research topic about corruption

How common is corruption? What impact does it have? And what can be done to reduce it?

By: Esteban Ortiz-Ospina and Max Roser

This page was first published in October 2016 and last revised in January 2024.

This topic page presents research and data on corruption — an important problem imposing political, economic, and environmental costs on societies worldwide.

Corruption involves many different aspects, and it is therefore hard to give a precise and comprehensive definition. However, at the core of most definitions of corruption is the idea that a corrupt act implies the abuse of entrusted power for private gain. Classic examples include bribery , clientelism , and embezzlement . Other, often more subtle and even legal examples of corruption include lobbying and patronage .

While long-run data on corruption is very limited, historical examples suggest that corruption has been a persistent feature of human societies over time and space. Two examples are the sale of parliamentary seats in ‘rotten boroughs’ in England before the Reform Act of 1832, and ‘machine politics’ in the US at the turn of the 19th century. 1

The unethical and often illegal nature of corruption makes measurement particularly complicated. Corruption data usually comes from direct observation (e.g. law enforcement records and audit reports), or perception surveys (e.g. public opinion surveys or expert assessments). In this topic page, we discuss data from both sources and discuss their underlying limitations.

As we show, although precise corruption measurement is difficult, there is a clear correlation between perception and behavior ; so available corruption data provides valuable information that, when interpreted carefully, can tell us something important about our world and contribute to developing effective policies.

For example, the data from perception surveys suggests that corruption correlates with human development, and several studies exploiting rich data from law enforcement records have shown that education is an important element explaining this relationship. Specifically, the data supports the idea that voters with more education tend to be more willing and able to monitor public employees and take action when these employees violate the law.

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See all interactive charts on corruption ↓

Empirical View

Evidence from surveys, where is perceived corruption high.

The non-governmental organization Transparency International (TI) estimates a 'Corruption Perception Index', which is arguably the most widely used indicator of corruption worldwide and shown in the map here.

The index scores countries on a scale of 0-100, where 0 means that a country is perceived as highly corrupt and 100 means that a country is perceived as very clean. The indicator is representative of experts’ opinions, as it is constructed by taking the averages of various standardized expert surveys, including those from the Bertelsmann Foundation, the World Economic Forum, the World Bank, and many others. 2

While TI's Corruption Perception Index has been estimated since 1995, the methodology has been changed recurrently up until 2012. As such, the data presented here starts in 2012. You can explore country-specific trends by clicking on the 'Chart' tab and then clicking 'Edit countries and regions' in the upper-right corner.

As we can see, countries that have received high scores (and thus are perceived as the ‘cleanest’) are Denmark, New Zealand, Finland, Singapore, and Sweden. At the other extreme, countries that have received low scores (and the highest perceived corruption) include Somalia, Syria, South Sudan, Yemen, and North Korea.

We can see that scores are fairly stable, and drastic changes in ranking are not common.

Where do people perceive corruption to be a major problem?

The data visualized previously relied on the perception of experts (e.g. business people, country analysts, etc.). Now we analyze data representing the perceptions of everyday people confronting corruption around the world.

The Global Corruption Barometer, also produced by Transparency International, surveys individuals worldwide, asking them about their opinions and experiences regarding corruption. The visualization shows the average national perception of corruption, as rated on a scale of 1 to 5 by respondents who were asked: "To what extent do you think that corruption is a problem in the public sector in this country?".

The map shows that everyday people's perception of the problems associated with corruption correlates with expert opinion (seen in the previous section) about how much corruption there is. However, the correlation is far from perfect, indicating that these two indicators present us with different perspectives.

The fact that the perceptions of experts and other citizens diverge is at the heart of perception measures: experts and non-experts have different reference points against which they assess whether corruption is a problem. Indeed, in countries where the public finds corruption extremely intolerable, the perception of its implications may be extreme, even if baseline corruption levels are lower than in other countries.

Corruption is sometimes hard to tackle precisely because it is common, so people perceive it to be a natural economic transaction: it is easier to act corruptly if many other individuals think it is acceptable to be corrupt.

Which institutions do people perceive as most corrupt?

The Global Corruption Barometer produced by Transparency International asks individuals across countries whether they perceive specific institutions as corrupt. The chart presents, by institution, the global aggregate figures. The numbers correspond to the percentage of survey respondents who think that "Most" or "All" of each institution is corrupt in their home country.

The estimates show that, globally, people perceive domestic police forces and the legislature to be particularly corrupt.

Perceived corruption of political parties

The next visualization digs deeper into corruption perceptions, specifically in the context of politics. It shows the percentage of survey respondents in each country who think political parties are "corrupt or extremely corrupt".

As we can see, there is substantial cross-country heterogeneity, and patterns again show differences concerning general corruption perceptions.

Where are people more likely to pay bribes to access public services?

Bribery is one of the most common forms of corruption. The following visualization shows the share of people who report having paid a bribe to access public services in the 12 months prior to the survey. The data comes from the Global Corruption Barometer, produced by Transparency International, and the public services in question are: education; judiciary; medical and health; police; registry and permit services; utilities; tax revenue and/or customs; and land services.

Once again, cross-country heterogeneity stands out. In some countries, a majority of survey respondents report having paid a bribe within the past year. In other countries, only a few percent of the respondents report having paid a bribe in the same time window.

While these results show that in some countries the paying of bribes is very rare, we have to consider that these estimates come from ordinary people interacting locally. As we show below , many countries where normal people do not frequently pay bribes, have far-from-perfect international records regarding international private-sector bribery.

How does petty corruption affect people with low incomes?

For those without money and connections, paying even small bribes to access basic public services such as public health or police can have significant consequences. Petty corruption in the form of bribes often acts as a regressive tax, since the burden typically falls disproportionately on people with low incomes.

This visualization, taken from the World Development Report (2011) , uses data from Ecuador to estimate the cost of bribes paid relative to income. More specifically, the right panel shows the self-reported cost of bribes paid by households (as a share of household income), while the left panel shows the self-reported cost of bribes paid by firms (as a share of firm revenue). The presented estimates are in percent and come from a 1999 survey of 1,164 enterprises and another of 1,800 households.

As we can see from this example, petty corruption seems to act as a regressive tax: poor households tend to pay a larger share of their income on bribes to access public services.

Where are firms more likely to be asked for bribes?

Bribes are also requested from and paid by firms in the private sector. The following visualization shows, for a selection of countries, the percentage of firms experiencing at least one bribe payment request during six transactions dealing with utility access, permits, licenses, and taxes. The data comes from the World Bank's Enterprise Surveys.

According to this source, a large majority of firms report being asked for bribes in some countries, while in others, it is almost no firm.

Which countries are perceived by business executives as more likely to 'export corruption'?

The previous visualization provides evidence of the frequency with which firms are requested to pay bribes — the demand side of bribing. Here, we explore the supply side, using data from Transparency International's 'Bribe Payers Survey.'

The survey asks senior business executives around the world for their perceptions of the likelihood of companies from countries they have business dealings with engaging in bribery when doing business in the executive’s own country.

Based on the answers, Transparency International estimates the average of the scores given by all the respondents who rated each country (on a scale from 0 to 10, where 0 means firms always pay bribes in that country, and 10 means they never do). This gives the so-called 'Bribe Payers Index'. 3

The map shows the results.

Evidence from law enforcement and regulation

Many firms from high-income countries engage in bribery across the world.

The Foreign Corrupt Practices Act (FCPA) in the US was passed in 1977 to make the bribery of foreign officials illegal. The visualization from the Mintz Group shows the global distribution of all penalties in US Government FCPA cases since 1977. Darker colors in the map denote larger penalties for activities in the corresponding country. Total penalties are measured in US dollars, so this chart combines the number and magnitude of cases. In Argentina, for example, the dark color is mainly due to one very large case involving Siemens (450 Million USD penalty, in 2008). An interactive version of this map, including details regarding specific penalties, is available from the Mintz Group at http://www.fcpamap.com .

These official records show that US firms have paid bribes in 80 countries since 1977—including in many OECD countries.

Diplomats from countries with high corruption perception tend to break traffic rules abroad more often

Corruption is commonly defined as "the abuse of entrusted power for private gain." Here, we provide evidence of how diplomats in New York City abused their diplomatic status to break traffic rules by parking illegally.

UN mission personnel and their families benefit from diplomatic immunity. In New York City, until November 2002, diplomatic immunity implied that UN mission personnel could park illegally and avoid paying the corresponding fines. The visualization maps the average unpaid annual New York City parking violations per diplomat by the diplomat's country of origin from November 1997 to November 2002. The data comes from Fisman and Miguel (2007) 5 , who in turn obtained information compiled by the New York City Department of Finance.

As we can see from the map, this ‘revealed-preference’ measure of corruption among diplomats correlates positively with the survey-based measures of corruption we have already discussed. Diplomats from countries where corruption perception is low (e.g. Denmark) seem to be generally less likely to break parking rules abroad, even in situations in which there are no legal consequences.

While the correlation is not perfect (e.g. Colombia has a high corruption perception but zero unpaid parking violations in the data) Fisman and Miguel (2007) show that statistically speaking, the positive correlation between corrupt behavior by diplomats 'abroad,' and corruption perception 'at home,' remains after controlling for factors such as national income in the diplomats’ home country, or the diplomats' salaries. This evidence suggests that cultural norms are one of the factors that affect corrupt behavior.

OECD countries are increasingly providing procedures for public officials to report corruption

Corruption is not something that only affects low-income countries—and in fact, many high-income countries have become increasingly aware of this in recent years.

The table details a list of OECD countries and whether they have specific procedures for public officials to report misconduct or suspected corruption.

As we can see, since 2000 many OECD countries have developed formal mechanisms to allow public officials to expose corruption ('whistle-blowing') more easily. Specifically, the table shows that the share of OECD countries that reported having legal whistle-blowing procedures went up from 44.8% in the year 2000 (13 out of 29 countries in the sample) to 79.3% in 2009 (23 out of 29 countries in the sample). Today, many of these countries supplement legal provisions with internal rules (e.g. minimum requirements for whistle-blowing programs).

These recent changes show that legal provisions to fight corruption are relatively new, and high-income countries are still trying to find new policy instruments to deal with corruption.

What is the relationship between corruption and development?

This visualization shows the cross-country relationship between development (as measured by the United Nations Human Development Index ) and corruption (as measured by Transparency International's Corruption Perception Index ).

As we can see, countries that score higher in the Corruption Perception Index (i.e. countries seen as less corrupt) tend also to have better scores in the Human Development Index.

Education and corruption

The relationship in the visualization above is just a correlation: many factors simultaneously drive corruption and development. Education is an important case in point.

The next scatter plot provides evidence of the cross-country relationship between educational attainment and corruption. The horizontal axis measures corruption using Transparency International's Corruption Perception Index , and the vertical axis measures average years of schooling .

As we can see, there is again a strong positive relationship: countries where people are more educated tend to have better scores in the Corruption Perception Index.

Several academic studies have tried to establish the extent to which this relationship is causal. Glaeser and Saks (2006) 7 , for example, show that within the US, states that are better educated tend to be less corrupt—notably, they show that this relationship holds even when using historical factors like Congregationalism in 1890 as a proxy for the current levels of schooling. In other words, they find that historical levels of education predict differences in levels of corruption across States several generations later. This is consistent with other studies that support the theory that voters with more education tend to be more willing and able to monitor public employees and to take action when these employees violate the law.

What is the relationship between corruption and accountability?

One of the most widely accepted mechanisms of controlling corruption is to ensure that those entrusted with power are held responsible for reporting their activities. This is the idea behind so-called 'accountability' measures against corruption. 8

The visualization shows the cross-country relationship between corruption and accountability. Here, corruption is measured as the share of people who admit having paid bribes in the past 12 months (as per the estimates from the Global Corruption Barometer), and accountability is measured by the Accountability Transparency Index developed by Williams (2015). 9 This index is constructed from a number of underlying indicators that provide information about the extent of free media, fiscal transparency, and political constraints.

As we can see, people are less likely to pay bribes in countries with stronger institutions supporting accountability.

Ferraz and Finan (2011) 10 show there is evidence that this relationship is causal. Specifically, they show that electoral accountability causally affects the corruption practices of incumbent politicians in Brazil. There is significantly less corruption in municipalities where mayors can run for reelection, and the positive effect of accountability via reelection is more pronounced among municipalities with less access to information and where the likelihood of judicial punishment is lower.

How effective are top-down audits to reduce corruption?

A common policy prescription to fight corruption is to increase monitoring and punishments. The logic supporting such policies is straightforward: better monitoring and harsher punishments increase the expected cost of acting corruptly, so people rationally choose not to break the rules.

To test the extent to which monitoring and punishments effectively reduce corruption, economists often rely on 'policy experiments,' where they administer these policies to 'treatment groups.' Olken (2007) 11 follows this approach, increasing the probability of central government audits from 4 percent to 100 percent (the 'policy treatment') in the context of Indonesian village road projects.

The study compares the outcomes for villages that received this intervention with those that did not and finds that audits significantly reduced missing expenditures, as measured by discrepancies between official project costs and independent engineers’ estimates. The following visualization summarizes these results. The height of the bars shows the percentage of expenditures that engineers found missing.

As we can see, missing expenditures were much lower in villages where audits were certain.

The study provides further evidence of the extent to which officials in charge of road projects responded to private incentives: it finds that (i) audits were most effective when officials faced elections soon, and (ii) village elites shifted to nepotism (the practice of hiring family members), which is a form of corruption that was harder for audits to detect.

How important is the link between cultural norms and corruption?

A study by Fisman and Miguel (2007) 13 shows that diplomats from countries where corruption perception is low (e.g. Denmark) seem to be generally less likely to break parking rules abroad, even in situations in which there are no legal consequences.

A world map showing the number of parking violations per diplomat across different UN diplomatic delegations in the New York, US, is available here . You can read more about the data in our section on Evidence from law enforcement and regulation above.

Fisman and Miguel (2007) show that the positive correlation between corrupt behavior by diplomats ‘abroad’ and corruption perception ‘at home’ remains after controlling for factors such as national income in the diplomats’ home country or the diplomats’ salaries. This evidence suggests that cultural norms are one of the factors that affect corrupt behavior.

Definitions, Measurement and Data Quality

Corruption involves many different aspects, and it is therefore hard to give a precise and comprehensive definition. However, at the core of most definitions of corruption is the idea that a corrupt act implies the abuse of entrusted power for private gain. Classic examples include bribery , clientelism , and embezzlement . Other, often more subtle – and sometimes even legal – examples of corruption include lobbying and patronage .

Measurement limitations

The unethical and often illegal nature of corruption makes measurement particularly complicated. Corruption data usually comes from direct observation (typically law-enforcement records) or perception surveys (e.g. general-population attitudinal surveys or expert assessments).

The main disadvantage of direct observation is that corruption is difficult to observe, as should be clear from its definition. This means that estimates are likely biased and are not generally suitable for cross-country comparisons since differences in levels may stem from differences in law enforcement rather than actual differences in corruption.

On the other hand, the main disadvantage of measuring the perception of corruption, rather than corrupt behavior directly, is that estimates are susceptible to how survey respondents — both experts and everyday people — form perceptions in the first place. For instance, differences in perceived corruption between countries may stem from differences in how corruption is defined or morally viewed rather than differences in actual behavior.

In any case, despite these limitations, both sources provide valuable information regarding underlying patterns. For example, studies relying on direct observation have been widely used for within-country studies, specifically in contexts where law enforcement is considered to be broadly constant across states or municipalities (see, for example, Glaeser and Saks 2006 14 , and Ferraz and Finan 2011 15 ).

Relationship between sources

This visualization shows the relationship between two different survey-based measures of corruption. In the vertical axis, perception is measured using Transparency International's Corruption Perception Index (lower scores reflect higher perceived corruption). In the horizontal axis, corruption is measured using self-reported bribe paying behavior (estimated as the share of survey respondents who reported having paid a bribe to access public services in the last year).

As we can see from this plot, there is a clear association between both measures: countries where people often report having to pay bribes also tend to score low in the Corruption Perception Index.

The fact that corruption perception does contain information about corrupt behavior has been corroborated by detailed case studies. Olken (2009) 16 , for example, shows that citizens' perception of corruption in infrastructure projects correlates with objective measures of 'missing expenditures', as measured by independent engineers’ estimates in Indonesia.

Interactive charts on corruption

'Rotten boroughs' were constituencies that had a tiny electorate, and could thus be used by a wealthy patron to secure influence; at the turn of the 19th century in immigrant US cities, 'machine politics' involved hierarchical political organizations that provided social services and jobs in exchange for votes. For more information, see: Aidt, T. S. (2003). Economic analysis of corruption: a survey. The Economic Journal, 113(491), F632-F652.

The list of sources that are considered (subject to availability for each country) are:

African Development Bank - Governance Ratings

Bertelsmann Foundation - Sustainable Governance Indicators

Bertelsmann Foundation - Transformation Index

IMD World Competitiveness Yearbook

Political Risk Services - Country Risk Guide

World Bank - Country Performance and Institutional Assessment

World Economic Forum - Executive Opinion Survey

World Justice Project - Rule of Law Index

Economist Intelligence Unit - Country Risk Assessment

Global Insight - Country Risk Ratings

Political and Economic Risk Consultancy - Asian Intelligence

Freedom House - Nations in Transit

Methodological details are available from Transparency International

Copyright© 2016 Mintz Group LLC. All Rights Reserved. The information and graphics contained in this map are copyrighted and may not be distributed, modified, reproduced in whole or in part without the prior written permission of Mintz Group LLC.

Fisman, R., & Miguel, E. (2007). Corruption, norms, and legal enforcement: Evidence from diplomatic parking tickets. Journal of Political economy, 115(6), 1020-1048.

This is Table D3 in OECD Government at a Glance (2009)

Glaeser, E. L., & Saks, R. E. (2006). Corruption in America. Journal of public Economics, 90(6), 1053-1072.

Transparency International defines accountability as "the concept that individuals, agencies and organisations (public, private and civil society) are held responsible for reporting their activities and executing their powers properly."

Williams, A. (2015). A global index of information transparency and accountability. Journal of Comparative Economics, 43(3), 804-824.

Ferraz, C., & Finan, F. (2011). Electoral accountability and corruption: Evidence from the audits of local governments. The American Economic Review, 101(4), 1274-1311.

Olken, Benjamin A. (2007). "Monitoring Corruption: Evidence from a Field Experiment in Indonesia." Journal of Political Economy 115(2): 200-249.

This Policy Briefcase was issued in March 2008, and revised in May 2012. The data comes from Olken, Benjamin A. 2007. "Monitoring Corruption: Evidence from a Field Experiment in Indonesia." Journal of Political Economy 115(2): 200-249.

Fisman, R., & Miguel, E. (2007). Corruption, norms, and legal enforcement: Evidence from diplomatic parking tickets. Journal of Political Economy, 115(6), 1020-1048.

Glaeser, E. L., & Saks, R. E. (2006). Corruption in america. Journal of public Economics, 90(6), 1053-1072.

Olken, B. A. (2009). Corruption perceptions vs. corruption reality. Journal of Public Economics, 93(7), 950-964.

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How the Perception of Corruption Shapes the Willingness to Bribe: Evidence From An Online Experiment

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José Incio, Manuel Seifert, How the Perception of Corruption Shapes the Willingness to Bribe: Evidence From An Online Experiment, International Journal of Public Opinion Research , Volume 36, Issue 3, Autumn 2024, edae035, https://doi.org/10.1093/ijpor/edae035

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Does the perception of corruption shape the willingness to bribe? This study evaluates the socio-psychological determinants of corruption by measuring how different types of messages influence the probability of engaging in corruption for access to public health, social programs, and official documents. This research uses the social norms approach to explore the link among messaging, perception, and behavior. An online experiment was conducted in Peru for two weeks between October and November 2021, using social media (Facebook) to recruit participants ( n  = 2584). The participants were divided into two treatment groups and one control group. Those in the treatment groups received informational displays on (i) the perception of corruption as widespread in the public sector (descriptive norm) or (ii) corruption as morally wrong (injunctive norm). The control group did not receive a message. Exposure to messages on corruption increased the overall probability of engaging in corruption. Unexpectedly, those in the injunctive norm group increased their willingness to bribe. Furthermore, this study also found significant differences in bribing behavior based on the different types of public service, gender, and age.

Corruption is a malaise that exists in all societies around the world. Its negative consequences undermine the rule of law, hinder economic growth, waste public resources, decrease the living standards of its citizens, and foster distrust of the political regime. Anti-corruption programs worldwide have mainly focused on normative and institutional reforms, leaving aside the individual’s behavior and its relationship with systematic corruption ( Fisman & Golden, 2017 ). However, in recent years, anti-corruption efforts have shifted toward an individual-level approach. States and international organizations have implemented policies and anti-corruption messaging to raise individual awareness of the pervasive nature of corruption ( OECD, 2018 ; UNDP, 2017 ). Within these, the UNDP implemented an anti-corruption program to raise awareness of the negative impact of corruption on development ( UNDP, 2017 , p. 21). Meanwhile, growing research has focused on the relationship between perceived corruption and individual behavior ( Cabelkova, & Hanousek, 2004 ; Corbacho, Gingerich, Oliveros, & Ruiz-Vega, 2016 ; Dong, Dulleck, & Torgler, 2012 ; Dupuy, & Neset, 2018 ; Peiffer, 2020 ; Persson, Rothstein, & Teorell, 2013 ; Rothstein, 2011 ; Tavits, 2008 ).

The social norms approach offers a framework to understand how the perception of corruption shapes the behavior. Social norms are unwritten rules of behavior that provide the individual with cues regarding what is an approved/disapproved behavior (injunctive norm) or what is commonly done in a given situation (descriptive norm). This approach builds upon how an individuals’ perception of social norms will guide their behavior ( Tankard, & Paluck, 2016 ). Recent works have used social norms and perceived corruption to understand the individual’s probability of bribing ( Cheeseman, & Peiffer, 2022 ; Corbacho, Gingerich, Oliveros, & Ruiz-Vega, 2016 ; Köbis, Troost, Brandt, & Soraperra, 2022 ). These studies showed that individuals primed with corruption information affected their probability of offering/soliciting a bribe. Thus, social norms provide the analytical tools to assess how perceived corruption can shape an individual’s behavior to engage in corruption.

This paper makes three fundamental contributions. First, it uses the social norms approach to test the differentiated impact of descriptive and injunctive messages on an individual’s probability of offering bribes. This differentiation allows for a more nuanced analysis of the effects of specific social norms on individual behavior. Second, this study tested the effect of the same descriptive/injunctive norm message on different types of public services (public health, social programs, official documents). Most studies have explored how different social norms affect corrupt behavior, showing that no single monolithic corruption norm exists in a society ( Köbis et al., 2020 ). However, in this paper, we decided to explore the mechanisms in another direction. Instead of testing how different social norms create normative pressure over the individual that engages in corruption, we tested if the exact same social norm (descriptive/injunctive) has a different effect on the probability of offering a bribe depending on the public service. This sheds new light on the strength of social norms and its interplay with the individual’s behavior. Third, this study is based in Peru, where corruption is widespread. As a low- and middle-income country, it expands the literature on corruption information and the types of individuals who are more/less prone to engaging in corruption.

The perception of corruption can affect the individual’s behavior in different realms of their daily life. Studies have addressed how corruption information shapes the support of the political system ( Hawkins, Brook, Hansen, Hoopes, & Rawson, 2015 ; Morris, 2008 ), trust in political institutions ( Beesley, & Hawkins, 2022 ), electoral turnout ( Chong, De La O, Karlan, & Wantchekon, 2015 ), electoral performance ( Ferraz, & Finan, 2008 ; Vera, 2020 ; Winters, & Weitz-Shapiro, 2013 ), the willingness to fight corruption ( Peiffer, 2020 ; Peiffer, & Alvarez, 2016 ), and the willingness to engage in corruption ( Accinelli, & Sanchez Carrera, 2012 ; Cheeseman, & Peiffer, 2022 ; Corbacho, Gingerich, Oliveros, & Ruiz-Vega, 2016 ; Tavits, 2010 ).

Individuals who perceive corruption as widespread are more inclined to engage in corruption. In an environment where corruption permeates all levels of society, where it is the “rules of the game,” people adopt the imitative behavior of their peers and are more prone to be corrupt ( Accinelli, & Sanchez Carrera, 2012 ). This perception of corruption’s pervasiveness and acceptability becomes an acceptable mode for exchange and influences bribe-giving ( Tavits, 2010 ). Furthermore, the awareness of corruption as widespread can create a “corruption fatigue” that triggers a sense of resignation ( Peiffer, 2020 ). Using the Global Corruption Barometer, the work from Peiffer and Alvarez (2016) showed that the willingness to fight corruption is hampered when the perception of corruption is widespread in a non-OECD setting.

This recognition of the social aspect of corruption has underpinned the increase in popularity over the last decade of studies using a social norms framework to study the persistence of corruption ( Köbis et al., 2020 ). Social norms theory offers an analytical framework for empirical research studies to assess the dynamics that reinforce corrupt practices in a given society and can provide policy recommendations to fight corruption.

Social norms are unwritten rules of conduct that guide the individual’s behavior ( Chung & Rimal, 2016 ; Coleman, 1994 ; Tankard, & Paluck, 2016 ). These are shared by members of the same group or society ( Hechter & Opp, 2001 ). Social norms are socially negotiated and understood through social interactions ( Chung & Rimal, 2016 ). How the individual perceives its surroundings and the social expectations under these conditions are embedded in this interaction. This approach posits that behavior is influenced by the perception of how our peers think and act ( Berkowitz, 1997 ). The reference network or the in-group the individual considers to be a part of plays a role when following a norm. The social norm, as a rule of behavior, will be followed by an individual if they believe most people in their reference network are following it and believe most people ought to ( Bicchieri, & Dimant, 2022 ). Whether seeking approval or avoiding a sanction, the individual’s behavior is shaped by its perception of a social norm.

The social norms approach allows us to understand the determinants of an individual’s behavior and it is built upon two types of norms: injunctive norms and descriptive norms. The former refers to the perception of which behaviors are commonly approved or disapproved, while the latter involves the perceptions of what people actually do ( Cialdini, 2003 ; Schultz et al., 2007 ). Injunctive norms are related to the moral realm and beliefs, and assist the individual in determining what is acceptable or unacceptable social behavior. These norms convey what ought to be done in each situation and to pressures individuals perceive to conform ( Lapinski, & Rimal, 2005 ). It refers to the perceived acceptability of a given behavior ( Bicchieri, & Mercier, 2014 ). They tend to imply moral judgement since actions viewed unfavorably carry social sanctions ( Chung & Rimal, 2016 ). Descriptive norms are based on observations around the individual where the perception is constructed based on the representation of how people behave and on what is commonly done ( Berkowitz, 2004 ; Cialdini, 2003 ; Schultz et al., 2007 ). They are a decisional shortcut that provides the individual with information on what other people actually do ( Bicchieri, & Mercier, 2014 ). It pertains to an individual’s perception of the prevalence of the behavior in question ( Lapinski, & Rimal, 2005 ). A key distinction between these two norms is that descriptive norms typically do not involve social repercussions for noncompliance ( Lapinski, & Rimal, 2005 ). Thus, whereas descriptive norms refer to the perceptions of what is commonly done in a given situation, injunctive norms refer to what other people approve or disapprove of.

There are numerous studies using social norms framework to assess its relationship with corruption. Some studies have focused on how different type of social norms can create normative pressure over individuals who then sustain corrupt practices. In their work, Jackson & Köbis (2018) highlight four different types of normative pressure that arise from society (sociability norms, kinship norms) and from within organizations (vertical and horizontal pressures). These social norms have an influence over the individual who, despite knowing that corruption is illegal, they still engage in it due to these pressures. Moreover, Hoffmann & Patel (2017) found that these pressures were present within the law enforcement community. In the survey they did in Nigeria, they discovered that senior law enforcement officers expected low-ranking officers to solicit bribes, whilst low-ranking officers expected senior officials to be involved in corruption.

Much attention has been given to quasi-experimental designs and corruption games to assess the interaction between social norms and corruption. These experimental approaches have shown there to be an effect on behavioral change by focusing the participants’ attention on tailored descriptive or injunctive norms ( Abbink, Freidin, Gangadharan, & Moro, 2018 ; Banerjee, Baul, & Rosenblat, 2016 ; Bicchieri, & Dimant, 2022 ; Borsari, & Carey, 2003 ; Cheeseman, & Peiffer, 2022 ; Corbacho, Gingerich, Oliveros, & Ruiz-Vega, 2016 ; Dorrough, Köbis, Irlenbusch, Shalvi, & Glöckner, 2023 ; Köbis, Van Prooijen, Righetti, & Van Lange, 2015 ; Manning, 2009 ). In their study Köbis, Van Prooijen, Righetti, & Van Lange, (2015) using corruption games they found that descriptive norms were highly correlated with corrupt behavior. The perception of corruption as widespread influenced the decision to engage in corrupt behavior ( Köbis, Van Prooijen, Righetti, & Van Lange, 2015 ). Moreover, Abbink, Freidin, Gangadharan, & Moro (2018) used a sequential bribery game to assess the effect of descriptive social norms and the possibility of sanctions on bribe offers. They found that participants were more willing to bribe when they thought the public official came from a mostly corrupt group ( Abbink, Freidin, Gangadharan, & Moro, 2018 ). The descriptive social norm (perception of corruption as widespread) had an effect on increasing the bribe offers. This can also be seen outside national borders. People tend to disproportionately offer more bribes if they believe the other person comes from a country with a high reputation for foreign bribes ( Dorrough, Köbis, Irlenbusch, Shalvi, & Glöckner, 2023 ).

In their study, Corbacho, Gingerich, Oliveros, & Ruiz-Vega, (2016) show that the perception of the level of corruption shapes the individual’s behavior to engage in corruption. In a survey experiment in Costa Rica, the results demonstrated that the participants exposed to information on how corruption has increased were more willing to bribe. These results are aligned with the findings of Cheeseman and Peiffer (2022) from Nigeria. They showed that individuals who consider corruption to be widespread across society were more inclined to engage in corruption despite the type of message received. On the other hand, descriptive norms that frame corruption as a less common phenomenon can reduce corrupt behavior. The work of Köbis, Troost, Brandt, & Soraperra (2022) in South Africa showed that descriptive norm messages put up as posters with messages saying that “less and less people in KwaZulu-Natal pay bribes” reduced the perception of corruption and decreased the willingness to accept bribes and offer bribes.

Now, using the social norms framework, we tested whether an individual primed with an injunctive norm or descriptive norm messages will shape the probability of bribing. Moreover, we tested if the descriptive/injunctive norm will have the same level of strength over the individual depending on the public service. We hypothesized that the descriptive message increases the willingness to engage in corruption as it increases the awareness of corruption as being widespread, whilst the injunctive norm reduces the probability of bribery since there is a higher moral cost to engaging in corruption.

People are more likely to commit a crime when the crime is widespread in their community ( Kahan, 1997 ). The “broken window” theory suggests that unrepaired windows send a signal that no one cares, and breaking more windows is permitted ( Kelling & Wilson, 1982 ). Building upon this, Keizer et al. (2008)  showed through a series of field experiments that the signs of inappropriate behavior (e.g., graffiti, broken windows) lead to other inappropriate behaviors (e.g., littering, stealing). Here, descriptive norms (where people observed inappropriate behaviors) influenced individuals to violate other norms and spread disorder ( Keizer et al., 2008 ). Now, if people believe that corruption is widespread, they are more likely to behave in a corrupt manner ( Accinelli, & Sanchez Carrera, 2012 ; Cheeseman, & Peiffer, 2022 ; Persson, Rothstein, & Teorell, 2013 ). The probability of bribing increases when the perception of corruption increases ( Corbacho, Gingerich, Oliveros, & Ruiz-Vega, 2016 ), and when more people perceive an organization as corrupt ( Cabelkova, & Hanousek, 2004 ). However, the opposite is also true. In Köbis, Troost, Brandt, & Soraperra (2022) study in South Africa, posters displaying information on the decreased level of bribery (descriptive norms) showed a decrease in the levels of bribery in the bribery game.

Social norms are well-suited to addressing the collective action problem of corruption ( Köbis, Troost, Brandt, & Soraperra, 2022 ). Within this scenario, descriptive norms bring the individual’s attention to their surroundings to determine what is acceptable behavior. These interdependent behaviors are conditional on the empirical expectations of what others do ( Bicchieri, & Dimant, 2022 ). This approach allowed us to address the combination of the social environment and individual factors. Therefore, H1 posits that the increased awareness of corruption in the public sector (descriptive norm message) increases the willingness of the individual to bribe. By highlighting that corruption is widespread across the public sector, the social expectation of engaging in corruption is aligned with what is commonly done when dealing with the public sector. However, even within this expectation, we want to assess whether the descriptive norm has the same effect for all three public services. If the message has the same effect, we expect that engagement in corruption to be similar for all public services. Suppose the individual is more prone to engage in corruption for one service over the other. In that case, this suggests that the salience of the norm shapes the individual behavior, but its strength has a limit in its influence. This introduces a degree of influence within social norms.

Hypothesis 1: If the perception of corruption in the public sector increases, the participants are more likely to pay a bribe to access public health care, be registered on a social program, and speed up the process to get a document from a state institution.

On the other hand, individuals also shape their behavior based on injunctive norms. Here the individual reflects on what ought to be done and acts according to what they consider good or bad ( Akers, 2009 ). If corruption is considered wrong, a person is less likely to engage in it ( Tavits, 2008 ). Morals play a role since guilt and shame can influence compliance behavior ( Dong, Dulleck, & Torgler, 2012 ). The greater the cost of doing something immoral in our consciousness, the less we will engage in immoral activity ( Rabin, 1994 ). These sentiments are intertwined with social norms and the cost of breaking them. The higher the moral cost of engaging in corruption, the lower the propensity of individuals to break this social norm ( Elster, 1989 ). Moreover, the adherence to norms against corruption and other illicit behaviors is more significant in women than men ( Sani, & Guglielmi, 2022 ). This is also picked up by Hoffmann & Patel, (2017) where they found that six out of 10 people though it was unlikely that women would engage in corruption, but if they do, they are sanctioned more harshly than men.

Injunctive norms focus their attention on the belief and moral standing of the individual and refer to the norms of what is right or wrong, and what ought to be. It sheds light on which actions most people approve or disapprove of. Exposure to an injunctive norm should reinforce the moral cost of breaking that norm and reduce the willingness to engage in immoral activity. Thus, H2 states that if an individual’s perception of corruption as morally wrong is reinforced, it should reduce their probability to bribe. As with H1, we also wanted to assess the strength of the injunctive norm could vary depending on the public services. As shown by Hoffmann & Patel (2017) survey, participants considered giving an unofficial payment to a nurse less objectionable than to a law enforcement agent. This means that people assess the appropriateness of bribing (injunctive norm), based on the context.

Hypothesis 2: If the perception of corruption as morally wrong increases, the participants are less likely to pay a bribe to access public health care, be registered on a social program, and speed up the process to get a document from a state institution.

Both H1 and H2 highlight the fact that citizens interact with multiple public services. The state provides multiple services to its population and that the population interacts with these at different frequencies ( Ansell, & Lindvall, 2020 ; Bland, Brinkerhoff, Romero, Wetterberg, & Wibbels, 2023 ; Centeno et al. , 2017 ). This multiplicity is reflected in the choices given to the participants and we explicitly chose different dimensions from dealing with red tape to improving well-being and quality of life. The value given to each public service will vary depending on the needs and context of each individual. A parent with a seriously ill child might value her child’s access to public health over public education, while a parent with a healthy child might value their access to public education more. Thus, we decided to test this variability by focusing on access to public health, registration on a social program, and expediting a bureaucratic document.

Dealing with bureaucratic procedures and government transactions can be a tedious process. The red tape can slow down investments, exclude people already worse off, waste the time of ordinary citizens, and decrease productive hours, among others. These issues are present in Latin America but are especially acute in Peru. According to a BID report, Peru is the second-ranked country in Latin America where a citizen needs more hours to complete a government transaction and requires more interactions with government offices for a transaction to be completed ( Roseth, & Reyes, 2018 ). Yamada Fukusaki and Montero de la Piedra (2011) , showed that Peruvian citizens require up to ten interactions with government institutions to complete a transaction. This situation incentivizes the process to expedite through whatever means are at hand for the citizen, including bribing the official. Thus, we considered including expediting a bureaucratic document as it is at the core of Peruvian interactions with government institutions.

Social programs target vulnerable populations and their aim is to improve their quality of life. Through these programs, the targeted population can be better prepared to deal with the risks associated with their vulnerability, improving their capabilities and access to public services. In Peru, almost 20% of its population is enrolled in a social program. The benefits of being enrolled in a social program make it attractive and thus, we consider including it as one of the public services. Additionally, the provision of public health has become a core service provided by the modern state ( Ansell, & Lindvall, 2020 ). Although it is one of its core functions, in Peru, the expenditure on public health is among the lowest in Latin America, as is the availability of hospital beds ( MINSA, 2019 ). Access to public health has become critical, and with this low resource setting of public health in Peru we considered that this was a good service to be tested.

Using these hypotheses, our research contributes to the field by understanding the causal relationship between corruption perception and engagement in corruption. This research tests the different impacts of descriptive and injunctive norm messages on individual behavior. Furthermore, we divide the individual’s disposition to engage in corruption according to a specific public service (public health, social programs, or bureaucratic documents). This will shed light on the fact that the strength of a social norm (descriptive/injunctive) can vary depending on the public service over which it exerts its influence. Previous studies have shown that the willingness to bribe can differ depending on the amount of the bribe ( Banerjee, Baul, & Rosenblat, 2016 ), participant’s background ( Abbink, Freidin, Gangadharan, & Moro, 2018 ; Dorrough, Köbis, Irlenbusch, Shalvi, & Glöckner, 2023 ), context ( Hoffmann, & Patel, 2017 ) or perceived descriptive norm ( Cheeseman, & Peiffer, 2022 ; Corbacho, Gingerich, Oliveros, & Ruiz-Vega, 2016 ; Köbis, Troost, Brandt, & Soraperra, 2022 ). However, this study goes one step further by assessing the effect of the same social norm of perceived corruption over three different public services. This allowed us to disentangle the causal process from the perception of corruption to behavior, and how the social normative forces themselves are subject to a degree of influence over the individual’s behavior.

Peruvian Context

Peruvian history has been marked by multiple manifestations and cycles of corruption ( Guardado, 2018 ; Quiroz, 2014 ). Since its return to democracy in 2000, all Peruvian presidents have been charged and prosecuted for corruption. It is one of the main problems and is perceived as worsening yearly. Most Peruvians believe that corruption is widespread and that more than half of all politicians are corrupt ( Corporación Latinobarómetro, 2021 ). Even though the popular Peruvian saying “roba, pero hace obra” (steals, but builds infrastructure) persists as a tolerance mechanism toward corrupt leaders, most agree that it is possible to eradicate corruption from politics.

One of the complexities encountered in the fight against corruption is the understanding of how it is perceived and how this perception shapes citizen behavior. Peruvians view corruption as a widespread negative and prejudicial phenomenon, distinguishing between high-level and low-level corruption (grand vs. petty corruption). As Huber (2008) points out, corruption in low- and middle-income countries encompasses a broader spectrum that extends beyond the conventional definition of corruption as “the abuse of public office for private gains” ( World Bank, 1997 ). This normative and institutional view overlooks the concept of corruption as a social practice ingrained in moral codes and informal interaction systems ( Huber, 2008 , p. 107). The normative/institutional view assumes a clear division between the state and society, which can become blurred in developing countries like Peru where a rational Weberian political development pathway has not been established. The use of one’s influence and political position to enrich oneself through corruption is not acceptable. However, this gray area fosters an environment where it becomes “acceptable” to secure a job from a relative who is the mayor or use one’s network to be hired as a teacher in a public school, among other scenarios ( Huber, 2008 ).

Now, a few studies have worked on how corruption information shapes the behavior of Peruvian citizens. These have focused on how corruption information impacts trust in political institutions ( Beesley & Hawkins, 2022 ; Hawkins, Brook, Hansen, Hoopes, & Rawson, 2015 ) or electoral preferences ( Vera, 2020 ). In their study, Beesley and Hawkins (2022) , differentiated the impact of high- or low-level corruption information according to institutional trust. They found that petty corruption information reduces individual-level trust more consistently in political institutions than grand corruption information ( Beesley & Hawkins, 2022 ). When citizens receive this type of information, it undermines the belief that political institutions function for the public good.

On the other hand, Vera (2020) showed that the participants are more lenient towards corrupt politicians who are competent in providing public services. These findings are aligned with the popular saying “ roba, pero hace obra ,” even though in a widespread corruption environment, most participants are less permissive with corrupt officials. Nonetheless, Vera’s study focuses on a voter’s tolerance towards the candidate and relates to how corruption information shapes electoral behavior rather than the individual’s engagement in corruption itself.

This research builds upon previous studies focused on Peru by understanding how corruption information shapes citizens’ behavior. However, it focuses on the probability of engaging in corruption rather than on electoral preference or trust in political institutions. Instead of addressing how perceived corruption shapes other realms of the individual’s life, we tested the individual relationship with corruption by testing the participant’s probability of bribing to access public health, social programs, or bureaucratic documents. Thus, we assess how the perception of corruption, via social norms priming, shapes the willingness to bribe.

Experiment Setting

To examine our hypothesis, we employed a survey experiment in Peru, using the social media platform Facebook for participant recruitment. This approach has proven highly effective in prior studies ( Samuels & Zucco, 2013 ). Following the methodology of previous research ( Pierri, Jarquín, De Michele, & Dassen, 2022 ), we engaged “EncuestamePe,” a polling provider specializing in targeted Facebook ad campaigns. This platform enabled us to distribute our survey through their dedicated fan page, encouraging participation by offering a raffle with four prizes of 200 Peruvian soles each (approximately $53 USD). The recruitment period was extended from October 27th to November 11th, 2021.

To prevent self-selection bias, the survey’s promotional advertisement intentionally did not mention its focus on opinions and attitudes toward corruption. The informed consent form at the beginning of the survey fully disclosed the research objectives. After reading the consent form, 59 participants decided to withdraw from the survey. Additionally, 768 participants provided consent but left before encountering the experimental prompts. We conducted an analysis, as described in Supplementary Appendix Table 5 , to compare the group that exited early with the remaining participants and ensure the absence of self-selection bias. The analysis revealed no significant differences in important demographic characteristics between the two groups.

Participants were allocated into two treatment groups and one control group. Our survey was administered using Qualtrics. The treatment groups received informational displays on (i) the perception of corruption being widespread in the public sector (descriptive norm) and (ii) corruption being morally wrong (injunctive norm). The control group did not receive any informational displays. The study’s design was preregistered on the OSF Registries before data collection commenced, with the blind preregistration detailed in Supplementary Appendix Section 1 .

Our preregistered goal was to enlist 3000 respondents, distributing them evenly across the two treatment groups and the control group (1000 each). We managed to gather data from 2548 respondents who received the treatments. Specifically, 853 respondents were exposed to the “descriptive norms” treatment (T1), 832 to the “injunctive norm” treatment (T2), and 863 were in the control group. Consequently, we note the possibility of our analysis being underpowered.

The first treatment (T1) aims to inform the respondents that corruption is a common and widespread problem among public bureaucrats. This arm corresponds to the first hypothesis, where we tried to gather the effect of “descriptive norms.” We showed the first message ( Figure 1 ) to the respondents selected for this treatment. The text in English is “6 of 10 Peruvians think that corruption among public workers is widespread.”

Descriptive norm message.

The second treatment (T2), as shown in Figure 2 , aims to remind the respondents that corruption is not tolerated. This arm measures the effect of the’ injunctive norm’ (H2). The message reads:“ 89.4 (%) of Peruvians believe that corruption is not tolerable.” The respondents in the control group did not receive any messages. We used factual data from a report published by Proetica (the Peruvian Chapter of Transparency International) to construct our treatments, ensuring no subjects were deceived by the information presented.

Injunctive norm message.

Figure 3 shows the distribution of age, sex, education, and PPI (probability poverty index4) across the treatment groups. No significant differences exist in age, education, socio-economic strata, and sex among the treatment groups and the control. These results give us confidence that the randomization process worked.

Participants’ distribution by sex, age, education, and probability poverty index (PPI) for each treatment arm.

The Outcome Variable

Our outcome was the respondents’ probability of engaging in bribery to receive public service. We asked them if they were willing to bribe to receive medical attention, to be included in a social program, and to get faster access to a needed official document.

We employed two strategies to measure our outcomes. The first strategy was to measure the willingness to engage in corruption through an indirect question. This behavior can be considered a sensitive and personal topic and thus can be subject to social desirability bias ( Hoffmann & Musch, 2016 ). To avoid this bias, researchers use the randomized response technique or sensitive survey technique. The idea behind these techniques is that by inserting an element of chance into the indirect question, the respondent’s privacy is fully guaranteed, and they are more inclined to cooperate and eliminate social desirability bias ( Corbacho, Gingerich, Oliveros, & Ruiz-Vega, 2016 ; Lee, 1993 ; Lensvelt-Mulders, Hox, van der Heijden, & Maas, 2005 ). Indirect questioning techniques “may be capable of yielding more valid prevalence estimates by granting respondents full confidentiality of their answers” ( Hoffmann, & Musch, 2016 , p. 1041). Similar to the randomized response technique of Warner (1965) we used a crosswise model that did not require a randomizing device ( Yu, Tian, & Tang, 2008 ), ensuring anonymity related to the sensitive issue.

In the indirect question, we gave three possible behaviors, one of them being a “bribe,” and asked the respondents how many of those were willing to do so to obtain the service (see Figure 4 as an example). The options were shown randomly. Therefore, the outcome variable for each scenario was the probability of giving a bribe, coded as when the respondent chose 1, 2, or 3 actions. In Table 1 , we show the answers’ distribution.

Descriptive statistics—indirect question.

Example of indirect question.

Our second strategy was to measure the participant’s probability of bribing through a “direct question.” We asked the participants if they would pay a bribe to get access to the service (see Figure 5 ). There were three options: “No,” “Yes,” or “Prefer not to respond.” We compare the group that responded “No” against those who responded “Yes” or “Prefer not to respond.” We grouped those two options, assuming that respondents who answered “No” had a clear preference for not bribing and those who had responded “Prefer not to respond” were closer to those who had responded yes ( Table 2 ).

Descriptive statistics—direct question.

Example of direct question.

There is an important variation among the type of services and the percentage of respondents open to engaging in bribery. These differences are more notorious when the direct question is applied. However, in both cases, respondents were more willing to accept that they would be bribed to access a public health service (14%) than to be included in a social program (7%).

Tables 3 and 4 present the impact of treatments on the outcome variable through direct and indirect questions. As per our pre-analysis plan, we created a model of the outcome variable, where we considered treatment as the main independent variable and used the control group as a reference.

Treatment effects—direct question.

+ p < 0.1, * p < 0.05, ** p < 0.01, *** p < 0.001.

With robust standard errors.

Treatment effects—indirect question.

+ p < 0.1, * p < 0.05, ** p < 0.01, *** p < 0.001

According to our analysis using a probability linear model, we found that T1 and T2 have a significant influence on the probability of people bribing for medical attention, as shown in Table 3 . Exposure to T1 increased the chance of bribery by 3.6 percentage points, while exposure to T2 resulted in a 4.3 percentage points increase. However, we did not observe any significant effect on the other two services. When the services are grouped together, T2 shows a significant effect, increasing the chances of bribery by 2.1 percentage points compared to the control group. T1, on the other hand, is not significant at a 95% confidence level (0.069 p -values), and the size effect is smaller at 1.6%.

The results from using the indirect question as the dependent variable are similar to those from the direct question, as shown in Table 4 . T1 significantly influences ( p value = .005) the likelihood of bribing for medical attention. Those who received the “descriptive norms” treatment (T1) showed a 1.9% increase in the probability of bribing for a medical appointment compared to the control group. Similarly, T2’s effects align with those observed with the direct question. However, this effect is not significant at a 95% confidence level, although it is very close with a p -value of .052. When the responses are combined, T1 has a significant effect, increasing the probability by 1.6% percentage points (column 4).

Results from Tables 3 and 4 affirm our first hypothesis while challenging our second. The direction of T2’s effect across all models was unexpected. This discrepancy may stem from salience bias, where vivid experiences or notable stimuli influence decisions ( Kahneman et al., 1982 ; Tiefenbeck et al., 2018 ). Using the term “corruption” in our message could have evoked prior corruption experiences, leading to an unintended backlash. As Bicchieri and Dimant (2022) suggest, publicizing any behavior, good or bad, may lead individuals to perceive it as acceptable (p. 445). The significance of the reference network in shaping perceptions of acceptable behavior is well-documented ( Bicchieri et al., 2018 ). In our case, the reference network extended beyond immediate social circles.

The unexpected findings from our research are particularly intriguing. They suggest that in a context of rampant corruption, paying bribes might be viewed not as undesirable but as a necessary response to the circumstances. This raises questions about the effectiveness of indirect questioning in such contexts, as it may nullify its intended purpose.

It is worth noting that more pronounced results were observed in public health-related questions, particularly after Peru’s second coronavirus disease 2019 (COVID-19) wave. The timing of the survey heightened the relevance of this public service for participants. Importantly, intercepts across all contexts were significant, indicating that the baseline level of “corruption intentions” was not minimal. This suggests that the potential for observing a reduction in corrupt behavior due to the treatments (T1 and T2) was indeed present within our sample. Consequently, the possibility of a “floor effect,” where a further reduction in corruption intentions could not be observed due to already low baseline levels, is mitigated.

Tables 3 and 4 assess treatment effects on the likelihood of bribing, controlling for age, sex, education level, and the poverty probability index (PPI). Education scores 0–9 points, with 9 indicating the highest degree (postgraduate).

Across all models, except social programs, age has a significant negative impact on the likelihood of bribery. However, this effect is minimal, with a 30-year age difference reducing the probability of bribery by 6%–12% percentage points. A noteworthy factor, PPI, indicates that individuals with higher PPI (indicating poverty) are less likely to be bribed for medical services or documents. Analysis of gender shows that women are generally less likely than men to engage in bribery for public services, particularly in healthcare, where the difference ranges from 4% to 2% percentage points.

Exploring treatment’s heterogeneous effects concerning gender, education, and age, we compared F statistics between a base model (treatment and controls) and one incorporating interactions. With five parameters in the base model and six in the interaction model, we compared models with the direct and indirect questions. We did not find any significant differences ( Table 6 in the Supplementary Appendix ).

Likewise, we compared the effects of two treatments, T1 and T2. To rigorously assess whether the effect of T2 significantly differs from that of T1, we utilized a post-estimation comparison method. Specifically, we employed linear models to estimate the probability of engaging in bribery, incorporating both treatments and key covariates such as age, sex, education level, and the probability of poverty. To compare the treatments, we conducted post-estimation tests using generalized linear hypotheses (GLHT) with the Tukey method for adjusting multiple comparisons, allowing for a pairwise comparison between T1 and T2.

The results in Table 7 in the Supplementary Appendix indicate no statistically significant difference between the effects of T1 and T2 across all outcomes analyzed. This uniform lack of significant differences suggests that, within the context of our study, the informational treatments regarding social norms and injunctive norms (T1 and T2, respectively) do not differ materially in their impact on individuals’ likelihood to engage in bribery across the various services considered.

Our results provide insights into how the perception of corruption shapes the willingness to engage in corruption:

The participants primed with corruption information were more likely to pay a bribe, regardless of whether they received a descriptive norm message or an injunctive norm message.

The effect of this treatment varied across public services, proving that engaging in corruption is a selective trait of the individual that can be triggered depending on the context and institution they have to deal with.

It establishes that social norms have a degree of influence where the same norm (descriptive or injunctive) can have a varied effect on an individual’s behavior.

The injunctive norm intervention did not have the intended effect on the probability of a bribe. On the contrary, participants were more inclined to engage in corruption after receiving the message. The actual word corruption in our message might have triggered a salience bias in the respondents in which, instead of focusing on the moral content of the message, it focused on previous vivid experiences of corruption. Previous studies have found an increase in smoking as a result of anti-smoking campaigns ( Earp, Dill, Harris, Ackerman, & Bargh, 2013 ) or a decline in sustainable seafood choices ( Richter, Thøgersen, & Klöckner, 2018 ). Injunctive norms require more self-awareness and cognitive activity to influence a behavior ( Jacobson, Mortensen, & Cialdini, 2011 ), and a light reading of the message might have made prominent the corruption cue and primed the individual towards the unintended direction.

These results speak to the importance of caution when designing anti-corruption campaigns. It underscores the importance of carefully designing anti-corruption campaigns to avoid a backfire effect ( Berinsky, 2017 ; Cheeseman, & Peiffer, 2022 ; Cialdini, 2003 ), and provoking a “corruption fatigue” where individuals get overwhelmed by the ill effects of corruption and reduce their belief in acting against it ( Peiffer, 2020 ). Moreover, the differentiated response based on public services highlights that a one-size-fits-all approach to fighting corruption will certainly fail. This suggests that any anti-corruption policy or campaign must be tailored to the public service sector, where it wants to reduce the level of corruption.

The message that appeals to the descriptive norms shows the strongest effect in the predicted direction. The fact that descriptive norms outperform injunctive norms within social norms was also present in the South African study by Köbis, Troost, Brandt, & Soraperra (2022) , and supports the literature where corruption, when seen as widespread, fosters corrupt behavior ( Accinelli, & Sanchez Carrera, 2012 ; Cabelkova, & Hanousek, 2004 ; Corbacho, Gingerich, Oliveros, & Ruiz-Vega, 2016 ; Kahan, 1997 ; Persson, Rothstein, & Teorell, 2013 ). However, the difference between the work of Köbis, Troost, Brandt, & Soraperra (2022) and our study is that whilst their descriptive message pointed out that corruption was less frequent, ours pointed out corruption as being widespread.

The selection of participants for sensitive topics such as corrupt practices can create a self-selection bias. This study addressed this limitation by ensuring that the Facebook advertisement did not mention any information about corruption. Moreover, there are no significant differences between participants who left the experiment after reviewing the information sheet (mentioning corruption) and those participants who still participated. Moreover, the absence of a baseline on desirable behavior regarding corrupt practices hinders the possibility of accounting for a boomerang effect on participants. This is attenuated by how the messages were written with the aim to reduce participants’ reactance, and thus, reducing the possibility of a boomerang effect.

Context does influence corrupt practices, and the implementation of this survey in the aftermath of COVID-19 in Peru, could explain the higher probability the higher probability to bribe when trying to gain access to public health. Regarding the other two services, bureaucracy and its paperwork can be a Kafkian process, and a lot of bureaucratic documents are required for personal and business activities. Expediting this process in your day-to-day activities might be considered a higher priority than being enrolled in social programs. In fact, to be enrolled in a social program, some bureaucratic documents are required that certify your eligibility.

On the other hand, based on the descriptive statistics, the results show that sex has a consistent and significant effect on the likelihood of bribery regardless of the type of service. Likewise, it significantly moderated the treatment effects. These findings are aligned with the previous evidence that demonstrates that in Peru, women are less likely to be bribed than men ( Baraybar Hidalgo, Guibert, & Muñoz, 2022 ). The effects of age found in this paper are aligned with the research that shows that older people are more risk-averse ( Albert, & Duffy, 2012 ; Deakin, Aitken, Robbins, & Sahakian, 2004 ). These results need further research to obtain a clearer estimate.

The nuanced findings from our study offer valuable insights that transcend Peruvian boundaries, shedding light on the complexity of designing and implementing effective policy interventions against petit corruption. This research illuminates the intricate relationship between individual perceptions of corruption and their willingness to engage in corrupt practices, demonstrating that responses to anti-corruption messages are not uniform but vary according to the public service in question. Importantly, our results reveal that interventions based on social norms—whether descriptive or injunctive—have complex effects on behavior, challenging the notion that a single strategy can be universally applied to combat corruption. Thus, the insights gained from this study are not only relevant to understanding and combating corruption in Peru but also provide a valuable framework for similar cases where corruption is a widespread phenomenon.

The perception of corruption shapes the individual’s probability of engaging in corruption. Our survey experiment showed that the participants primed with corruption information were more prone to paying a bribe to get a medical appointment, enroll in a social program, or expedite a bureaucratic document. Whether the information points out that corruption is widespread or that engaging in corruption is morally wrong, receiving information about corruption augments this probability.

The probability of engaging in corruption varies according to the public service over which the person wants to gain an advantage. Individuals were more prone to paying a bribe for a medical appointment over expediting a bureaucratic document or securing enrollment in a social program. This suggests that the surroundings and context in which the behavior takes place greatly influence the decision-making process. Further research is needed to disentangle why people behave differently when engaging in corruption based on the public service. Is it strictly due to contextual factors, or does the individual have an internal hierarchy regarding which public services are more worth bribing to access than others?

These questions speak to another contribution of this paper on social norms. The experiment shows that social norms have a degree of influence over the individual’s behavior. Even though a specific norm (descriptive or injunctive) shapes the behavior, the influence itself has a gradation of strength over the individual. Social norms can have varying levels of influence on an individual’s behavior. This means that the strength of a social norm can differ and that there are nuances to the effect it has on individuals. Further research could explore these nuances. This paper thus contributes to the literature on social norms by highlighting this phenomenon.

This novel survey experiment shows that corruption is a complex polylithic phenomenon and that its perception affects the individual willingness to bribe differently. It contributes to the understanding of how messages can shape the probability of engaging in corruption and how this probability is itself influenced by the public service over which one wants to gain an advantage. These results illustrate how future public policies and anti-corruption campaigns can have wider positive effects through the use of behavioral approaches.

José Incio holds a PhD in Political Science from the University of Pittsburgh. He is an Assistant Professor at the Department of Social Sciences of the Pontificia Universidad Católica del Perú. His substantive areas of interest are corruption, local bureaucracy, and democratic erosion in Latin America. He specializes in quantitative analysis and the use of computational tools in social science. He is an associate researcher at Instituto de Analítica Social e Inteligencia Estratégica Pulso-PUCP.

Manuel Seifert holds a PhD in Politics from King’s College London (KCL). He is a mixed-method researcher with an interest in areas such as social norms, subnational politics, state capacity, and quality of democracy. He specializes in political behavior. He is currently working in a research project led by KCL using economic and self-regulation interventions to prevent depression and anxiety among adolescents living in poverty.

The data used in this paper was collected by the Anti-Corruption Innovation Lab (ACIL) of UNDP Peru www.acil.pe . We thank them for their initiative and contribution to this research by permitting us to analyze their database.

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Untangling the corruption maze: exploring the complexity of corruption in the health sector

• Margit Sommersguter-Reichmann   ORCID: orcid.org/0000-0002-0501-8416 1 &
• Gerhard Reichmann   ORCID: orcid.org/0000-0003-1280-9192 2  

Health Economics Review volume  14 , Article number:  50 ( 2024 ) Cite this article

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Healthcare corruption poses a significant threat to individuals, institutions, sectors, and states. Combating corruption is paramount for protecting patients, maintaining the healthcare system's integrity, and preserving public trust. As corruption evolves, takes new forms, and adapts to changing socio-political landscapes, understanding its manifestations is critical to developing effective anti-corruption strategies at individual and institutional levels.

The aim was to comprehensively collate the manifestations of different types of corruption in healthcare to illustrate prevailing patterns and trends and to provide policymakers, practitioners, and researchers with practical insights to inform research agendas, regulatory and governance strategies, and accountability measures.

We conducted a narrative review of scientific articles published between 2013 and 2022 using keyword searches in SCOPUS and EBSCO. We utilized the corruption typology proposed by the European Union and Thompson's Institutional Corruption Framework to systematically identify manifestations across different corruption types. The Prisma scheme was employed to document the selection process and ensure reproducibility.

Bribery in medical service provision was the most frequently investigated form of corruption, revealing rather uniform manifestations. Misuse of high-level positions and networks and institutional corruption also received considerable attention, with a wide range of misconduct identified in institutional corruption. Extending the analysis to institutional corruption also deepened the understanding of misconduct in the context of improper marketing relations and highlighted the involvement of various stakeholders, including academia. The pandemic exacerbated the vulnerability of the healthcare sector to procurement corruption. Also, it fostered new types of misconduct related to the misuse of high-level positions and networks and fraud and embezzlement of medical drugs, devices, and services.

Conclusions

The review spotlights criminal actions by individuals and networks and marks a notable shift towards systemic misconduct within specific types of corruption. The findings highlight the necessity of customized anti-corruption strategies throughout the healthcare sector. These insights are crucial for policymakers, practitioners, and researchers in guiding the formulation of legal frameworks at local and global levels, governance strategies, and research priorities.

Introduction

Corruption in its various forms is a persistent problem across countries and industries, including health care. Corruption, however, is contextually manifest. Unique corruption cases in the health sector emerge due to particular characteristics of nations, regional settings, health systems, and the nature of the stakeholders involved. Savedoff, Hussmann [ 30 ] highlight uncertainty, asymmetric information, and numerous interacting stakeholders with diverse and divergent interests as specific characteristics of the health sector that form a breeding ground for corruption.

Scholars [ 33 , 40 ] and organizations [ 4 , 5 , 7 ] have thus put forward diverse classifications to capture the complexity and nuances of corruption in health care to develop effective remedies. Underlying these efforts is the idea that effective countermeasures require a comprehensive understanding of the complexity of corruption, its influencing factors, and nested effects.

Transparency International [ 38 ], an umbrella organization with over 100 national chapters that combat corruption in their home countries, defines corruption as 'the abuse of entrusted power for private gain' [ 39 ]. In 2013, the European Union (EU) released a comprehensive corruption typology covering six categories of (primarily criminal) misconduct tailored to the healthcare sector and its stakeholders [ 4 ]. Conflicts of interest (COI), i.e. circumstances that risk a secondary interest influencing a primary interest unduly [ 34 ], represent drivers in each category. Another strand of corruption research that goes beyond the issues of criminal conduct and COI gained momentum with Thompson's seminal work on institutional corruption (InstCorr), which he derived from the nature of corruption in the US Congress [ 35 ]. InstCorr results from behavior that is a necessary or desirable part of institutional duties that nonetheless undermines its overall purpose. Thompson [ 36 ] contrasts InstCorr with individual corruption, noting that the latter predominantly represents criminal conduct. Lessig [ 18 ] vividly characterizes InstCorr, likening it to a magnet that causes a compass needle to no longer indicate the magnetic north. So far, extensive research on InstCorr has been conducted mainly in the pharmaceutical industry, including the undue influence of pharma on treatment decisions [ 26 ].

The scholarly literature highlights that corruption significantly affects health outcomes such as mortality (or life expectancy) and health status. For instance, Hanf et al. [ 10 ] explored the relationship between under-five mortality rates and Transparency International's Corruption Perception Index across 178 countries. They estimated that corruption indirectly contributes to 140,000 child deaths annually. Similarly, a Turkish study aggregating actual corruption incidences into a country-specific corruption index finds that corruption increases infant mortality rates in the long run [ 3 ]. Other studies link perceived and experienced corruption [ 43 , 31 ] with poorer mental health outcomes. Still, others highlight the exacerbation of disaster-related deaths due to corruption in events like droughts, floods, and earthquakes [ 2 ]. SARS-CoV-2 drew attention to the negative impact of corruption on incidence, mortality [ 15 ], and vaccination rates [ 8 ] during a pandemic, a problem that low-income countries have been struggling with for much longer [ 25 , 32 ].

Grasping the extent of corruption in general or in the health sector, in particular, using cost estimates is challenging in the case of individual corruption because of its hidden nature and InstCorr because of the complex acts with their multiple intertwined effects. The European Commission outlined that corruption costs the European Union (EU) member states between € 179 billion and € 990 billion annually, corresponding to 1.08 to 5.9 percent of its gross domestic product (GDP) [ 6 ]. Another study estimating the cost of healthcare fraud reports an average loss of 6.2% of global healthcare spending (€ 5.65 trillion), thus amounting to € 350 billion in absolute terms [ 9 ]. As the indirect economic, social, and political consequences of individual corruption are challenging to measure and InstCorr has rarely been addressed, the total costs of corruption are likely much higher than its estimates. However, apart from economic losses, corrupt actions impair the public's trust in the state, social cohesion, willingness to abide by the rule of law, and social development.

These negative consequences underscore the urgent need for comprehensive efforts to prevent and combat corruption at all levels. Several countries, such as the United States (US) with the Foreign Corrupt Practices Act and the 2010 Physician Payments Sunshine Act, the United Kingdom (UK) with the 2010 Bribery Act, and Germany with its 2015 Healthcare Corruption Prevention Act, to mention a few, have implemented solid general and health sector-specific anti-corruption laws. For low- and middle-income countries, these laws can serve as models for pushing the enactment of pertinent laws in these countries.

The scholarly literature offers different perspectives on the phenomenon, contributing to a comprehensive understanding of its complexity and involved stakeholders, including providers, patients, private firms, regulatory bodies, and research [ 12 , 13 , 14 , 17 , 19 , 21 , 29 , 40 ] and facilitating the development of effective remedies [ 41 , 16 , 22 , 27 ]. As corruption can involve individual and institutional wrongdoing, implementing context-specific anti-corruption legislation and other regulations and, when necessary, revising institutional frameworks to combat corruption effectively are required. The healthcare sector, however, has given little attention to addressing InstCorr, likely because of the challenges of identifying and mitigating it.

The importance of addressing corruption in the health sector, with its far-reaching negative impact on individuals, communities, and societies, cannot be overstated. As corruption evolves, takes new forms, and adapts to changing socio-political landscapes, understanding its manifestations is critical to developing effective anti-corruption strategies at individual and institutional levels. The need to oversee corrupt activities to combat healthcare corruption effectively motivates the present review.

The aim was thus to comprehensively collate the manifestations of different types of corruption in healthcare and keep abreast of any developments and trends. To systematically identify manifestations across various corruption types, we utilized the EU corruption typology and Thompson's institutional corruption framework [ 4 , 35 ]. We chose the EU and Thompson typologies for specific reasons. The EU typology specifically caters to the healthcare sector rather than country characteristics (such as being a low, middle, or high-income country, [ 42 ]) and, in our opinion, offers a thorough and systematic guide for examining the different types of corruption. We consider the Thompson typology a valuable addition that enhances our understanding of corrupt behavior primarily associated with criminal activity. Table 1 provides an overview of the various types of corruption and the stakeholders involved, as delineated by the two typologies.

The EU typology distinguishes six distinct corruption types, each contingent upon the sector and the involvement of specific stakeholders (patients, providers, industry, regulators, payers, and political parties). These types encompass bribery in medical service delivery (BribMSD), procurement corruption (ProcCorr), improper marketing relations (ImproperMR), misuse of high-level positions and networks (MisuseHPN), undue reimbursement claims (UndueRC), and fraud and embezzlement of medical drugs, devices and services (FraudDDS).

Table  1 highlights exemplary manifestations of each type of corruption, which are the focus of our review. In this study, a manifestation refers to any actual misconduct of individuals, organizations, or entire networks.

BribMSD primarily involves exchanging a financial advantage or non-cash gift between the provider and the patient for privileges or treatment. ProcCorr captures misconduct, such as (pharmaceutical/medical device) industry agents bribing doctors to procure medical drugs, and involves industry, providers, and regulators. ImproperMR can occur between industry, service providers, and regulators, encompassing gifts, sponsorship, and money-spinning consultancy contracts. MisuseHPN can develop among regulators, political parties, industry, and providers, manifesting, among others, as lobbying, favoritism, or trading in influence. UndueRC involves payers and service providers and comes as insurance fraud or more subtle acts, such as upcoding. Service providers engage in FraudDDS by harvesting healthcare funds for private gain [ 4 ].

Thompson [ 35 ] distinguishes individual corruption, prevalent in most corruption types according to the EU typology, from InstCorr based on three crucial elements: the gain for the institution, the advantage for the beneficiary outside the institution, and the interaction between the two. In InstCorr, the gain is a by-product of appropriate service. In individual corruption, the gain is not part of proper action. The second element concerns the advantage granted to the beneficiary outside the institution. Here, Thompson distinguishes between an undeserved advantage, implying individual corruption, and an advantage where the focus lies not on the beneficiary's worthiness but on the manner of bestowal. The third element relates to the connection between the gain and the benefit. While individual corruption often involves quid pro quo motives, InstCorr typically stems from systemic conditions and represents a pattern in regular service delivery.

The rest of the paper comprises four sections. Sect. 2 explains the methodology for this narrative review. Sect. 3 unfolds the results. Sect. 4 discusses the findings, navigates through the implications and limitations of our study and concludes with remarks reaffirming the value of our research.

Materials and methods

We opted for a narrative literature review to identify as many different actual manifestations of corruption as possible across a broad spectrum of research spanning various areas and perspectives. While allowing a comprehensive perspective, considered particularly relevant for a highly complex phenomenon like corruption, a narrative review might suffer from biases due to subjective paper selection and interpretation. To overcome these limitations, we followed a rigorous protocol (see  Literature search , Paper selection and Paper analysis  Sections) for searching, selecting, and analyzing the original papers.

Literature search

We selected the period from 2013 to 2022 to cover a decade and ensure up-to-date coverage of corrupt manifestations. The decision to commence the review in 2013 aligns with the rising scholarly attention towards InstCorr in the health sector.

We initially conducted a primary search for scientific journal articles on corruption in the healthcare sector using SCOPUS, which is known for its extensive collection of peer-reviewed articles across diverse disciplines. Additionally, we performed a supplementary search in EBSCO to ensure thorough identification of relevant articles for the review. The final queries for journal articles published in English that resulted from preceding test queries were (TITLE-ABS-KEY ( corruption) AND ABS (( medical AND health) OR (health AND care) OR healthcare OR (medical AND device*) OR pharma*)) AND PUBYEAR > 2012 AND PUBYEAR < 2023 AND (LIMIT-TO (SRCTYPE, "j")) AND (LIMIT-TO (PUBSTAGE, "final")) AND (LIMIT-TO (LANGUAGE, "English")) for SCOPUS and (TI corruption OR AB corruption OR SU corruption) AND (AB ( medical AND care) OR AB ( health AND care) OR AB ( medical AND device*) OR pharma*)) for EBSCO.

Paper selection

We used the Prisma scheme to document the selection of relevant papers [ 24 ] and ensure reproducibility (Fig.  1 ). The keyword search returned 937 records. After removing duplicates and evident short contributions (e.g. comments, editorials, etc.) based on the titles and page numbers, we screened the abstracts of the remaining 762 records, excluding an additional 84 ineligible contributions. We could not retrieve six articles from the remaining 678 papers, leading us to assess the eligibility of 672 documents.

We included only articles addressing actual manifestations of at least one of the seven corruption types. The exclusions encompassed articles that did not discuss corruption manifestations in the health sector ('Unrelated'), focused solely on corruption indices ('Index use only'), were review papers ('Review'), and were not in English despite our query excluding non-English language publications ('Not in English').

While the focus on the health sector explains the exclusion of corruption studies outside the health sector ('Unrelated'), we justify excluding index-use papers and reviews as follows. Index-use articles do not contribute to our research question, enhancing our understanding of how corruption manifests and evolves in the health sector. We did not consider prior reviews as they had a different scope or lacked up-to-date information. Moreover, we aimed to synthesize the literature independently to offer a fresh perspective on the dynamics of the manifestations of corruption.

Regarding InstCorr, we included papers that explicitly refer to the InstCorrr framework and those investigating institutional settings (without referencing InstCorr explicitly) that likely promote behavior that systemically compromises an overall purpose. However, categorizing the contributions along the two main typologies and even within the EU typology may occasionally be blurred following the overlap of corrupt activities.

The article selection process passed several stages, with the authors re-evaluating the remaining articles after each exclusion, resulting in 143 papers. A supplementary file contains the references and their identifier (ID). In the following sections, we refer to these references with their ID in curly brackets, i.e. {ID}, to distinguish them from the in-text references in square brackets covered in the reference list at the end of this paper.

Paper analysis

We employed a template to analyze the selected original articles consistently. In addition to the seven possible types of corruption and their associated manifestations, this template covered further contextual information, such as standard bibliometric data, the aims of the article, the research questions, and the involved countries or regions and institutional sectors. We also collected information regarding the research approach (empirical or theoretical), the data sources (survey data, observational data, interview data, literature, newspapers, etc.), the study design (qualitative, quantitative, or mixed methods), and the specific methodological approach (thematic analysis, content analysis, regression analysis, etc.). In addition, we compiled the drivers and effects of corruption and actual and potential remedies, but these are not the topics of this article.

Table 2 displays the frequency of addressing corruption types, with bold diagonal numbers highlighting their occurrences. The total frequencies surpass the number of articles (143), reflecting that each article included in the review may address multiple types of corruption. BribMSD received the most analyses, followed by MisuseHPN and InstCorr. However, InstCorr comprises 12 articles from a 2013 special issue in the Journal of Law, Medicine, and Ethics [ 26 ]. Studies on ProcCorr and ImproperMR each amount to 29 articles, while 25 contributions cover FraudDDS. With 14 contributions, UndueRC received the slightest investigation.

The numbers above the diagonal depict the frequency of studies exploring multiple corruption types. InstCorr frequently coincides with MisuseHPN (13) and ImproperMR (12), highlighting systemic misconduct in ImproperMR and MisuseHPN. Its occurrence in conjunction with other forms of corruption is rare, typically happening only once or twice.

The studies exhibit a significant geographic variation across the corruption types (Table  3 ). BribMSD studies are evenly spread across Africa, Asia, and Europe. The studies on BribMSD target the poorest countries in Africa and Asia [ 42 ], including Congo, Ethiopia, Rwanda, Sierra Leone, Uganda, and Afghanistan. In Europe, Ukraine—a country with a lower middle-income economy—frequently emerges in discussions on bribery. Cross-country analyses and studies without a specific country focus combined show a comparable frequency. However, many articles addressing ProcCorr, ImproperMR, and InstCorr have no country focus. Among those that have, Europe, particularly Ukraine (ProcCorr), Asia (ImproperMR), and North America, particularly the United States (InstCorr), emerge as predominant. Asian studies lead research regarding MisuseHPN, UndueRC, and FraudDDS.

Differences persist in the dominating data utilized across corruption types. BribMSD primarily draws upon (secondary) survey data (e.g. the Eurobarometer survey, life-in-transition survey, and global corruption barometer) and primary data gleaned from interviews and focus group discussions (FGD). Conversely, InstCorr studies heavily rely on secondary data from scholarly literature, case reports, legal documents, and other resources. Except for ImproperMR, where secondary data from relevant literature predominates over primary data from interviews and FGD and survey data, the data sources across the remaining corruption types (ProcCorr, MisuseHPN, UndueRC, FraudDDS) are balanced. Rare data sources comprise Twitter tweets {416}, mystery client visits {711}, tenders {595}, COI disclosure data {565}, social media posts {410}, lobbying disclosure data {453}, social security claims {348} and covert shopping {76}.

Thematic analysis is the primary methodological approach across all corruption types. However, in BribMSD, econometric approaches are nearly as prevalent as thematic analyses, which makes bribery studies unique, as quantitative analyses are far less common in other corruption studies.

Regarding stakeholder involvement, the comparison between the EU typology and the findings from the reviewed articles reveals no significant disparities, only refinements. Thompson's framework allows all stakeholders to engage in InstCorr. Stakeholder involvement in BribMSD, UndueRC, and FraudDDS involves the fewest stakeholders. BribMSD comprises doctors, nurses, and pharmacists on the supply side and patients, including their relatives and friends, on the demand side. UndueRC and FraudDDS and involve providers as perpetrators. However, UndueRC also encompasses patient misbehavior. In both types of corruption, healthcare funders (such as health insurance and governments) are the bribed stakeholders. Conversely, the remaining corruption types (ProcCorr, ImproperMR, MisuseHPN, and InstCorr) encompass a broader spectrum of stakeholders, with industry representatives and researchers playing a significant role, particularly in ImproperMR and InstCorr.

The sectors involved directly correlate with the stakeholders engaged. ImproperMR underscores the pharmaceutical industry's significant influence on healthcare, academia, and regulatory sectors. The observation that improper marketing is not primarily the misconduct of individual perpetrators but rather the misconduct of entire sectors points to systemic dysfunction. Comparing stakeholders and sectors of ImproperMR and InstCorr reinforces this conclusion. MisuseHPN demonstrates a similarly broad scope across sectors, while the remaining corruption studies (BribMSD, ProcCorr, UndueRC, FraudDDS) primarily concentrate on the health sector.

Bribery in medical service delivery

BribMSD often comes in cash payments or gifts in kind (Table  4 ). Numerous studies {e.g. 62, 82, 92, 124, 141, 297, 299, 321, 416, 425, 656, 670, 711, 743} investigate informal payments without detailing them further. Others describe them regarding nature (cash versus non-cash benefits, {e.g. 6, 65, 105, 169, 265, 266, 267, 298, 664, 673, 710}), initiation (whether claimed by the provider or offered by the patient, {e.g. 274, 592}), timing (requested/provided before or after the treatment, {e.g. 123, 762}), and recipients (physician, pharmacist, nurses, other healthcare staff, {e.g. 229, 301, 408, 416, 631}). Patients bribe for shorter waiting times, (high-quality) treatment, or simply gratitude, but also for quite unusual purposes, such as falsifying true causes of death {82}, avoiding hospital staff withholding birth records {147}, and incentivizing discharge from or longer stays in the healthcare facility {631}.

A considerable number of contributions addresses physician absenteeism and dual practice, including redirecting patients from public to private facilities to receive financial benefits {e.g. 5, 14, 147, 311, 431, 490, 516, 552, 639, 640, 714, 721, 758}. However, some studies also discuss nepotism as a specific type of misconduct {e.g. 239, 274, 590}.

Procurement corruption

The papers scrutinize the misbehavior of the pharmaceutical industry, healthcare providers, public officials, and politicians in procuring pharmaceuticals, (sizeable) medical devices, and healthcare facility siting (Table  5 ). The primary form of corruption is usually bribery of stakeholders involved in the procurement process {e.g. 496, 603, 696}. Frequently, the industry acts as the bribing party, targeting public officials and members of tender committees. However, depending on the circumstances, bribery may also originate from other parties, such as state institutions, and may be aimed at the industry {82}. The industry pays bribes to influence tender processes, secure (public) procurement contracts, obtain licenses for constructing healthcare facilities, expedite contract procedures, win tenders, get drug and device registration, and manage customs clearance.

Stakeholder collusion manifests as bid rigging {e.g. 82, 141, 216, 431, 595, 639, 696} (to set inflated prices) and establishment of satellite companies (to obscure tender participation and distort competition). When public authorities participate, ProcCorr manifests as an abuse of public office. Further manifestations encompass price manipulation, including overpricing {179, 216} and falsifying reference prices {446, 538, 603}, contract underperformance {179, 431, 639}, eventually due to awarding contracts to shell companies or inexperienced providers with ties to high-level officials {617}, lobbying {61}, and other forms of fraud at all stages of the procurement process {212, 370, 507, 529}. Manifestations also extend to information manipulation {538}, bogus offers {507}, and money laundering {603}. Several papers address ProcCorr in a disaster context. Most of them refer to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic {212, 225, 529, 617, 692, 696}, highlighting fraud and mismanagement of medical equipment and funds, price collusion following revolving door conduct, procuring unreliable products, and bribery. A single contribution addresses breaches of procurement contracts during the Ebola outbreak in Africa {101}.

Improper marketing relations

The studies identify various manifestations of ImproperMR, emphasizing its dynamics and illustrating the need for ongoing assessment of pertinent misconduct (Table  6 ). The industry's influence on doctors using money, gifts, and direct (e.g. covering travel costs) and indirect favors (e.g. supporting children's enrollment at the preferred school) to endorse off-label drug use and promote drug prescribing is widespread {145, 263, 408, 565, 635}. Various tactics for concealing improper payments emerge in this context, such as employing purported post-marketing surveillance studies {61}, falsified expense reports, offshore accounts, subsidiaries, slush funds, and sham contracts {226, 555}. ImproperMR includes deceptive, unethical, latent, or even criminal conduct, such as the systematic acculturation of medical experts as key opinion leaders (KOL) {43, 437, 145}, aggressive advertising of drugs and devices at healthcare facilities {17} and the suppression/delay/concealment of information about appropriate use and adverse effects of drugs and devices {44, 263}.

ImproperMR extends to a sector frequently involved in these corrupt links: the scientific arena. Studies highlight practices like concealing undesirable findings of clinical trials, eventually under the guise of data protection {44, 596}, systematically generating improper dependencies and COI via funding clinical trials, continuing medical education (CME) and medical expert committees, or initiating 'pseudo' trials designed for marketing purposes rather than scientific evidence {43, 44, 106, 141, 415, 431, 596, 639, 717}. The industry also captures prominent medical journals through these practices, threatening scientific and peer-review standards. A contribution that discusses advisory committee members' 'pay-later' COI {565, p. 17} resulting from the financial compensation of drug review committee members at some time after the decision-making highlights the dynamic nature of pertinent misconduct.

Further misconduct comprises bypassing statutory regulations on Good Laboratory/Clinical/Medical Practice, engaging in price manipulation {44, 145, 415, 496}, and influencing regulatory authorities and the state {717}, even across national borders. One contribution highlights misconduct that involves exploiting patients' rights, partly due to misunderstandings related to informed consent and insufficient adherence to trial standards, particularly notable in emerging countries {639}.

Misuse of high-level positions and networks

MisuseHPN ranges from individuals' misbehavior to an entire industry's misconduct (Table  7 ). Frequent conduct comprises lobbying activities of the pharmaceutical industry to influence political decision-making processes and regulatory authorities, aiming at selectively enforcing or relaxing laws and regulations {105, 394, 431, 437, 483, 596}. Furthermore, the research underscores clientelism (e.g. appointing hospital managers based on political party affiliation rather than qualification {103}), nepotism (e.g. promoting family members or friends {141, 411, 565}), and favoritism (exemplified by politicians who disproportionately support their home regions {740}).

Further wrongdoing extends to collusion among stakeholders to divert money, such as International Federation of Red Cross and Red Crescent Societies staff colluding with bank officials to fraudulently access disaster funds {101}. Studies also highlight the bribing of high-level public officials to divert public funds for private or corporate gain {179} and controlling/manipulating/distorting information and facts, such as creating an ostensibly independent research foundation aimed at influencing (inter)national policies {318}. Furthermore, studies report on high-level providers intentionally provoking an emergency to create a teaching opportunity and senior staff abusing public resources for private gain and forcing subordinate staff to participate {721}. Researchers providing biased evidence, causing experts to recommend distorted treatment protocols, represents another misconduct {288}. In the SARS-CoV-2 pandemic context, a critical discourse highlights the conduct of reducing decision-making authority to a limited cadre of experts, fostering the possibility of abusing high-ranking positions {483}.

Undue reimbursement claims

Dominant misconduct encompasses fraudulent and bogus reimbursement claims and improper practices like upcoding, unbundling, and overprovisioning services (Table  8 ). This misconduct has various forms, such as prescription drug-related fraud in the form of exaggerated billing of insurance companies {229}, private providers, whether hospitals or individual doctors, submitting exaggerated or bogus claims for treatments or tests {540, 608}, manipulating coding systems to inflate reimbursement by exaggerating the severity of a patient's condition {373, 552} and disregarding prescription standards {348}. The SARS-CoV-2 pandemic demonstrates additional instances, including medical professionals stockpiling medications ‒ purported as potential coronavirus treatments ‒ by prescribing them for personal use or their family members {696}.

Further misbehavior comprises patients hiding diseases at the time of buying insurance to avoid higher premiums {540}, physicians colluding with pharmacists to foster the mass sale of prescription drugs {408}, and enrolling patients multiple times in national health insurance to exploit double premiums {556}.

Fraud and embezzlement of medical drugs, devices and services

Corrupt activities span various pertinent issues (Table  9 ). Commonly discussed misconduct covers embezzling, misappropriating, and misallocating funds, drugs, and devices {e.g. 141, 179, 200, 229, 357, 446, 561, 640}, and producing and circulating counterfeit or substandard medications (i.e. medications lacking proper or adequate active pharmaceutical ingredients, containing undisclosed substances, featuring incorrect dosages) and selling expired drugs after relabelling their expiry date {e.g. 44, 76, 236}. Misconduct extends to illicit drug trafficking, unauthorized storage and unregulated sale of drugs {408, 721}, and quantity fraud by documenting larger quantities than the patient received {105}. During disasters, additional and increased misconduct emerges, such as payroll fraud during the Ebola crisis{101}, issuance of fake Coronavirus Disease 2019 (COVID-19) test results {436}, and increased misappropriation of funds and medical equipment during the SARS-CoV-2 pandemic {212, 696}.

Institutional corruption

A subset of articles {116, 163, 164, 165, 173, 217, 222, 232, 257, 420, 437, 466, 611, 613, 654, and 662} explicitly engage with the works of Thompson or Lessig while the remaining articles do not directly reference the InstCorr framework. Instead, they delve into its core principles, such as disparities between an institution or system's intended purpose and the actual outcomes, COI impacting stakeholder performance, and improper dependencies among parties. One contribution addresses the 'institutional corruption' within healthcare bodies but uses the term independently of the InstCorr framework {268}.

Most research focuses on the pharmaceutical sector, leading to significant parallels with manifestations of ImproperMR. Table  10 elaborates on these manifestations, spanning research, marketing, and regulatory spheres, highlighting additional parallels with MisuseHPN and underscoring the intricate interdependencies among these entities.

A dominant form of industry misconduct spanning all areas involves nurturing financial COI {e.g. 145, 222, 257, 338, 420, 437, 466, 613}, thereby fostering inappropriate financial dependencies of the involved stakeholders, to shape their behavior in a manner that aligns with the industry's interests. Such undue dependencies may arise among any party with financial ties to the industry, whether stemming from CME funding {654}, financially supporting medical societies {163}, user-fee funding of regulatory agencies (such as the Food and Drug Administration) {420} or financial incentives for providers to participate in marketing studies for non-interventional post-operative treatments, promoting off-label drug use and increasing prescriptions {466}. These dependencies also manifest through advertisements in scientific journals {596}.

Prominent misconduct affecting the realms of research and service delivery, partially intersecting with ImproperMR, involves the systematic acquisition of KOL. Such conduct entails identifying esteemed researchers, mapping their influence, and consistently managing them to advance industry interests by shaping scientific knowledge and influencing how healthcare providers diagnose and treat medical conditions {e.g. 145, 232, 418, 596, 654}.

Research also underscores biasing clinical trials as common misconduct (partly due to dependence corruption). This wrongdoing manifests in several ways, including selective enrollment of trial participants, such as excluding pre-trial participants already on medication experiencing significant side effects {288}, selective reporting of trial outcomes, like communicating findings other than the intended ones after failing to find the expected results {217} and biased trial conduct, such as encouraging researchers to administer medications to mitigate side effects of the tested drug {288}. Further biases arise from practices like conducting 'in-house' studies {596}, performing drug tests against placebos {420}, and researching only minor variations of existing drugs rather than investing in new ones to favor shareholders and investors at the expense of patients {222, 232}.

Promoting the trial-journal pipeline to influence the entire research process, starting with the design of the clinical trial to the publication of the outcome {420}, disease-mongering {163} astroturfing {596}, exploiting individual researchers' dependence on (industry-funded) networks {257} and harassing researchers to discourage negative conclusions {232} represent further wrongdoing. However, the contributions acknowledge that learned behaviors such as trust in company data or replicating improper actions and inappropriate incentives within scholars' career paths, compounded by the consequences of inadequate public research funding and the failure of publishers, editors, and reviewers to uphold standards of science and peer review, can indeed foster significant misconduct {e.g. 43, 116, 338}.

Rule-making and rule-gaming illustrate the industry's capture of regulatory authorities, thereby highlighting the considerable overlap between the manifestations of InstCorr and MisuseHPN. Lobbying, campaign contributions, and other types of financial relationships, including the industry's user-fee funding or lagged compensation of treatment advisory committee members {116, 420, 565}, reinforce the industry's ability to assert its various interests effectively.

Some contributions underscore further misconduct, such as non-disclosure of COI in industry-sponsored research, publications, and clinical practice guidelines{411}, counseling service providers to structure remuneration transactions to appear compliant while circumventing their true intent {611}, leveraging asymmetric information in business-to-business and business-to-consumer marketing {613} and colluding with public institutions (e.g. Centers for Disease Control and Prevention, Japan Tobacco {318, 410}).

What insights do we gain from the review? First, it highlights differences in addressing the individual types of corruption in academic discourse. The scientific literature predominantly emphasizes BribeMSD and the MisuseHPN. Articles on InstCorr also occupy a significant place, while ProcCorr, ImproperMR, and FraudDDS are moderately prevalent. UndueRC receives limited attention in the scientific literature. However, the divergent coverage of these corruption types could stem from database selection and corruption type-specific characteristics, such as pre-existing countermeasures and difficulties in identifying relevant misconduct, underscoring the need for further investigation into these areas.

Additionally, the disparity in how these corruption types are covered likely hinges on several factors: the problem's urgency, the availability and accessibility of relevant data, the public interest that regional or nationwide scandals can amplify, and the focus of national and international policy, often influenced by geographic relevance. Additionally, academic priorities, driven by funding bodies, play a crucial role in shaping the research agenda. Consequently, further research is needed to gain a balanced and comprehensive understanding of the contextual factors that influence the focus on different types of corruption in the literature.

Second, the review emphasizes the geographic variation across the corruption types. BribMSD poses a significant challenge to African, Asian, and post-socialist European healthcare systems. In low and lower-middle-income African and Asian countries, individuals financially incapable of bribing healthcare providers risk denial of essential healthcare services. The persistent prevalence of BribMSD in post-socialist countries results from the prevailing attitudes of the population towards corruption and their perceptions of what constitutes corrupt behavior. In those countries, bribes for health workers, especially doctors, are intended to express appreciation and ensure faster and supposedly higher quality treatment. Dual practice and absenteeism of medical staff also present significant challenges. In low and lower-middle-income countries, however, these manifestations can be life-threatening if patients lack access to medical care. In affluent, well-developed nations with robust essential healthcare services, the adverse effects of dual practice may not pose life-threatening risks but are still decidedly disadvantageous for the overall health system whenever providers' financial objectives compromise the health system's overarching goals, including equal access for equal needs. The review, therefore, highlights that both the severity of repercussions and the classification of corrupt behavior will likely depend on the context.

ProcCorr, another breeding ground for corruption, implies a considerable waste of money. Investigating ProcCorr is challenging because of highly complex procurement processes, limited oversight and access to relevant information, and sophisticated cover-ups. As with UndueRC, studies highlight data-based tools such as electronic procurement that help ensure procurement procedures are less susceptible to corruption. Additionally, many countries have adequate laws and regulations to combat ProcCorr. The OECD [ 23 ] provides an overview of applicable laws, rules, and tools, including general anti-bribery laws, laws tailored to procurement, initiatives that foster transparency in the procurement process, and tools that reduce information asymmetries and increase stakeholder participation. However, anti-corruption laws, whether broad or specific, are no guarantee for reducing corruption per se, as several studies and experiences from different countries show [ 11 , 20 , 37 ]. A wide range of factors can influence the effectiveness of laws. Laws require unambiguous wording, comprehensive problem coverage, appropriate sanctions, and independence from lobbyists' rule-making attempts. Laws also require consistent enforcement and foresight regarding potential rule-gaming, such as exploiting loopholes or the lack of independent jurisdiction and resources. With rule-making and rule-gaming as typical manifestations of InstCorr [ 28 ], the latter can potentially affect the effectiveness of legal approaches to curb individual corruption.

Additionally, anti-corruption legislation and compliance with the rules require regular evaluation to keep pace with corruption's dynamic nature and assess its impact on reducing corruption. Overall, it appears essential to complement legal initiatives with additional measures, such as transparency, oversight, awareness, and economic initiatives. However, a considerable challenge lies in addressing the complexity of corruption while maintaining a consistent and effective countermeasures system.

Employing two distinct corruption typologies exposes the interrelated nature of corrupt activities. This association becomes particularly apparent in the EU classifications of ImproperMR and MisuseHPN when juxtaposed with Thompson's InstCorr. These three corruption types unveil an intricate network involving many stakeholders, including the pharmaceutical industry, academia, regulators, medical advisory committees, and patient advocacy groups, giving rise to many potential corruption drivers. However, the InstCorr framework highlights that individuals seeking personal enrichment are not the sole drivers of corruption. Instead, structural elements rooted in institutions' motivational and incentive structures can foster COI and dependence corruption among multiple stakeholders. Therefore, blaming and penalizing individual wrongdoers may not be an appropriate solution. Instead, the InstCorr research recommends identifying, evaluating, and adjusting institutional frameworks that encourage such misbehavior.

Less frequently addressed than other corrupt practices, studies handle UndueRC. However, many countries with well-established health insurance systems have sophisticated plausibility checks in often automated insurance claims billing. Those make it easier to detect reimbursement fraud, such as billing for services not rendered or multiple billing for the same service. In developing countries where health insurance systems are still evolving, the distinction between UndueRC and BribMSD can blur, for example, when doctors bill patients for services covered by health insurance while simultaneously pocketing the insurance payments privately. Such behavior might explain ‒ at least partly ‒ the comparably high number of bribery studies in emerging Asian and African countries. However, sophisticated insurance systems face more significant problems resulting from doctors' rooms for maneuvers. Unbundling and upcoding, in particular, are issues here. These activities are challenging but not impossible to identify. Whenever systemic, but not criminal, misconduct appears, such behavior likely indicates InstCorr. Data mining approaches are promising tools for identifying such trends, but only a few studies examine the effectiveness of these approaches in uncovering relevant misconduct.

Within the EU category, FraudDDS includes misconduct not addressed by other forms of corruption. SARS-CoV-2 research highlights various fraudulent acts, such as national interests taking precedence over a globally coordinated disaster response, threatening entire populations. Literature also examines the dynamics and rapid occurrence of misconduct following exogenous shocks. Increased vulnerability to corruption during a pandemic sometimes arises from regulators' need for swift action, emphasizing the importance of preventive measures and informed remedial actions. Overall, evidence on pandemic-related fraud underscores the necessity of organizational changes to enable healthcare systems to absorb adverse impacts, adapt to new environments, and transform the health system towards functionality beyond the pre-shock level [ 1 ].

The InstCorr literature offers new perspectives on corrupt behavior and thoroughly examines its manifestations. The studies highlight the challenges in establishing a definitive basis for judging whether institutionally corrupt behavior has occurred. Somewhat, these acts veer away from a normative standard of behavior dictated by ethical considerations or fiduciary obligations but not criminal law. Academic literature also teaches us that it is insufficient to focus solely on individuals in the fight against corruption. Instead, it is crucial to scrutinize the environment and its influence on the behavior of those involved and to identify any distorted incentives. However, this approach can quickly become intricate and perplexing, requiring a focus on the misbehavior that is most likely to occur and has a significant detrimental impact. Although high-income countries primarily tackle InstCorr, low- and lower-middle-income countries can benefit from a comprehensive understanding of its manifestations. This knowledge allows political decision-makers in these countries to identify potential forms of corruption early and combat them effectively.

Third, synthesizing extensive manifestations of corruption in the health sector provides critical insights for policymakers to derive effective and robust anti-corruption measures at local and global levels. Attempting to eradicate corruption, however, is doomed to failure. Instead, we should focus on curbing corruption to cushion its adverse effects. In certain instances, like UndueRC and FraudDDS, robust anti-corruption laws can contribute to a lasting reduction in corruption, provided the relevant laws are consistently enforced. However, the InstCorr literature highlights that a legal framework has limitations in regulating systemic forms of misconduct that may not be inherently illegal, underscoring the necessity for organizational remedies.

Effective countermeasures must extend beyond the health sector to encompass other domains like education, legislation, international affairs, and public finance, thus complicating the situation further. Given the distinct responsibilities inherent in these sectors, divergent interests arise, adding complexity to coordinated efforts. Furthermore, confining remedial actions to local initiatives may prove inadequate following conflicting country-specific laws and regulations, divergent interpretations of corruption, and variations in the capacities of individual states to enforce countermeasures. Concerted cross-country research involving stakeholders from affected sectors is required to derive effective remedies. Assessing the effectiveness of existing and proposed countermeasures in light of the intricate nature of corruption highlights a promising research agenda.

The fight against corruption remains a Sisyphean task. Metaphorically speaking, while extinguishing one fire, another one flares up elsewhere. Vigilant surveillance of corrupt practices, encompassing the discernment of patterns and trends, is therefore pivotal. The wealth of scholarly insights into corrupt practices within healthcare and allied domains provides a solid groundwork for this endeavor.

Fourth, the review highlights the increased vulnerability of ProcCorr, MisuseHNP, and FraudDDS during pandemics, underscoring the need for preventative measures. Context-dependent variations in the effects of corruption also became apparent, enabling the development of countermeasures.

Finally, the review accentuates the significant contribution of the InstCorr literature in enhancing comprehension of ImproperMR and MisuseHPN while emphasizing the pivotal role of the scientific community in addressing these issues, thus signaling a crucial area necessitating further investigation.

While this review offers valuable insights into corruption within the health sector, it is crucial to acknowledge certain associated limitations.

First, the choices in selecting databases, keywords, and observation periods may introduce biases in the results. While we do not expect any significant impact from searching additional databases, we assume that changing (the combination of) keywords will influence the number of records identified. The advanced search for the keywords we selected confirms this assessment: In the 2013 Special Issue on InstCorr in the Journal of Law, Medicine, and Ethics, the search did not retrieve all articles of the special issue—despite their potential relevance—because their titles, abstracts, subjects or specified keywords did not match our search terms. As this is a limitation independent of the type of corruption, we decided not to include these articles to avoid biasing the selection process towards InstCorr. However, we see this limitation as an impetus for further research using broader search strategies, such as bibliographic snowballing, to capture additional manifestations of (institutional) corruption.

Second, categorizing contributions along the corruption typologies and their types is susceptible to subjectivity, further complicated by the interconnected nature of corrupt activities. Third, focusing solely on the health sector may pose challenges in identifying emerging forms of corruption from other industries that could infiltrate the health sector. Nonetheless, these limitations serve as an impetus for future research endeavors.

Overall, we believe the central role of the review, highlighting manifold manifestations, lies in its relevance to combating corruption effectively. Understanding corrupt behavior's diverse and often unpredictable manifestations is not merely an academic exercise but a fundamental necessity in devising robust and effective anti-corruption strategies. Theoretical models and considerations may fall short as they fail to fully represent or capture misbehavior's complex and dynamic nature as it manifests in reality. By constantly updating the relevant knowledge through detailed reviews of how corruption manifests and develops, we equip researchers, policymakers, law enforcement, and regulatory bodies with starting points for actions.

However, we recognize that documentation alone is insufficient. Knowledge about misconduct has to lead to identifying who is involved in misbehavior, under what circumstances, how often and why misconduct occurs, and how serious it is. Therefore, understanding misbehavior is at the core of further action: identifying risk factors, estimating impacts, and crafting effective anti-corruption strategies. Thus, while uncovering manifestations is a critical first step, it is only the beginning of a deeper exploration into the dynamics of corrupt practices, which should be the focus of future research agendas.

Availability of data and materials

No datasets were generated or analysed during the current study.

Abbreviations

Conflicts of Interest

Food and Drug Administration

Key Opinion Leaders

Continuing Medical Education

Centers for Disease Control and Prevention

Organisation for Economic Co-operation and Development

European Union

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Sommersguter-Reichmann, M., Reichmann, G. Untangling the corruption maze: exploring the complexity of corruption in the health sector. Health Econ Rev 14 , 50 (2024). https://doi.org/10.1186/s13561-024-00530-6

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148 Essay Samples and Topics on Corruption

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• The Corruption of the Catholic Church in Chaucer’s Works Using the central theme of religious hypocrisy, Chaucer successfully used the Pardoner, the Friar, and the Summoner characters to expose the church representatives’ corruption and evil practices.
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• How Pushkin Illustrates the Theme of Corruption in the “The Queen of Spades?” Alexander Pushkin in his writing, “The Queen of Spades”, takes the reader through the world of faro gambling at the time of the Imperialist Russia in the beginning of the early 19th century.
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• Terrorism, Corruption, and Climate Change as Threats Therefore, threats affecting countries around the globe include terrorism, corruption, and climate change that can be mitigated through integrated counter-terror mechanisms, severe punishment for dishonest practices, and creating awareness of safe practices.
• Discussion: Bribery and Corruption Is an Issue That Threatens Sustainability Therefore, multinational enterprises should audit their supply chains to eliminate unsustainable practices such as bribery and the use of child labor and promote socially and environmentally responsible production.
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• A Moderate Approach of Treating Corruption Propositions The more corruption is entrenched in the government, the more difficult it is for businesses to exist in conditions of local competition with other corrupt officials.
• Corruption During Disaster Relief One of the most notable elements about most of the disasters that have been documented in various parts of the world is lack of adequate preparation in case of their occurrence.
• Public Corruption and Embezzlement For a party to be guilty of an offense, the elements of the guilty mind and the actual commission of the crime must be present.
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• Corruption in Kuwait: Analysis of Different Aspects of Kuwait’s Corruption Kuwait is a nation that is affected by corruption cases, and it is one of the states in the world that are highly corrupt.
• Agency Interaction and Police Corruption One of the officers told me that I do not need to pay for my food at this restaurant because the owners give it free to the police officers.
• Police Corruption, Misconduct and Brutality: When a Good-Cop-Bad-Cop Routine Goes Wrong The given cases show that, sadly enough, power abuse among the members of the police department is still an issue, and it is probably going to be as long as the means to coordinate the […]
• Elite Squad 1&2: The Theme of Corruption The media sugarcoats the drug lords and extorts their reporting of the events in the Rio’s crime and corruption as seen in the film “Elite Squad 2” instead of exposing the truth.
• Institutional Corruption: Praise the Lord Club For example, in the case of bribery, the crime is fuelled both by the person who asks for the bribe and the one who pays it out.
• Corruption of Public Officials It has been identified that individuals of the upper class also commit crime by the virtue of the positions that they hold and the trust and power that is vested to them.
• Anti-Corruption Strategies in Kazakhstan On the backdrop of the notion that corruption is an international issue of concern5, the aim of this paper is to evaluate the success of anti corruption strategies in Kazakhstan.
• Public Corruption and Its Impact on the Economy Corruption is in itself a very negative aspect that impedes the economic growth of the affected country, or organization irrespective of the status of development.
• Corruption and Integrity in Modern World The difference in the levels of corruption in these countries is a result of different parameters and at the same time, the effects are diverse.
• Touch of Evil: The World of Drug Lords and Corruption Janet Leigh, who is considered to be an outstanding American actress of the 50s, perfectly played one of the leading roles in the movie, the role of Susan Vargas.
• Corruption and Ways to Prevent Its Occurrence Power is the authority and ability to control. Emotional intelligence is the capacity and ability to integrate, assess and manage feelings of self or of others.
• Police Corruption in “The Detonator” by Wesley Snipes Judging by the content of high-level corruption within the police as exhibited in the movies, it is only reasonable to say that police have deviated from their traditional role of being the custodians of social […]
• African Corruption and Sapolsky’s “A Primate’s Memoir” The preservation of the wildlife is necessary in order to ensure that the animals are protected from being killed hence they do not become extinct as many other animals have furnished due to lack of […]
• Corruption of Government in Church Some people argue that that most of the actions of the church in the course of its development cannot be regarded as corruptive whereas others state that the desire of the church to enrich itself […]
• Relationship Between Lobbying and Corruption Lobbying can be defined as the act of influencing government leaders for the alteration of law or the creation of new legislation that will support the interest of a particular group or organization. The basis […]
• Police Reform in Russia: Evaluation of Police Corruption Which individual, institutional, and organizational factors of corruption did Medvedev’s 2011 police reform target, and how successful was it in eliminating the practice of corruption among law enforcement officers in Russia compared to other states?
• Corruption, Media and Public. Cocalero Documentary However, for the public to act against such cases, the media has to play its role in spreading nonpartisan information concerning the occurrence of corruption in a given area.
• Anti-Corruption Efforts in Trading With China Under this law, any person who is found guilty of operating business in a country in an effort to give property or money to customers so as to sell or purchase products is liable to […]
• Corruption in New York and Ethical Obligations When discussing the violations of ethical principles in the case of Smith and Halloran, it is essential to mention that the established rules of ethics in political leadership are put in place to prevent classic, […]
• Police Corruption and Citizen’s Ethical Dilemma There are three key stakeholders in the given situation, which are the policemen, who set the terms; the father, who is to take the pivoting decision; and the family, who depends on the decision which […]
• Corruption Shaping Democracies in Latin America This research paper gives a detailed analysis of the nature of this problem and how it affects the welfare of different communities, regions, and citizens.
• Private Prisons’ Ethics and Capital-Driven Corruption The promotion of private prisons in the U.S.context was a response to the identified crisis. Even though there is a slight propensity to justify the idea of private prisons as the tools for containing prisoners […]
• American Police Corruption and Its Classification The invention of camera phones gave everybody the ability to document the wrongful actions of police and have undermined the trust people had in the police authority.
• Noble Cause Corruption and Virtue Ethics The answer lies in the purpose and the implied public image of the police. The role of the policeman is to uphold the law dictated by the government and the constitution of the country.
• Corruption in Arbitration in the United Arab Emirates As such, when conducting a research that focuses on corruption and how to deal with it, it is important to have a clearly guided approach of the study that can help in achieving the desired […]
• Bribery and Corruption in International Arbitration The tendency towards the globalization created the basis for the improved cooperation between states, companies, agencies, individuals, etc.and preconditioned the shift of priorities towards the global discourse as the most promising mean of cooperation.
• Public Corruption as a Phenomenon and Explanations Thus, to describe the phenomenon of public corruption, four major hypotheses exist the concept of “slippery slope,” the society-at-large hypothesis, the structural or affiliation hypothesis, and the rotten apple hypothesis.
• Gift Culture and Corruption in the World The main argument in this kind of claim is that corruption is a critical attribute of many societies that embrace the gift culture practice.
• Theater of Corruption in “Syriana” by Stephen Gaghan The aim of this paper is to explore the overlapping of oil and politics in the context of the movie. In scene 20 when discussing the negotiations of the prince’s brother with American lawyers, Woodman […]
• The Corruption Issue in the Contemporary Society Further, pinpointing the necessary aspects that foster the development of the skill besides assessing the influence of faith and spirituality in the reinforcement of the quality would be the concentration of the paper.
• Global Business: Culture, Corruption, Experiments This paper summarizes the main points of three articles focusing on international business, gives the writer’s respective position and rationale, and provides employer best practices in the specific areas examined.
• Foreign Corrupt Practices Act: United States vs. John Blondek, et al. Hence, the description of the chain of events that has led to the indictment, as seen by the Judge: “Blondek and Tull were employees of Eagle Bus Company…they paid a $50,000 bribe to Defendants Castle […]
• Corruption in Business Environment For instance, the business environment of China is in the state of transition because of significant changes in political regimes and leaders.
• Corruption and Corporate and Personal Integrity Bribery, embezzlement of funds and illegitimate procurement always impose extra and unjustified costs to the cost of acquiring public services and damages the credibility of those institutions that are involved in the vice.
• Sociology: Is Guanxi Corruption? In China, Guanxi has been in use for a very long time and has been socially accepted as a way of life, both in the day-to-day activities and also in business practices.
• Excessive Business Regulations and Corruption For the purpose of the paper, business regulation is taken to mean the laws and institutions established by governments to govern the establishment of businesses either by local citizens and companies or by foreign investors.
• Corruption and Accountability of Police Work In this regard, lack of strong and proper policies on misconduct and unethical behavior in the line of duty has helped to perpetrate the corruption of law enforcement officers in various sectors of their work.
• Political Corruption: Causes, Consequences and Strategies The ethics of the process deals with the methods that public officials apply in the execution of their duties. Political corruption exists in all countries and harms their systems of economic and political governance through […]
• Corruption and Ethics in China’s Banking Sector The ranking of China among the most corrupt countries is illustrative of the rampant corruption both in the state and in the private sector. In America, corruption is a civil tort and perpetrators of the […]
• Mexican Political Parties Role in Corruption and Insecurity The top political brass of Mexico is to blame for the misfortunes in the country. This separation led to reduced influence of the church in political activities.
• Political Corruption in the Airline Industry The cartoon relates to this in that the two nationals may have used corrupt means to avoid security checks, and the pilot also had a personal political affiliation which may have caused him to divert […]
• Political Corruption as a Trigger of Democracy Hence, the development of the political systems invites more active voters who contribute to the development of the democratic principles. Therefore, the democratic influence on political power is closely associated with the development of the […]
• Political Corruption: Least and Most Corrupt Countries This has led to not only following of the laws to the latter but also avoiding the labeling of corruption in their work place.
• Addressing Corruption in the Engineering Field I chose this topic because corruption is a moral ill in society, especially among engineers and in the recent past it has led to deadly consequences such as the death of people, destruction of the […]
• Corruption Imagery in R.W. Fassbinder’s “Lola” (1981) It is the second in the said trilogy with The Marriage of Maria Braun being the first and Veronika Voss the last.
• Ethical Problems in Corruption The notion that in a court of law, it is normally the suspects’ arguments against the amount of evidenced presented before the courts have greatly contributed to noble cause corruption.
• Global Financial Crisis: Corruption and Transparency Due to the large number of the emerging markets, the global financial regulators lacked a proper mechanism to handle the situation.
• The Roles of Vertical and Shared Leadership in the Enactment of Executive Corruption: Implications for Research and Practice Responsibility disposition refers to the tendency of a leader to feel obliged to do the right thing for the welfare of the majority.
• Public Policy on Corruption The rationale of the policy The rationale of this policy is to eliminate corruption. Besides, this model will ensure that there is universality when it comes to the application of these policies.
• What Contributes to the Corruption? Neo-liberalism and corruption One of the major factors that contributed to the apparent rise and spread of corruption and which is a subject of debate is neo-liberalism which started in the 1970s and the 1980s.
• Judicial Corruption in Developing Countries It originates from the judges and lawyers who are at the center of the legal systems in Africa. There is a lingering culture of impunity in African leadership that is the primary cause of corruption.
• Cairo Revolution Against Corruption and Injustice The success of that protest led to the formalization of the movement with a mission to organize and mobilize ordinary people to fight for their rights.
• Corruption and Bribery in the Oil Sector in Nigeria and Angola It is identified that the west, through their MNCs, are solely to blame for the rampant cases of corruption in Nigeria and Angola.
• Corruption and Bribery in the Oil Sector of Angola The oil industry in the African continent, particularly in the largest oil producers like Angola and Nigeria is the centre of corruption and there is a need to introduce transparency in the management of oil […]
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• Corruption in Russia The rising corruption cases have been related to the 2006 Russian president’s policies that were meant to strengthen the state on the expense of the Russia’s civil society.
• Corruption in Russia: Causes and Consequences In addition, because of the clear connection between corruption and increased crime, security standards have declined in Russia, because of the ever-increasing net of criminal gangs, which evade the long arms of the law, because […]
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• The Corruption Perceptions Index (CPI) Due to the fact that the Corruption Perceptions Index reflects the degree of corruption in countries, it can also denote the level of integrity performance.
• Corruption in Law Enforcement Some developments in the state fought the criminality of the state machinery indirectly, such as the endorsement of the civil rights in 1964.
• Law Enforcement: Noble Cause Corruption Since the policeman knows the driver/occupant of the vehicle is a threat to the society, he dramatically puts some illegal drugs on the car which will act as a basis for his/ her arrest.
• Concepts of Corruption as Threat of Security The political officers who are charged with the core obligation of discharging their mandate with the cardinal objective of protecting the interest of the public have gone astray and turned a threat to the welfare […]
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• Can Salaries and Re-Election Prevent Political Corruption?
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• Can Corruption Function as “Protection Money” and “Grease Money”?
• Does Corruption Facilitate Trade for the New EU Members?
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• Does Corruption Foster Growth in Bangladesh?
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• Can Institutional Reforms Reduce Corruption?
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• Published: 15 July 2024

Impact of corrupt admission on the mental health of Chinese adolescents

• Hongbin Yuan 1 ,
• Danyang Li 2 ,
• Feiran Yang 3 &
• Zhijian Zhang 1  

Scientific Reports volume  14 , Article number:  16263 ( 2024 ) Cite this article

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• Health care economics
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Through preferential treatment by education officials or through bribery, some adolescents can obtain admission to a junior high school. However, it is unclear whether it affects the mental health of adolescents. This study used Propensity Score Matching to examine the effects of corruption on adolescent mental health. A total of 17,254 junior high school students sample (11–18 years old; 48.7% girls and 53.1% boys) were used from the China Education Panel Survey. 14.1% of adolescents attended a junior high school by corrupt means, corruption had a significantly negative effect on the mental health of these adolescents (ATT = −0.388, p  < 0.01), the reasons grounded in the fact that they received more criticisms from teachers and wanted to leave their current school. In general, corruption in the admissions process can have detrimental effects on the mental health of adolescents. This study extends the previous articles on how to improve adolescent mental health and complements the application of cognitive dissonance theory. Findings from this study revealed that anti-corruption in the education sector is necessary, and the institutional design to ensure fair enrolment in basic education will contribute to the mental health of adolescents.

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The phenomenon of corruption is a salient issue across multiple domains in developing nations and gaining increasingly studied due to its huge impacts on economic growth and individual development 1 , 2 , 3 , 4 , 5 , 6 . Corruption in the education sector is a question worth exploring, as it is closely related to the human capital accumulation of school-age adolescents. In China, due to the extreme scarcity of high-quality education resources and institutional imperfections, corruption is frequently observed in the school admission process. Through preferential treatment by education officials or through bribery, some parents can secure admission for their children into schools for which they would not otherwise meet the eligibility criteria. This kind of corruption is common in Chinese education sectors and may potentially impact the mental health of adolescents. As indicated by the Cognitive Dissonance Theory, when there is inconsistency between an individual's beliefs and actions, psychological discomfort may arise 7 . However, there have been few studies examining its possible effects on adolescent mental health. This research aims to fill this gap by exploring the effect of corruption in the admission process of junior high schools on the mental health of adolescents.

Previous literature has established a link between corruption and mental health. In Vietnam, it has been found that corruption causes a significant decline in revenue and thus has a negative impact on residents' mental health 2 . Furthermore, studies conducted in Europe and Africa have suggested a negative association between corruption and mental well-being 8 , 9 . While these studies are useful in understanding the impact of corruption on adult mental health, the existing literature on education corruption mainly focused on its correlation with test scores or discusses anti-corruption policy 10 , 11 , 12 , and less is known about the effects of corruption in the school admission process.

In China, junior high school education constitutes the last three years of the compulsory nine years of education, and admission is primarily based on " Xuequ ", which refers to the geographic distance between a student's family property and a specific school. If a family owns property within a certain distance of the school, their adolescent children become eligible for admission. Xuequ is designated by local governments, meaning that a family's geographic location ultimately determines their child's admission to junior high school. However, government leaders in charge of education affairs and school leaders have the power to expand the number of admissions, creating opportunities for corruption. Those who have close relationships with these leaders may use these connections or resort to bribery to enroll their children in desired schools.

Corruption may hurt adolescent mental health. Corruption implies a violation of social norms, which in turn incurs psychological costs 13 , negatively impacting the mental health of adolescents. According to cognitive dissonance theory, when individuals face conflicting beliefs and behaviors, they experience psychological discomfort or tension 7 . Adolescents who attend school through corrupt means may become aware of corruption as wrongdoing, it can inevitably lead to conflicting beliefs and behaviors that negatively impact their mental health. Additionally, students who gain admission through corrupt means are often perceived as having obtained unfair advantages. As a result, this may affect their relationships with classmates. Teachers, in their role as upholders of fairness, are more likely to criticize these students further in order to obtain psychological compensation. However, empirical research on this topic remains limited.

Based on a nationally representative survey sample, the current study utilized Propensity Score Matching (PSM) methods to empirically examine the effect of corruption in Chinese junior high school admissions on adolescent mental health and further explored the mechanisms behind it. To our knowledge, this is the first study that builds a correlation between corruption in junior high school admission and adolescent mental health.

The data used in this study were drawn from 2013 to 2014 school year of the China Education Panel Survey (CEPS), a nationally representative junior high school survey conducted by Renmin University of China that aimed to investigate how adolescents’ development is affected by parents, school, and community. The survey was collected by a four-stage probability sampling design, including students of 7th and 9th graders, 19,487 students were randomly selected from 438 classes across 112 junior high schools in 28 counties of China.

In the CEPS, four types of questionnaires were used to collect information on students, their parents, teachers (including head teacher and main subject teachers like English, Chinese, and Math), and school administrators. We merged these four types of data and deleted the samples with missing values, totaling 2233, which accounted for 11.46% of the original sample size. Ultimately, the sample used in this study was 17,254 students from 7 and 9th grade.

• Mental health

The dependent variable is mental health, we referred to the measurement methods used in existing literature 14 , 15 , which was measured by a series of questions related to adolescent psychological conditions. Specifically, in the CEPS, respondents were asked whether they had ever felt unhappy, depressed, anxious, sad, or had little interest in doing things in the past seven days. All of the responses were rated with five options included never (1), seldom (2), sometimes (3), most of the time (4), and always (5). In this study, we assigned high scores for enhanced adolescent mental health by reversing the values of five options and then summing up the five items to create a continuous variable. We also tested for internal consistency, with Cronbach's alpha value at 0.8551, indicating excellent consistency.

The independent variable in this study refers to the corruption during the junior high school admission process, which implies a violation of the admission rules. In the CEPS, parents of adolescents were asked whether they had done any of the following to get their child into junior high school. Two options were related to corruption: “got a friend to help” and “bribed relevant officials”. The other options were not related to corruption and included: “pay extra” (Some local governments stipulate that migrant populations can obtain admission to certain schools by paying additional fees), “have children take various academic or specialty examinations”, “buy a house in the specific area where the school is located”, “change the household registration ( Hukou ) status”, “register the Hukou at a relative or friend’s residence”, and “none of above”. These options were considered permissible under the admission policy. A dummy variable was thus constructed to capture corruption, where the variable takes a value of 1 if either of the option “got a friend to help” or “bribed relevant officials” were selected, and a value of 0 if any other non-corrupt options were selected.

In this study, we employed a series of covariates that might affect the relationship between adolescent mental health and its determinants. These control variables encompassed individual-level covariates such as age, gender, nationality, test scores, and grade level. At the family level, we included covariates related to economic conditions and parents' education level. Furthermore, we also considered class and school-level covariates, including the number of students in a class, class rank within a school, and school rank within the district.

Mechanism variables

Four mechanism variables were used in this study: interpersonal relationships, students receiving criticism from teachers, parents receiving criticism from teachers, and students' desire to leave school. For interpersonal relationships, the CEPS student questionnaire included the question “How many best friends do you have”. Students were asked to answer the number of best friends they have. We used this quantity to represent students' interpersonal relationships, as having more friends implies better interpersonal relationships for students. Regarding students receiving criticism from teachers and parents receiving criticism from teachers, the CEPS student questionnaire includes the following two questions: “In terms of school life, do you agree with the following statement: My head teacher often criticizes me”, and “Regarding school life, do you agree with the following statement: My parents often receive criticism from teachers about me”. The response options for both questions are: strongly disagree (1), disagree (2), agree (3), strongly agree (4). We use the responses to this question to measure teacher criticism, higher scores indicate that students or parents perceive more teacher criticism. Moreover, for students' willingness to leave the school, in the CEPS student questionnaire, there is a question: “Regarding school life, do you agree with the following statement: I wish to attend another school”. The response options include: completely disagree (1), somewhat disagree (2), somewhat agree (3), completely agree (4). We used the responses to this question to measure students' willingness to leave the school, with higher values indicating a greater desire among students to leave their current school.

Empirical strategy

Comparing the mental health of adolescents admitted to a school through corrupt means to those admitted through non-corrupt means would not allow for an accurate assessment of the effect of corruption on mental health. Factors that determine mental health may indeed be correlated with the choice of corruption, leading to selection into the treatment. In this situation, standard regression methods are not recommended, as it assumes that covariates follow a common distribution and functional form across treatment and control groups 16 . Therefore, we exploited Propensity Score Matching (PSM) to estimate the effect of corrupt admission on adolescent mental health, which is a suitable method to obtain robust causal effects in this situation for selecting comparable treatment and control samples from given characteristics 17 .

PSM relies on the assumption that the treatment is exogenous, the differences between the treatment group and the control group are due to the treatment 17 . In this study, the treatment means those who attend a junior high school through corruption. It is worth noting that we use non-experimental data, and the treatment is not totally exogenous. For example, those with a wealthy family background are more likely to benefit from corrupt admission, and the economic status of the family has been proven to be correlated with adolescents’ mental health 18 , 19 . The advantages of PSM lie in its conditional independence assumption (CIA), which is helpful to tackle the aforementioned challenge. To make the CIA more plausible, propensity scores are first generated to enable subjects with similar scores to be comparable. The propensity score represents “the conditional probability of assignment to a particular treatment given a vector of observed covariates” 17 . Therefore, the first step of PSM is to estimate the propensity score using logit regression based on a series of observed covariates.

The second step of PSM is to choose a matching algorithm, which means how to match treatment individuals (those attending a junior high school through corrupt means) and control individuals, for which the treatment effects are therefore been estimated. In this study, we use four kinds of matching algorithms. The first one is nearest neighbour (NN) matching, the individual from the control group is chosen as a matching partner for a treated individual that is closest in terms of the propensity score. We use 1:1 nearest neighbour matching and 1:4 nearest neighbour matching respectively, that is, the nearest one and the nearest four from the control group are selected to match a treatment individual. Nearest neighbour matching is not perfect, it faces the risk of bad matches if the closest neighbour is far away 20 . Therefore, to ensure the robustness of our estimates, we exploited more matching algorithms including caliper matching and kernel matching. Applying caliper matching means that an individual from the comparison group is chosen as a matching partner for a treated individual that lies within the caliper (propensity range) 20 . A variant of caliper matching named radius matching is recommended 21 . The basic idea of this variant is to use not only the nearest neighbour within each caliper but all of the comparison members within the caliper, bad matches are avoided due to many comparison units within the caliper are available for matching. The caliper width is 0.1 in this study, implying the samples within 0.1 in terms of the distance of propensity score from the control group are selected to match a treatment sample. Kernel matching can be seen as a weighted regression of the counterfactual outcome on an intercept with weights given by the kernel weights 22 .

Once the after-match control group was constructed, we could calculate the average treatment effect for the treated (ATT). In this study, it means the difference between the average mental health for adolescents who attend junior high school through corrupt means and the average mental health for the same group under the hypothetical scenario that they did not participate in corruption.

Ethics approval and consent to participate

All data used in the current study are secondary sources of data and freely available in the public domain. The ethics approval and consent to participate of this study was not applicable. All the methods were carried out in accordance with relevant guidelines and regulations.

Descriptive statistics

Table 1 presented the descriptive statistics. We divided the samples into a treatment group and a control group, representing those who attended junior high school through corrupt means and those who did not. It is worth noting that the number of students attended junior high school through corrupt means was not negligible, the treatment group consists of 2440 adolescents, which accounts for 14.142% of the total sample. Furthermore, there were significant differences in mental health between the treatment group and the control group. Students who gained admission through corrupt means exhibited poorer mental health, and the difference was statistically significant at the 1% level.

Covariates also revealed differences between the two groups. On average, adolescents admitted through corrupt means were older, in higher grades, had worse test scores, and were more likely to be male and ethnic minorities. Furthermore, their family economic conditions were relatively affluent, and there were more students in their class. However, although it showed that corruptly admitted students came from relatively higher-ranked schools, their class ranking within the school was relatively low.

Matching results

In Table 2 , we displayed the bias before and after matching, all the standardized bias of covariates, except for parents’ education level, has significantly reduced. On average, the standardized bias has reduced from 10.4 to 2%, that is, 80.8% of the bias has been reduced due to the matching. Rubin's B is an indicator that measures the absolute standardized difference between the means of the linear propensity score index in the treated and non-treated groups, after matching, the value of Rubin's B was 6.6. For the samples to be considered sufficiently balanced, it is recommended that Rubin's B be lower than 25 23 . In sum, matched individuals exhibited a high degree of similarity with regard to covariates, implying favorable outcomes of the matching procedure.

The propensity score distribution and common support area were shown in Fig. 1 . All 2440 treatment group samples had suitable matches, while very few individuals in the control group did not have a suitable match and would be excluded from subsequent analysis. Importantly, matched individuals in the treatment and control groups had similar propensity scores, indicating that the quality of the matching is reliable.

Propensity score distribution and common support. “Treated” indicates those who attended junior high school through corrupt means. “Untreated: Off support” indicates those without corrupt that do not have a suitable match. “Untreated: On support” indicates those without corrupt that have a suitable match.

Impact of corruption on adolescent mental health

The impact of corruption on adolescent mental health were shown in Table 3 . Attending junior high school through corrupt means has a significant negative impact on adolescent mental health. The average treatment effect on the treated (ATT) was −0.273 and significant at the 5% level in the 1:1 nearest neighbor matching. This indicated that the mental health of those who attended school through corrupt means is worse by 1.402%. When we expanded the matching scope by using 1:4 nearest neighbor matching to match more samples in the control group, the ATT was −0.388 and significant at the 1% level, indicating that the mental health of those who attended school through corrupt means was worse by 1.984%. We also reported the results of Radius matching and Kernel matching in Table 3 . The ATT values were −0.511 and −0.462, respectively, and both were significant at the 1% level. Generally, when employing various matching methods, the ATT values are consistently negative. This implies that the mental health of students admitted through corrupt practices significantly deteriorates compared to what it would be if their admission had not been through corrupt means. This demonstrates the adverse impact of corrupt admissions on mental health.

Our research has demonstrated the negative effect of corruption on adolescent mental health. However, further exploration is needed to reveal the mechanisms through which it exerted the impacts. Table 4 presents the results, we conducted mediation effect tests following the method proposed by Baron and Kenny (1986) 24 . We first regressed the independent variable on the dependent variable, then regressed the independent variable on the mediator. Finally, we regressed both the independent variable and the mediator on the dependent variable simultaneously. Using ordinary least squares regression, we reported the impact of corruption on adolescent mental health in Column (1) of Table 4 , with a significantly negative coefficient (coefficient = −0.425, p value < 0.01). The results in Column (2) show that corruption in school admissions does not have a significant impact on adolescents' interpersonal relationships, and the Sobel test is also not significant, although the results in Column (3) indicate that adolescents' interpersonal relationships affect mental health. This suggests that corruption in school admissions does not impact mental health through adolescents' interpersonal relationships.

Teacher criticism is an important mechanism through which corruption in school admissions affects adolescents' mental health. The results in Column (4) of Table 4 show that corruption in school admissions significantly increases the likelihood of students being criticized by teachers. The results in Column (5) indicate that teacher criticism has a significant negative impact on mental health, and the coefficient for corruption in school admissions (coefficient = −0.392) is smaller than in Column (1) (coefficient = −0.425). Similarly, the results in Column (6) show that corruption in school admissions also significantly increases the likelihood of students' parents being criticized by teachers. The results in Column (7) indicate that teacher criticism of students' parents has a significant negative impact on mental health, and the coefficient for corruption in school admissions (coefficient = −0.373) is smaller than in Column (1) (coefficient = −0.425) indicating that teacher criticism is an effective mediating variable. The Sobel tests for these two mechanisms are significant at the 1% level, with the mediation effects accounting for 8% and 11.1% of the total effect, respectively.

Adolescents who were admitted to schools by corrupt means had a lower sense of identity with the school. The results in Column (8) of Table 4 show that corruption in school admissions significantly increases students' desire to leave the school. Column (9) indicates that, after including this mediator, the coefficient for corruption is lower than in Column (1). Additionally, the Sobel test is significant at the 1% level, with the mediation effect accounting for 24.6% of the total effect. Therefore, students admitted through corruption lack a sense of belonging to the school and desire to leave, which negatively impacts their mental health.

To our knowledge, this is the first study to explore the impact of corruption on adolescent mental health. Given the limited educational resources and the opaqueness of political systems in developing countries like China, the education sector is particularly susceptible to corruption. We have uncovered evidence that corruption in junior high school admissions can harm adolescent mental health. By using a nationally representative sample of Chinese adolescents, we revealed that those who attended junior high school through corrupt means had worsened mental health. Different matching algorithms of PSM were employed and demonstrated the robustness of the results. We employed four matching methods, including 1:1 nearest neighbor matching, 1:4 nearest neighbor matching, radius matching, and kernel matching. All these different matching methods yielded consistent results. The previous research on the topic of corruption has mainly focused on the employees in public sectors, and the development of the economy 25 , 26 , 27 . However, there has been relatively little attention paid to the issue of corruption during school admission in developing economies. Our study fills this research gap and provides a new perspective to understand the mental health problems among Chinese adolescents.

Corruption engenders asymmetrical outcomes, whereby certain individuals reap benefits at the expense of others. We argued that even for adolescents who benefited from corruption, it may not lead to the phenomenon of "winner takes all". Although those who attended junior high school by corrupt means may gain benefits, cognitive dissonance theory suggests that people have a natural tendency to seek consistency between their beliefs and actions, when there is a conflict between these elements, it creates a state of mental discomfort 28 . For adolescents who have benefited from corruption, their belief in fairness, which stems from basic educational concepts, inspiring the idea that unfairly enrichment through corruption is entirely wrong. However, since they gained admission by corrupt means, the conflict between their belief and behavior created negative mental health effects. We proposed an extension of the cognitive dissonance theory by providing insight into the psychological mechanisms underlying the conflict between moral values and corrupt experience among adolescents.

We have revealed some of the mechanisms by which corruption can have a negative impact on adolescent mental health. Existing literature mainly explored the mechanisms from the perspective of economic or income fluctuations 2 . Focused on adolescents, this research provides a new angle to understand why corruption can hurt their mental health. We found that corruption did not have a significant impact on interpersonal relationships. One possible reason is that classmates may not be aware of each other's admission processes, and friendships are often based on common interests and hobbies. Teacher criticism is the primary mechanism, they play a crucial role in maintaining justice and may inclined to strive to completely eradicate corrupt practices and ensure that everyone in the class is enrolled through fair and legal means. However, the current educational system is difficult to change dramatically in the short term, which means that corrupt practices during the admission process may persist for some time. Teachers themselves are unable to change this situation. As a means of upholding justice, teachers tended to offer more criticism towards those who benefited from corrupt practices as a form of psychological compensation. Moreover, criticism is a common means for teachers to provide negative feedback, it may trigger a series of negative mental health outcomes, including undermining adolescents' self-concept and sense of worth 29 , 30 . Chinese students are particularly sensitive to negative feedback from teachers, which may lead them to depreciate their own abilities 31 , trigger defense mechanisms, resulting in feelings of resentment 32 , and in severe cases, even mental health disorders 33 . Moreover, when teachers criticize students' parents, it may be perceived as a punishment for engaging in corrupt practices, causing increased psychological distress and evoking feelings of shame among adolescents, amplifying the negative psychological impacts generated by cognitive dissonance. Remaining in the current situation becomes a psychological torment, to ease this punishment, they are more inclined to leave the current school. Therefore, these punishments and psychological costs have exacerbated the mental health of adolescents.

This paper contributes to a broad literature focused on justice in the school environment. The first strand used physical environmental justice and found environmental risks, such as poor air quality, poor community design, or contaminated playgrounds, could lead to respiratory illness, and poor performance in school 34 , 35 . The second strand focused on perceived school justice, and examined its correlation with students’ engagement, academic performance, reported bias-based bullying, and school violence 36 , 37 , 38 , 39 . This article differs from the existing literature as we studied the negative effects of ex-ante injustice in junior high school, and we demonstrated the importance of educational justice from a new perspective.

This research echoes the significance of anti-corruption efforts in education sectors, inattention to corruption in school selection will place all other aspects of a nation’s economic and social ambitions at risk 40 . Empirical evidence has revealed that anti-corruption campaigns in China have effectively reduced the BMI and overweight rates of public sector employees 25 , while similar campaigns in Vietnam have had substantial positive impacts on the mental health of adults 2 . Our results suggest that the actions of anti-corruption in junior high school admissions might improve adolescent mental health.

Although China has a relatively sound legal system to combat corruption in admissions, corruption in the admissions field still occurs and is reported frequently. The lack of sufficient constraints and supervision over the power of education officials is the root cause of corruption, while the unequal distribution of educational resources exacerbates the likelihood of such corruption occurring. Measures to curb admission corruption should be strengthened. First, it is crucial to improve the institutional framework for combating corruption in the education sector, which can be achieved by implementing transparent and equitable admission procedures and imposing stringent penalties for corrupt activities. Second, the financial support for basic education should be distributed fairly in different schools, which can reduce the gap in school educational facilities. Third, promoting teacher rotation between schools is necessary for the equalization of teacher resources. In sum, the findings of this paper underscore the importance of developing countries prioritizing efforts, and implementing timely and effective measures to ensure equity within the education sector.

This study has limitations that should be noted. First, it should be noted that corruption in China varies significantly across different regions, and the presence of a large number of internal migrants may lead to diverse educational resource demands in different areas, highlighting the significance of exploring regional differences. However, the data used in this study does not provide comprehensive geographic information, which hinders us to examine the impact of corruption based on regional variations. Second, due to the strict confidentiality of personal information in the questionnaire, and the fact that corrupt admission behavior will not be subject to subsequent punishment after admission, parents have no need to systematically provide incorrect answers to this question. Nevertheless, it must be acknowledged that there may still be some parents who did not provide truthful answers. Third, adolescent mental health trauma can persist over an extended period 41 , and have a profound impact on an individual's development. Examining the long-term mental health effects of corruption are both interesting and meaningful. Unfortunately, the limited sample periods provided by the China Education Panel Survey (CEPS) make it impractical to uncover this phenomenon at present.

Data availability

The data used in this paper is from the China Education Panel Survey (CEPS). The official direct accessible link to the survey is http://www.cnsda.org/index.php?r=projects/view&id=72810330 .

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Thanks to the China Education Panel Survey for providing detailed data support for this study.

The funding was provided by Zhijiang Youth Special Project from Zhejiang Provincial Philosophy and Social Sciences Planning (No. 24ZJQN062Y).

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Research on Corruption: Critical Empirical Issues

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Past research on corruption, both prolific and with a long history, covers many fields. It is not the intention of this chapter to faithfully survey where research stands today or to give an objective and comprehensive view of the many paths such research could take in the future. 1 Instead, I try to discuss areas of research emphasis for the next phase of corruption research in an admittedly selective fashion, explicitly recognizing the author’s bias as an operationally-oriented research economist. As such this chapter aims at putting some heretofore under-emphasized issues at the forefront of discussion, as well as furthering debate on unresolved issues. 2

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Kaufmann, D. (1998). Research on Corruption: Critical Empirical Issues. In: Jain, A.K. (eds) Economics of Corruption. Recent Economic Thought Series, vol 65. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-4935-2_7

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130 Corruption Essay Topics

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• Corruption, Pollution, Inequality Are Top Concerns in China

Many Worry about Threats to Traditions and Culture

Table of contents.

• Methodology

China’s economic growth rate may be slowing, but the Chinese public overwhelmingly recognizes the economic progress their country has made over time. Most say they are better off financially than they were five years ago, and with near unanimity they believe they enjoy a higher standard of living than their parents did.

Meanwhile, there are signs that China’s remarkable economic expansion has had some negative side effects. For instance, many Chinese are concerned about air and water pollution, as well as widening inequality. And serious concerns about food safety have nearly tripled since 2008.

These are among the key findings from a Pew Research Center survey in China, which is based on face-to-face interviews conducted from April 15 to May 27, 2015, among a nationally representative sample of 3,649 randomly selected adults. 1

Corrupt Officials Seen as Top Problem

Among the 15 issues included in this survey, nine are considered either a very big or moderately big problem by at least 70% of the Chinese public. However, no issue tested is rated as a very big problem by half or more of the population. Concerns over corrupt officials top the list, with 44% of Chinese saying this is a very big problem. Still, this is down 10 percentage points from 2014, when 54% cited corrupt officials as a top concern.

Only about two-in-ten cite corrupt businesspeople, education, unemployment, traffic and working conditions as very big problems for China.

While the safety of medicine and the quality of manufactured goods are cited as a top worry by fewer than three-in-ten Chinese, concerns have risen by 19 points and 15 points, respectively, since 2008.

On the other hand, concerns about inflation have eased substantially. In 2008, when inflation stood at 5.9% , about seven-in-ten Chinese (72%) were very concerned about rising prices. With a more manageable 1.4% inflation rate projected for 2015, only 30% cite rising prices as a top concern, a decline of a staggering 42 percentage points over seven years.

Chinese Divided on Whether Many Problems Will Get Better or Worse

In China’s two largest cities, pessimism about air quality is widespread. More than half of those living in Beijing and Shanghai (53%) say air pollution will get worse in the next five years, compared with roughly a third (34%) of those living elsewhere in China. A recent study linked air pollution to 1.6 million deaths a year in China, with some of the most concentrated sources of pollution found in the northeast corridor that extends from Shanghai to Beijing.

On the issue of corruption, optimism about improvement varies considerably by education and income. For example, 71% of higher-income Chinese believe corruption will improve in the next five years, compared with 58% of those with lower incomes. 2 Roughly two-thirds of Chinese with a secondary education or higher (68%) expect corruption to get better, compared with about six-in-ten among people with less than a secondary education (59%).

Widespread Belief that Standard of Living Has Improved

Despite concern about a wide range of issues, many are satisfied with their economic situation. Majorities in China have consistently rated their personal economic situation positively. In 2008, 66% of Chinese said their personal finances were good. In 2015, 72% hold this view.

Roughly three-quarters of Chinese (77%) believe their family is better off today than they were five years ago. Only 4% say they are worse off financially than they were five years ago and 17% say they are about the same.

Not only do many Chinese rate the current state of their finances positively, but an overwhelming majority sees the effects of China’s economic advancement over the past generation. Nearly all Chinese (96%) say their current standard of living is better than their parents’ standard of living at the same age. This is relatively unchanged from 2012, when 92% of Chinese said their standard of living was superior to that of their parents’ generation.

Chinese See Traditions and Culture under Threat

• The survey was conducted prior to the August downturn in Chinese stock markets and the devaluation of the yuan. ↩
• Income categorization based on income levels that are higher and lower than the median household income within China. ↩

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Nigerian Budget Allocates N100M To Atomic Energy Commission For Sewing, Grinding Machines In Anambra, N100M To Chemical Research Agency For Tricycles In Borno

According to Tracka, an accountability organisation monitoring public projects across the country there are instances where funds designated for specific constituencies were incorrectly assigned to unrelated government agencies, raising concerns about fiscal accountability and transparency.

The 2024 Federal Government budget has come under scrutiny following revelations of significant misallocation of funds across several Zonal Constituency Intervention Projects (ZIPs). 

Among the discrepancies identified, the National Mathematical Centre received N163 million for the provision of three-in-one solar street lights in various communities within Ezza North/Isihe Local Government Area, Federal Constituency of Ebonyi State. 

This allocation is originally intended for local development projects aimed at enhancing infrastructure within the constituency.

Similarly, the Nigeria Atomic Energy Commission was allocated N100 million for empowerment materials, including sewing and grinding machines, purportedly for Ogbaru Federal Constituency, Anambra State. 

Meanwhile, the National Research Institute for Chemical Technology (NARICT) in Zaria received N100 million for the provision of tricycles (Keke Napep) in Borno South Senatorial District, Borno State, which deviates from its intended scope.

Further discrepancies include the Nigeria Institute of Oceanography and Marine Research, which was allocated N50 million for the construction of classrooms in Obudu/Bekwarra/Obanliku Federal Constituency, Cross River State. 

These misallocations extend to projects such as the provision of comprehensive medical outreach by the National Space Research and Development Agency (NASRDA) in Awe, Doma, and Keana Federal Constituency, Nasarawa State.

Moreover, the News Agency of Nigeria (NAN) received N100 million for agricultural empowerment in Kwande/Ushongo LGA, Benue State, originally earmarked for women and youth empowerment initiatives. 

The Nigerian Army was also allocated N80 million for a solar-powered borehole in Arochukwu Local Government Area, Abia State, which was meant for infrastructure projects within the state.

Also, the National Lottery Trust, allocated N125 million for ICT centres in Delta Central Senatorial District, Delta State, and the National Space Research and Development Agency Development, which received N95 million naira for solar street lights in Katsina Central Senatorial District, also faced scrutiny for improper allocations.

This incident underscores the importance of transparency and accountability in public finance management to maintain public trust and foster effective implementation of developmental projects nationwide.

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