Conflicts of Interest: An Invisible Force Shaping Health Systems and Policies
Despite years of discussion and frustration about why public health evidence does not influence policy decisions as much as it should, there has been little attention to a fundamental force in decision making: conflicts of interest. Conflicts of interest arise when the potential for individual or group gain compromises the professional judgment of policy makers or health-care providers. Conflicts of interest underpin rent-seeking and informal practice across the world, but their nuanced nature makes them challenging to identify, research, and address. Conflicts of interest are often very subtle; no action needs to be taken for them to exist.
In many countries, the heterogeneous nature of mixed health systems and complex care pathways are compounded by weak governance mechanisms, which increase the potential for conflicts of interest to occur and make them difficult to address with existing regulatory and policy frameworks, including self-disclosure mandates or malpractice procedures. To begin to illuminate these issues and to develop a research agenda, the present authors have characterized three different types of conflicts of interest that are particularly pervasive in mixed or pluralistic health systems (table). The authors emphasize how these conflicts impede the development of health policies to better structure and govern state and non-state health-care providers.
- The first type of conflict of interest occurs when policy makers or regulators have multiple or dual roles.
- The second type of conflict of interest occurs because of hidden financial relationships between formal (licensed) and informal (unlicensed) health-care providers.
- The third type of conflict of interest occurs when policy makers are influenced into taking a course of action that is more likely to win political support, rather than following public health evidence.
The authors have discussed the role of conflicts of interest in mixed health systems with weak governance mechanisms, but the influence of conflicts of interest on health policies is widespread.
Although conflicts of interest remain a global issue that is neglected, underestimated, and overlooked by health policy makers and researchers, conflicts of interest connect with many wider issues within health policy and systems research. At present, there is a growing body of evidence and concern surrounding corruption in health systems. This attention to corruption is likely to result in interest in examining and making sense of conflicts of interest in the coming years. The authors hope that their characterization of conflicts of interest is a useful tool in beginning this necessary work.