Administrative tasks are essential at all levels of the health care system, from ministries and insurers to health providers. Many tasks are vital to ensure access, equity and quality of health care provision. Other activities may be of limited use, adding no value for patients.This chapter looks into differences in administrative costs at the level of the health care system, for both health care facilities and individual health workers. Some differences are related to the way health care is financed. Many countries see the need to tackle inefficiencies in health care administration. The most promising strategies to increase efficiency are centred on simplifying procedures – partly by making better use of ICT – and optimising the size of administrative bodies to generate economies of scale. Additionally, regulatory changes can have an enormous and immediate effect on administrative costs and the administrative workload of health providers.

This chapter discusses fraud, abuse, corruption and other integrity violations that divert resources from the health care system and as such are wasteful. The first section explains why the health sector is prone to integrity violations and gathers evidence on the scale of the problem in OECD countries. The second section analyses in more details integrity violations in service delivery and financing and reviews how OECD countries detect, prevent and tackle them. The third section points to the most common inappropriate business practices observed across health care systems and maps some of the regulatory and self-regulatory approaches used by countries to limit such practices.