Understanding the limited presence of petty corruption in Finnish healthcare
PULSE chief researcher prof. Anna-Maija Lämsä shares insights into why petty corruption is rare in the Finnish healthcare system
PULSE chief researcher prof. Anna-Maija Lämsä shares insights into why petty corruption is rare in the Finnish healthcare system
As part of the project Petty Corruption Unveiling in the Lithuanian Healthcare Sector: Exploring Individual Choices, Institutional Patterns, and Anticorruption Policy Perspectives (PULSE), funded by the Research Council of Lithuania (No. S-MIP-24-25), one strand of the project focuses on identifying practices in Finland that address and help eliminate petty corruption in the healthcare sector.
To discuss about this topic, a series of discussions were held with healthcare specialists and experts in professional ethics familiar with the Finnish healthcare context. To ensure promised full anonymity, all participants are referred to using alphabetical identifiers (A, B, etc.). At the end of this blog, the timing of each discussion and the participants’ profession are provided. All participants possess extensive professional experience in the healthcare sector, ranging from many years to several decades. Moreover, their experience across multiple roles has contributed to the development of comprehensive and nuanced perspectives on the issue.
In this blog, drawing on the PULSE project objectives, the aim is to analyze and deepen understanding of the following questions:
– Why is petty corruption uncommon in Finnish healthcare, with particular focus on the values that shape professionals’ mindsets and behavior? What kinds of moral emotions are associated with these values?
Across discussions with healthcare professionals and experts, a consistent view emerged: the relative absence of petty corruption in Finnish healthcare cannot be explained solely by specific practical arrangements—such as transparent digital systems, well-designed whistleblowing channels, clear and publicly available fee structures, complaint mechanisms, and patient ombudsman system, important as these are. Rather, the interviewees emphasized the broader significance of values—both within healthcare and in Finnish society more generally—in shaping expectations and practices that reduce the likelihood of petty corruption.
This prompted a more explicit examination of the topic in this blog. To do so, it is drawn on well-known Finnish proverbs to illustrate the issue, as they convey moral meanings and cultural beliefs within a community (Ferrari & Siqueira, 2023; Lakoff & Johnson, 2008). The following two proverbs can be seen as expressing important value-based principles that guide people’s mindsets and behavior in Finland:
– “Honesty brings lasting rewards”
– “You get what you deserve”
Proverbs can be understood as culturally embedded, metaphorical expressions that both reflect and shape shared understandings of what is considered appropriate, right and wrong in a given society. As Helkama (2018) suggests, such expressions carry, reproduce, and reinforce culturally grounded moral meanings, thereby contributing to the formation of individuals’ identities and moral reasoning. In a similar vein, Lakoff and Johnson (2008) argue that metaphors are not merely linguistic devices but are central to how people understand and make sense of the world. From this perspective, proverbs can be seen as part of the cultural-cognitive framework through which social reality—including notions of moral appropriateness, obligation, and fairness—is constructed and maintained.
The question addressed in this blog is relevant, as available evidence indicates that corrupt behavior is relatively uncommon in Finland, and Finns rarely encounter corruption in their daily lives (Anti-corruption efforts; Corruption in Finland). This is reflected in Transparency International’s Corruption Perceptions Index (2025), in which Finland ranks as the second least corrupt country out of 182. Interestingly, despite ongoing challenges in the Finnish healthcare sector—such as diminishing financial resources and structural reorganization—the occurrence of petty corruption has not increased, even though such pressures could act as potential triggers. Furthermore, the high level of interpersonal and institutional trust in Finland—among the strongest in OECD countries—underpins the functioning of democratic governance and public healthcare systems, which can be considered to be associated with the relatively low prevalence of petty corruption (OECD, 2021).
One of the most well-known proverbs in Finland, “Rehellisyys maan perii”—translated as “Honesty brings lasting rewards”—captures a central Finnish cultural belief particularly relevant here. It conveys the importance of being truthful and transparent in both personal and professional conduct (Helkama & Portman, 2019). The proverb provides a moral message that acting with honesty ultimately leads to long-term benefits, whether social, personal, or material. It reflects the belief that honesty is both morally valued and a practical path to success, alongside an expectation that individuals act accountably.
Overall, honesty encompasses values such as integrity, openness, and accountability, referring to adherence to moral standards and a commitment to truthfulness in one’s actions and interactions (OECD, 2021). For example, respondent F emphasized that healthcare professionals are bound by a professional duty to provide good care without engaging in questionable practices, and that this duty must be upheld in everyday work to sustain patients’ trust. Moreover, F noted that, as healthcare in Finland is largely tax-funded, there is a broader societal expectation that healthcare professionals uphold this promise and act in a trustworthy and honest manner.
This proverb is so widely recognised that it could be argued that nearly every Finn learns it and becomes familiar with it from childhood. Individuals are thus socialised from an early age to adhere to this principle, which they tend to internalise and enact in practice (Schwartz, 2012). In line with Helkama and Portman (2019), honesty appears to be consistently appreciated, recognised and upheld in national, individual, and behavioral contexts. Its pervasive presence in Finnish culture reflects a deep-rooted expectation that honesty serves as a guiding principle in everyday life, including professional contexts such as healthcare. This emphasis on honesty was also evident in respondents’ accounts (e.g., E and F), who framed petty corrupt behavior in healthcare—and in society more broadly—as an ethical problem, including cheating, violations of professional ethics, and breaches of trust.
The healthcare specialists I spoke with reported that they would be extremely surprised if a patient or a family member attempted to offer any form of petty corruption (C, E, F). For example, respondent E noted that accepting even a minor informal payment would trigger a profound sense of shame, pose a reputational risk to one’s professional “face” (Goffman, 1955), and potentially result in the loss of the legitimacy and legal right to practice their profession. The respondents emphasized that it would never occur to them to accept such an offer, nor would they expect anyone to make one. This discussion illustrates that when honesty is activated—even in a hypothetical scenario—it becomes readily infused with the moral emotion of shame (Greenbaum et al., 2020; Haidt, 2003) in Finland, constructed as a response to perceived violations of generally accepted and valued moral behavior while also functioning as a moral constraint that discourages engagement in such behavior.
Furthermore, respondents E and F emphasized that, both as healthcare professionals and as human beings, being honest and maintaining a clear conscience is essential for self-respect—a sense of personal worth and dignity that comes from acting in ways that align with important moral values and uphold one’s integrity. Based on their statements in our discussion, acting honestly appears to be associated with ways of behaving that may generate a sense of moral pride. This, in turn, can strengthen feelings of personal worth and dignity, thereby having the potential to foster a positive cycle of ethical behavior among healthcare professionals.
At the same time, as respondents A and C noted, a risk exists because healthcare professionals—especially medical doctors—often demonstrate strong loyalty to one another (Mascia, 2013), which can make it difficult to reveal or intervene in a colleague’s dishonest or unethical behavior. However, they emphasized that the contemporary healthcare system includes channels and mechanisms to ensure that such issues are addressed and revealed. Respondents B, C, and D further highlighted that advanced digitalization system, in particular, can enhance transparency among actors in healthcare services, though it represents only one of several ways to promote honesty and accountability.
This popular proverb, “Sitä saat mitä tilaat”—translated as “You get what you deserve”—reflects the values of fairness and justice, suggesting that individuals ultimately experience the consequences of their actions, whether as rewards or punishments, in accordance with their behavior. It conveys a widely shared cultural belief in Finland that fairness, justice, and responsibility guide how people are treated and what outcomes they experience in life. The proverb also implies that such outcomes may not be immediate but emerge over time; for instance, someone who exploits others’ work or situation for personal gain may achieve short-term advantages, but over time these may turn into losses that outweigh the initial benefits.
As highlighted by Airaksinen (1987), although the concepts of fairness and justice are often used interchangeably, they can be distinguished. Justice refers to institutional arrangements, such as laws, policies, and rights, and addresses the question: What is the right rule or principle? For example, a healthcare policy that allocates resources according to medical needs reflects justice. Fairness, by contrast, refers to how people perceive and experience treatment, focusing on whether specific behavior is regarded as appropriate, right, or reasonable in a particular situation. For instance, a patient who feels they were treated equally by healthcare professionals is experiencing fairness.
Helkama and Portman (2019) suggest that values such as justice and fairness, while operating at different levels, are interconnected and collectively shape the behavior of both institutions and individuals in Finland. In line with this, respondent B emphasized the importance of embedding ethical values in healthcare education—not only as a curricular topic, but also through institutionalized policies and practices across schools and the wider healthcare system. This not only helps prevent petty corruption in healthcare but also fosters professional pride and creates opportunities for satisfaction in everyday work.
Respondents linked justice and fairness with equality and equity in healthcare. Equality refers to equal provision of services to all, whereas equity denotes the absence of avoidable and unjust differences in access to and quality of care, ensuring that services are provided according to individuals’ needs (World Health Organization, 2008). Respondents E and F emphasized that institutional rules and arrangements in the Finnish healthcare system are central to realizing these values, and that professionals have a responsibility to adhere to them.
Respondent E highlighted the Finnish Public Health Act (Kansanterveyslaki 66/1972), in force from 1972 to 2022, as foundational both to the value base and organizing of healthcare in Finland. The Act required municipalities to establish low-cost health centers and marked a shift toward preventive care, with the aim of improving access and reducing health inequities. Although replaced in 2023 following healthcare reform, its core values of justice and fairness—intended to ensure the equal treatment of patients and all those in need of care—remain embedded in professionals’ mindsets and practices.
Consequently, the values of justice, fairness and responsibility continue to guide professional ideals, particularly the commitment to equality and equity. As E and F noted, all individuals, regardless of their background, are expected to receive equal care—a principle instilled in healthcare professionals. A key aspect of this is being perceived, by oneself and others, as a trustworthy and respected professional who adheres to professional and general duties and established rules.
Moreover, respondents C and F noted that public and organizational control and complaint systems exist in healthcare to address corrupt behavior in everyday work, and that there is confidence in their effectiveness in general. C added that colleagues can report concerns through these systems. F emphasized that healthcare professionals are well aware that petty corruption or any unethical behavior is likely to be detected, generating fear and anxiety about potential punishment, which in turn reduces their willingness to engage in such practices.
In general, research suggests that fear of detection and punishment act as deterrents to unethical and corrupt behavior (e.g., Kaptein, 2011; Paternoster, 2010). Thus, guilt as a moral emotion, together with the perceived risk of being found to have violated rules, tends to play an important role in addressing and helping to eliminate petty corruption—particularly when control and complaint systems are visible, trusted, and operate effectively.
The discussion in this blog is summarized in Table 1.
| Guiding principle | Values | Moral emotions |
| Proverb: “Honesty brings lasting rewards” | Integrity, openness, accountability |
Pride when the values are followed Shame when the values are not followed |
| Proverb: “You get what you deserve” | Justice, fairness, responsibility |
Pride and moral satisfaction when the values are followed Guilt when the values are not followed |
Foundation: High interpersonal and institutional trust in Finland
In Table 1, the key ideas relevant to the PULSE project objectives are presented, combining insights from respondent discussions with literature sources. Overall, the values and associated moral emotions discussed in this blog are characteristic of Finland’s Protestant-influenced society, as highlighted by Helkama and Portman (2019). The high level of trust in Finland—widely recognized as a high-trust society—exists at both interpersonal and institutional levels (OECD, 2021; European Social Survey). These forms of trust are closely interconnected and help sustain respect for the values in healthcare discussed here. Consequently, they underpin the effective functioning of healthcare institutions and shape everyday social interactions.
However, other values and moral emotions related to petty corruption, which are not covered here, also can exist. For example, empathy—the concern for patients’ well-being—is worth examining in future, as it can promote ethical behavior by prioritizing others’ needs over self-interest, thereby reducing the likelihood of petty corruption. At the same time, excessive empathy toward a specific patient may carry the risk of unfairness, for instance in equitable access to care.
A conceptual clarification is relevant here. The term moral emotion is used in this blog (see, e.g., Greenbaum et al., 2020; Haidt, 2003), but the concept can be controversial. It is not always clear whether a given emotion is genuinely moral, even if it appears so on the surface. For example, shame, as discussed here, can be understood as a moral emotion: it reflects negative self-evaluations of one’s moral character or behavior, in which healthcare professionals may worry that others will perceive them as acting against standards of virtuous, right, and ethical conduct (Greenbaum et al., 2020). At the same time, shame may sometimes be unrelated to morality, functioning instead as a socially embedded feeling arising from, for instance, failing to follow etiquette or polite behavior.
Based on this blog, an interesting topic would be to compare values and associated moral emotions related to petty corruption in healthcare between Finland—the focus here—and Lithuania, the empirical context of the PULSE project. Such a study could illuminate cultural differences that help explain the higher prevalence of petty corruption, particularly informal payments, in Lithuanian healthcare (Stepurko et al., 2015; Pakstaitis, 2019; Transparency International) compared with their limited occurrence in Finland. For instance, Castro et al. (2019) and Torsello (2024), who examined corrupt practices outside healthcare, argue that the most challenging situations arise when corrupt behavior is regarded as culturally acceptable within a specific field. Consequently, adopting a cultural lens can provide valuable insight for understanding and addressing petty corruption in healthcare.
Finally, one may ask whether healthcare professionals in Finland always act according to the principles and values discussed here. Clearly, they do not always, nor do all of them. Nevertheless, it is my belief that most strive to act, and generally do act, in accordance with these values. The gap between values and actual behavior has a long tradition in literature. While a broader discussion is beyond the scope of this blog, it is important to acknowledge its existence.
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A. Responsibility and Ethics Consultant (Expert in Healthcare Organization Ethics), 28 February 2025
B. Health Sciences Researcher (Expert in Professional Ethics in Healthcare), 24 September 2025
C. General Physician (Healthcare Specialist), 7 November 2025
D. Kanta Services (Expert in the Operations of Healthcare Systems), 8 December 2025
E. Special Physician (Healthcare Specialist), 30 January 2026
F. Clinical Nurse Specialist (Healthcare Specialist), 10 March 2026