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Corruption and Health Outcomes Within an Economic and Cultural Framework Corruption and health outcomes within an economic and cultural framework Monica Violeta Achim, Viorela Ligia Văidean & Sorin Nicolae Borlea The European Journal of Health Economics ISSN 1618-7598 Eur J Health Econ DOI 10.1007/s10198-019-01120-8 1 23 Your article is protected by copyright and all rights are held exclusively by Springer- Verlag GmbH Germany, part of Springer Nature. This e-offprint is for personal use only and shall not be self-archived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com”. 1 23 Author's personal copy The European Journal of Health Economics https://doi.org/10.1007/s10198-019-01120-8 ORIGINAL PAPER Corruption and health outcomes within an economic and cultural framework Monica Violeta Achim1 · Viorela Ligia Văidean1 · Sorin Nicolae Borlea2,3 Received: 4 May 2019 / Accepted: 23 September 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract The purpose of this paper is to investigate the relationship between corruption and population health. Our cross-sectional sample covers 185 countries (54 high-income and 131 low-income countries) and the period of the analysis is 2005–2017. This research provides clear evidence that the level of corruption signifcantly afects physical health (expressed as life expectancy and Mortality rate) and mental health (expressed by happiness), under the moderating role of economic develop- ment and cultural framework. Moreover, we validate a powerful and positive correlation between the income level and both physical and mental health. Culture also has an important role in the corruption–health nexus, because we fnd evidence sup- porting four out of the six dimensions of culture (individualism versus collectivism, indulgence versus restraint, uncertainty avoidance and masculinity vs femininity) as having infuence upon the physical and mental health of individuals. When we estimate the results on subsamples of countries (high-income and low-income countries), we validate a crisscross efect of corruption. Thus, a high level of corruption more deeply afects the physical health of population in low-income countries than in high-income countries. On the other hand, mental health is more pronouncedly afected by corruption in high-income countries than in low-income countries. This study may have important implications for national or international policy makers who need to acknowledge that anti-corruption policies play an important role in increasing population health, but they also need to adopt them according to the economic and cultural context of each nation. Keywords Corruption · Physical health · Mental health · Wealth · Culture JEL Classifcation I18 · I31 · H42 · Z10 Electronic supplementary material The online version of this Introduction article (https ://doi.org/10.1007/s1019 8-019-01120 -8) contains supplementary material, which is available to authorized users. The idea of this paper sprang from [3] who fnd that “83% * Monica Violeta Achim of all deaths from building collapse in earthquakes over the [email protected] past 30 years occurred in countries that are anomalously Viorela Ligia Văidean corrupt”. A high level of corruption would mean a low trans- [email protected] parency, paying bribes for getting some contracts, jobs or Sorin Nicolae Borlea services by violating the law and rules, which may create [email protected] people’s dissatisfaction or even huge damages in society. Important evidences on the destructive role of corruption 1 Faculty of Economics and Business Administration Cluj-Napoca, Department of Finance, “Babeş-Bolyai upon people’s lives are revealed by the numerous fres under University”, Street Teodor Mihali, No. 58-60, Cluj-Napoca, the illegal operating permits which kill many people. There Romania can be mentioned the recent 2015 Colectiv nightclub fre 2 Faculty of Economics, Informatics and Engineering, from Romania which killed 64 people and injured other Department of Economics, ‘Vasile Goldis’ Western 147. That huge accident created a large mass movement University of Arad, B-dul Revolutiei, No. 94, Arad, Romania entitled “corruption kills”, against the painful situation of 3 Faculty of Economics, Doctoral Scool of Economics, Romania. The Romanian government was perceived as a University of Oradea, Street Universitatii No. 1, Oradea, symbol of corruption and it was forced to resign [17, 35]. Romania Vol.:(0123456789)1 3 Author's personal copy M. V. Achim et al. But Romania’s case has not been an isolated one. Around on the relation between corruption and health outcomes [4, the world, there were many similar cases: the 2013 Kiss 6], we are also interested whether this relation may vary or nightclub fre from Brazil who killed 230 people, the 2003 not among high-income and low-income countries. Thus, a Station nightclub fre in Rhode Island in the United States fourth aim of our research rises in this respect. that killed 100 people, the 2008 deaths in Wuwang Club fre Nevertheless, we are interested in the cultural context of in Shenzhen, China, the 2004 República Cromañón night- societies that might infuence the degree to which individu- club fre in Argentina, Buenos Aires that killed 194 people, als are and feel physically and mentally happy. the 2015 Formosa Fun Coast explosion from Taiwan that For our purpose, we use a cross-sectional sample cover- killed 14 people and injured 498 and many other painful ing 185 countries over the period 2005–2017. We fnd clear examples [36]. evidence that a higher level of corruption afects health (in All these mishaps constitute the starting point of our both its forms—physical and mental health) and this infu- research and thus, the overall aim of this paper is to empiri- ence difers among high-income and low-income countries. cally explore the relationship between corruption and popu- Our paper is structured as follows: the next section sets lation health. Actually, during recent years, the corruption out a literature survey along with the working hypotheses, phenomenon in the health care sector has gained considera- Sect. 3 describes our data sources, Sect. 4 presents the ble attention, as it acknowledges the fact that service provid- econometric models, Sect. 5 highlights our empirical fnd- ers who are acting in accordance with the institutional and ings, which are further discussed in detail. The paper ends environmental settings can undermine a healthcare system’s with the conclusions including a summary and a brief dis- purposes. [41] study whether the Austrian healthcare system cussion of policy implications, limitations and the avenues is prone to institutional corruption or not and if it is, which for future research. will be the channels for corruption development. Conceptually, a frst main element of originality of our research consists in analysing the relation between cor- Literature review ruption and health outcomes by viewing health outcomes through their two facets: people’s physical but also mental Holmberg and Rothstein [27] comes with an extremely inter- health. Although since 1948, the World Health Organization esting remark on indicators of population health, consider- have kept the same defnition of health as “a complete state ing that they can be interpreted as revealing more about a of physical, mental and social well-being and not merely society than just how healthy its population is. Taking mat- the absence of disease or infrmity” [50], so far, we have ters further, they support the idea that population health is not identifed studies that would investigate the infuence of a measure of how successful diferent societies are. It is our corruption on people’s health through its both sides (physi- frm belief that, to a certain extent, a healthy population is cal and mental health) in the specialized research literature. the product of a powerful country with well-developed and The literature contains numerous studies documenting healthy systems. a clear relationship between corruption and the perception Corruption, perceived as a wide-spread phenomenon upon healthcare (or healthcare satisfaction) and these are and an important problem in the health sector, has a major revealing negative efects of corruption on healthcare sat- impact on access to and the quality of health services, and isfaction [7, 21]. But we have identifed very few empiri- these in turn, further afect health outcomes. Gaitonde et al. cal studies (such as [23, 27, 30, 33]) that validate a clear [18] further emphasize the idea that corruption reduces the relationship between corruption and the physical health of efectiveness, efciency and equity of health services, which people, when the latter is expressed not as a perception but in turn has adverse efects on health outcomes and devel- rather as a fact refected by indicators such as Life expec- opment. Their study reviews interventions to be applied to tancy or Mortality rate. Thus, a second aim of our research reduce the incidence of this phenomenon and its adverse consists in flling such a gap in the literature by investigating efects on health. One of their main conclusions is that the the corruption–health relationship when the physical health large amount of corruption in the health sector determines of population is expressed as an indicator of objective evi- wasted resources, worse health care and worse health out- dence not as a perception. comes [18]. Furthermore, within the feld of the corruption–happiness Petkov and Cohen [37] consider healthcare systems to be nexus, we have found very few research studies [4, 5, 14, 20, particularly vulnerable to corruption for several reasons.
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