of all patients who went into labour in 1998 in three of the four hospitals participating in the study.