Profiting from Marginalized Patients: Examining the Links Between Collective Corruption and Marginalization in Public Healthcare

Using data from three teaching hospitals in Peshawar, Pakistan, we show how a group of senior doctors in public hospitals encouraged a vulnerable group of low-income patients to pay for expensive private healthcare. The doctors had established a dual system of running private clinics alongside their jobs in public healthcare, recruiting public hospital staff to work for them and collaborating with profit-seeking associates to build their businesses. Leveraging hegemonic power and social control, they persuaded patients from low-income marginalized communities to pay large sums for private healthcare. As these poorer patients were increasingly steered away from the state system, it became clear to them that the net result would be the continued descent into debt, destitution, and misery. We contend that by using positional power for financial self-interest, the senior doctors resorted to cultural isolation to instill fear and socially exclude low-income patients. By elucidating how doctors exploited this marginalized group, we contribute to theories of cultural marginalization and collective corruption.