Informal patient payments and public attitudes towards these payments: evidence from six cee countries

Abstract

Informal patient payments are deeply rooted in Central and Eastern European countries. Despite the socio-political changes in the health care sectors after 1990s and the subsequent health care reforms, informal payments for health care services continue to serve patients` and physicians` interests. These payments also fill gaps in health care funding in this European region. Nevertheless, unofficial payments are not a desirable payment channel. They lack transparency and distort the efficiency and equity in health care provision. Still, the successful elimination of these payments will depend on the public attitude towards these payments. This study aims to compare public attitudes towards informal patient payments and payment experience in six Central and Eastern European: Bulgaria, Hungary, Lithuania, Poland, Romania, and Ukraine. The data have been collected in 2010 in nation-wide representative surveys using an identical standardized question- naire administrated via face-to-face interviews. We have collected about 1000 questionnaires in each country. The results show that a major group of respondents in each country expresses a negative attitude towards both informal cash payments and in-kind gifts. 208, 187, and 174 respondents paid informally for out-patient service in Ukraine, Romania, and Hungary respectively. We also analyse the relation between public attitudes and respondents` past experience with informal payments, e.g. whether they have paid informally payment for out-patient service used last year. In Bulgaria and Poland, negative attitude is mostly observed among those who have not paid informally. The existence of positive and indifferent attitudes towards informal pay- ments as reported in our study, indicates a challenge for policy makers in Central and Eastern European countries. The acceptance of government initiatives aimed at the elimination of informal payments will largely depend on the governments` ability to create a social resistance towards these payments.