In its annual corruption report, Transparency International estimates that corruption costs Germany's healthcare system between 8 and 24 billion euros ($10 and 30 billion) a year.
Does the pharmaceuticals industry have an unhealthy influence?
In its latest yearbook, the German chapter of the non-profit, non-governmental organization working to counter corrupt international business and government practices warned against the increasing influence of the pharmaceutical industry on doctors and researchers and called for tougher action against those who abuse the system.
It alleged that the most serious aspect of corruption in the German health system is the influence exerted by the pharmaceuticals industry on the licensing, medical and therapeutic assessment and marketing of products. TI accused companies of paying doctors to prescribe their products, infiltrating self-help groups and using dubious studies in their marketing strategies.
State-by-state system creates complexity
Federal differences make health care a complex business
Transparency International (TI) said that over the past few decades, fraud, waste and corruption had well and truly eaten into the structures of Germany's health system, which is organized on a state-by-state basis. In its "Yearbook Corruption 2006," it said that owing to the market power of the pharmaceutical industry and its associations, the system's obscure structures could hardly be understood.
"One of the main problems for our susceptibility to corruption in Germany is linked to the fact that whereas other countries have one health minister, we have 17 – 16 state ministers and one federal minister," said TI board member Anke Martiny. ""We also have about 250 separate statutory insurance companies, while in other countries the health system is handled much more centrally. It goes without saying that under such circumstances the power of the functionaries has got rather out of control."
According to Transparency International, the behavior of the pharmaceutical industry is particularly critical.
TI pharmacologist Peter Schönhofer says the industry has adapted its products to marketing possibilities and not the other way round:
How much do doctors know?
"Since 1990, about 460 new substances have come onto the market, but only seven of them are genuine innovations," he said. "Another 25 offered improvements. Pseudo-innovations are produced with the sole purpose of raising the price."
Schönhofer also pointed out that none of the other 460 products improved patients' chances of being cured and would only be marketed by employing corruption strategies. These included inviting doctors to further education seminars, which Schönhofer dismissed as a means to advertise a company's products.
That's not all. "Faking medical research has also become considerably more common," added Schönhofer.
Ties between companies and clients need to be made public
Calling for more effective measures to combat corruption, Transparency International said insurance companies, organizations of doctors who treat non-privately insured patients and medical associations should work more professionally.
It also proposed treating leading functionaries in professional corporations as office-bearers who would face punishment in cases of corruption, making ties between sponsors and experts more transparent, and finally, introducing forgery-proof pharmaceutical packaging to curb illegal trading in medicines.