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Horodnic AV, Williams CC, Ciobanu CI, Druguș D. Informal payments by patients, institutional trust and institutional asymmetry. Front Psychol 2022; 13:1015208. [PMID: 36337539 PMCID: PMC9632436 DOI: 10.3389/fpsyg.2022.1015208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this paper is to evaluate the extent of the practice of using informal payments for accessing the services of public clinics or hospitals across Europe and to explain the prevalence of this corrupt practice using the framework of institutional theory. To achieve this, a multi-level mixed-effect logistic regression on 25,744 interviews undertaken in 2020 with patients across 27 European Union countries is conducted. The finding is that the practice of making informal payments remains a prevalent practice, although there are large disparities in the usage of this practice in different European countries. However, informal payments by patients are more likely when there is a lower institutional trust and a higher degree of asymmetry between formal and informal institutions. The resultant proposal is that policy makers need to address the institutional environment to tackle such informal payments. How this can be achieved is outlined.
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Affiliation(s)
- Adrian V. Horodnic
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
- *Correspondence: Adrian V. Horodnic,
| | - Colin C. Williams
- Management School, University of Sheffield, Sheffield, United Kingdom
| | - Claudia Ioana Ciobanu
- Faculty of Civil Engineering and Building Services, Gheorghe Asachi Technical University of Iași, Iași, Romania
| | - Daniela Druguș
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
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Horodnic AV. Trends in Informal Payments by Patients in Europe: A Public Health Policy Approach. Front Public Health 2021; 9:780337. [PMID: 34881220 PMCID: PMC8645776 DOI: 10.3389/fpubh.2021.780337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: A new institutional approach toward informal payments in healthcare views informal payments as arising when there is a misalignment between values/norms (informal institutions) and the formal rules (formal institutions) of patients. However, less knowledge is available on the effectiveness of this approach in tackling informal payments in healthcare. This study aimed to fill this gap by evaluating the trends in the effect of institutional misalignment on informal payments made by patients. Methods: A quantitative study design with data extracted from the last three waves of special Eurobarometer surveys on corruption was used to model the propensity of European patients in 27 European Union countries and the United Kingdom to make informal payments. Multilevel logistic regression analysis was employed in order to test the relationship between the formal-informal institution misalignment and the likelihood to make informal payments. Sensitivity analyses were also performed to test the robustness of the findings. Results: The finding is that there is a strong association between the formal-informal institution misalignment and the likelihood to make informal payments for public healthcare services. Similarly, social norms play a pivotal role. When patients perceive that informal practices are widespread in the public healthcare sector they are more likely to make informal payments themselves. Conclusion: The outcome is a call for complementing deterrence measures toward informal payments in healthcare with measures aiming to reduce the formal-informal institution misalignment and to change the social norms. This can be achieved by improving the structural conditions at country level and by changing values/norms and beliefs of patients.
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Affiliation(s)
- Adrian V Horodnic
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania
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Institutional Determinants of Informal Payments for Health Services: An Exploratory Analysis across 117 Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312421. [PMID: 34886147 PMCID: PMC8657077 DOI: 10.3390/ijerph182312421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022]
Abstract
Healthcare accessibility and equity remain important issues, as corruption in the form of informal payments is still prevalent in many countries across the world. This study employs a panel data analysis over the 2006-2013 period to explore the role of different institutional factors in explaining the prevalence of informal payments. Covering 117 countries, our findings confirm the significant role of both formal and informal institutions. Good governance, a higher trust among individuals, and a higher commitment to tackling corruption are associated with diminishing informal payments. In addition, higher shares of private finance, such as out-of-pocket and domestic private health expenditure, are also correlated with a lower prevalence of informal payments. In policy terms, this displays how correcting institutional imperfections may be among the most efficient ways to tackle informal payments in healthcare.
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Horodnic AV, Williams CC, Drugă RI, Incaltarau C. Informal Payments by Patients in Central and Eastern Europe during the COVID-19 Pandemic: An Institutional Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10914. [PMID: 34682651 PMCID: PMC8535994 DOI: 10.3390/ijerph182010914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/01/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
Confronted with a global pandemic, public healthcare systems are under pressure, making access to healthcare services difficult for patients. This provides fertile ground for using illegal practices such as informal payments to gain access. This paper aims to evaluate the use of informal payments by patients during the COVID-19 pandemic and the institutions that affect the prevalence of this practice. Various measurements of formal and informal institutions are here investigated, namely the acceptability of corruption, the level of trust, transparency, and performance of the healthcare system. To do so, a logistic regression of 10,859 interviews with patients conducted across 11 Central and Eastern Europe countries in October-December 2020 is employed. The finding is that there are large disparities between countries in the prevalence of informal payments, and that the practice is more likely to occur where there are poorer formal and informal institutions, namely higher acceptability of corruption, lower trust in authorities, lower perceived transparency in handling the COVID-19 pandemic, difficult access to, and poor quality of, healthcare services, and higher mortality rates due to the COVID-19 pandemic. These findings suggest that policy measures for tackling informal payments need to address the current state of the institutional environment.
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Affiliation(s)
- Adrian V. Horodnic
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (R.I.D.); (C.I.)
| | | | - Răzvan Ionuț Drugă
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (R.I.D.); (C.I.)
- Faculty of Economics and Business Administration, “Alexandru Ioan Cuza” University of Iași, 700505 Iași, Romania
| | - Cristian Incaltarau
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (R.I.D.); (C.I.)
- Centre for European Studies, “Alexandru Ioan Cuza” University of Iași, 700507 Iași, Romania
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Buch Mejsner S, Kristiansen M, Eklund Karlsson L. Civil Servants and Non-Western Migrants' Perceptions on Pathways to Health Care in Serbia-A Grounded Theory, Multi-Perspective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10247. [PMID: 34639551 PMCID: PMC8547138 DOI: 10.3390/ijerph181910247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/15/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Informal patient payments continue to persist in the Serbian health care system, exposing vulnerable groups to private spending on health care. Migrants may in particular be subject to such payments, as they often experience barriers in access to health care. Little is known about migrants paying informally to access health care in Serbia. The study aims to explore pathways of accessing health care, including the role of informal patient payments, from the perspectives of civil servants and non-western migrants in Serbia. (2) Methods: Respondents (n = 8 civil servants and n = 6 migrants) were recruited in Belgrade in 2018, where semi-structured interviews were conducted. The interviews were analysed applying the grounded theory methodological steps. (3) Results: Data reveal different pathways to navigate the Serbian health care system, and ultimately whether paying informally occurs. Migrants appear less prone to paying informally and receive the same or better-quality health care. Locals experience the need to pay informal patient payments, quasi-formal payments and to bring medicine, materials or equipment when in health facilities. (4) Conclusions: Paying informally or using private care in Serbia appear to have become common. Despite a comprehensive health insurance coverage, high levels of out-of-pocket payments show barriers in accessing health care. It is highly important to not confuse the cultural beliefs with forced spending on health care and such private spending should be reduced to not push people into poverty.
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Affiliation(s)
- Sofie Buch Mejsner
- Unit for Health Promotion Research, University of Southern Denmark, Degnevej 14, 6705 Esbjerg, Denmark;
| | - Maria Kristiansen
- Department of Public Health, Center for Healthy Aging, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark;
| | - Leena Eklund Karlsson
- Unit for Health Promotion Research, University of Southern Denmark, Degnevej 14, 6705 Esbjerg, Denmark;
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Doshmangir L, Sajadi HS, Ghiasipour M, Aboutorabi A, Gordeev VS. Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran. BMC Public Health 2020; 20:539. [PMID: 32312238 PMCID: PMC7171751 DOI: 10.1186/s12889-020-8432-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2014, a revision of the national medical tariffs for inpatient health care services took place in Iran, and a new hotline was set up to report informal payments. It was expected that such measures would eliminate or decrease informal payments prevalence. This study estimates the prevalence of informal payments for inpatient health care services in the post-reform period, explores factors associated with informal payments and examines patients' and healthcare providers' views regarding the causes of informal payments and possible practical solutions for their reduction. METHODS We surveyed by phone patients who used inpatient health care services in seven Iranian hospitals in 2016. Descriptive and regression analyses were used to estimate the prevalence and determine factors associated with informal payments. We conducted a qualitative analysis through thematic analyses based on focus group discussions and in-depth interviews. RESULTS Of 2696 respondents, 14% reported paying informally for inpatient services. Informal payments were reported more frequently among private hospital users, given more frequently to physicians in public teaching hospitals and 'other staff' in private hospitals, in the form of cash and voluntary. Being an adult, hospital or treatment type, being insured, and household head's education influenced the probability of paying informally. The amount paid informally was associated with being insured, the educational status of the household's head, household size, service, and hospital types. Based on qualitative findings, the leading causes of informal payments reported by patients and healthcare providers can be categorized into four groups - financing challenges; governance challenges; service delivery challenges; and actors and stakeholders. Modifying, adjusting and applying policy interventions; supervision, monitoring and evaluation; and actors and stakeholders were identified as possible solutions for tackling informal payment in the inpatient health care services. CONCLUSION The prevalence of informal patient payments for inpatient services in the post-reform period seems to have reduced; however, they remain to be common. Regular monitoring, reviewing of payment policies to the physicians, informing patients, changing the behaviour of healthcare providers and patients, and developing ethical guidelines to prevent informal payments were suggested for reduction and elimination of informal payments in the Iranian healthcare sector.
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Affiliation(s)
- Leila Doshmangir
- Social Determinants of Health Research Center, Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Haniye Sadat Sajadi
- Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Maryam Ghiasipour
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Aboutorabi
- School of Management and Medical Informatics, Iran University of Medical Sciences, Tehran, Iran
| | - Vladimir Sergeevich Gordeev
- Department of Infectious Disease Epidemiology, The London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Institute of Population Health Sciences, Queen Mary University of London, Mile End Road, London, E1 4NS, UK
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Pourtaleb A, Jafari M, Seyedin H, Akhavan Behbahani A. New insight into the informal patients' payments on the evidence of literature: a systematic review study. BMC Health Serv Res 2020; 20:14. [PMID: 31902368 PMCID: PMC6943960 DOI: 10.1186/s12913-019-4647-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 10/16/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Nowadays, a growing literature reveals how patients use informal payments to seek either better treatment or additional services, but little systematic review has been accomplished for synthesizing the main factors. The purpose of this study was to analyze the content of literatures to demonstrate the factors for informal patient payments. METHODS In this systematic review study, PubMed, Web of Science, Wiley Online Library, Science Direct, Ovid, Scopus, and Iranian databases were investigated without time limitation for eligible English and Persian studies. Achieved data were analyzed using content analysis approach and MAXQDA 10 software. RESULTS Themes related to informal payments in external context of health system were demographic features of health service consumers, patient's personality features and social & cultural backgrounds of the community. Health system challenges' themes were about stewardship weakness, and sustainable financing and social protection weakness. These were followed by human resources' organizational behavior challenges, drugs, medical products, and services delivery provision process challenges and finally change management weakness for reducing and dealing with IPs. CONCLUSION It appears that improving the quality of health care services and accurate monitoring of delivery processes, along with performing some strategies for regulating payroll and medical tariffs, strict rules and regulations and improving health staff motivation, would be effective ways against informal payments. Improving the health insurance contribution, promoting transparency & accountability in health system especially in financing, identify precise control mechanism, using empower patient/public related approach, modifying community perception, reinforcing social resistance to unofficial payments and rebuilt lost social capital in health care are some of the other recommendations in this field. To practice these strategies, a comprehensive and systemic vision and approach is needed, however, the key point is that before applying any strategy the impact of this strategy on access, efficiency, equity, and other health systems' goals and policies should be investigated due to the consideration.
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Affiliation(s)
- Arefeh Pourtaleb
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Health Managers Development Institute, Ministry of Health and Medical Education, Tehran, Iran
| | - Mehdi Jafari
- Health Managers Development Institute, Ministry of Health and Medical Education, Tehran, Iran
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hesam Seyedin
- Department of Health in Disaster and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Meskarpour Amiri M, Bahadori M, Motaghed Z, Ravangard R. Factors affecting informal patient payments: a systematic literature review. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2019. [DOI: 10.1108/ijhg-01-2019-0006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Informal payments (IPs) for healthcare are a serious obstacle to equitable access and universal health coverage in developing countries. Policy makers need to know more about the hidden nature of informal patient payments (IPPs) before any policy adoption and implementation. The purpose of this paper is to systematically review the main factors affecting IPPs.
Design/methodology/approach
This systematic review was conducted in 2018 using the standard guideline of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses. All English original articles on the determinants of IPPs published in the scientific journals, whose full text was available through Scopus, PubMed and Web of Science databases, which were given consideration for review.
Findings
The results showed that IPPs were greatly dependent on the characteristics of healthcare consumers, providers, healthcare system and services. Among healthcare consumers’ characteristics affecting IPPs, the income, age, education, gender, employment and health status were more cited factors, respectively. Among healthcare providers’ characteristics affecting IPPs, the providers’ experience, reputation, and salary satisfaction were better known, respectively. Among healthcare services features, the hospitalization, service specialty and the level of treatment urgency were more noted, respectively.
Originality/value
Policy making against IPs in the health sector requires precise attention to all components of healthcare market, including healthcare consumers, providers, healthcare system and services characteristics.
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9
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Horodnic AV, Williams CC. Informal payments by patients for health services: prevalence and determinants. SERVICE INDUSTRIES JOURNAL 2018. [DOI: 10.1080/02642069.2018.1450870] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Adrian V. Horodnic
- Faculty of Medicine, ‘Grigore T. Popa’ University of Medicine and Pharmacy, Iasi, Romania
| | - Colin C. Williams
- Sheffield University Management School (SUMS), University of Sheffield, Sheffield, UK
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10
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Yang X. Path Selection of China’s Medical Reform Based on Empirical Measurement of Asymmetric Information. Health (London) 2018. [DOI: 10.4236/health.2018.1010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Williams CC, Horodnic AV. Rethinking informal payments by patients in Europe: An institutional approach. Health Policy 2017; 121:1053-1062. [PMID: 28867153 DOI: 10.1016/j.healthpol.2017.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 07/12/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
Abstract
The aim of this paper is to explain informal payments by patients to healthcare professionals for the first time through the lens of institutional theory as arising when there are formal institutional imperfections and asymmetry between norms, values and practices and the codified formal laws and regulations. Reporting a 2013 Eurobarometer survey of the prevalence of informal payments by patients in 28 European countries, a strong association is revealed between the degree to which formal and informal institutions are unaligned and the propensity to make informal payments. The association between informal payments and formal institutional imperfections is then explored to evaluate which structural conditions might reduce this institutional asymmetry, and thus the propensity to make informal payments. The paper concludes by exploring the implications for tackling such informal practices.
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Affiliation(s)
- Colin C Williams
- Sheffield University Management School (SUMS), University of Sheffield, Conduit Road, Sheffield S10 1FL, Room: D038.a, United Kingdom.
| | - Adrian V Horodnic
- Sheffield University Management School (SUMS), University of Sheffield, Conduit Road, Sheffield S10 1FL, Room: D038.a, United Kingdom
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Stepurko T, Pavlova M, Gryga I, Groot W. To pay or not to pay? A multicountry study on informal payments for health-care services and consumers' perceptions. Health Expect 2015; 18:2978-93. [PMID: 25292329 PMCID: PMC5810640 DOI: 10.1111/hex.12281] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although the literature offers various theoretical explanations for the existence of informal patient payments, empirical research has mostly focused on socio-demographic features as determinants of these payments. The role of health-care users' perceptions on informal payments are rarely taken into account especially in multicountry surveys. OBJECTIVE Our aim is to examine the association between informal payments for health-care services and perceptions of health-care consumers about paying informally as well as socio-demographic characteristics. DESIGN We use data from a multicountry quantitative empirical research conducted in 2010. SETTING AND PARTICIPANTS A national representative sample is drawn in six Central and Eastern European countries - Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine. In each country, about 1000 respondents are interviewed. MAIN VARIABLES STUDIED Data related to informal payments for health-care services consumed during the preceding 12 months are analysed in addition to data on respondents' perceptions about paying informally and socio-demographic data. RESULTS Health-care users in Bulgaria and Poland are less inclined to make informal payments, while health-care users in Romania and Ukraine most often report such payments. The informal payment rates for Hungary and Lithuania fall between these two groups. In all six countries, individuals who feel uncomfortable when leaving the physician's office without a gratuity and who feel unable to refuse the request of medical staff to pay informally, more often make informal payments. CONCLUSIONS Such consumers' perceptions can undermine policy efforts to eradicate these payments; therefore, health policy measures should reinforce social resistance to informal payments.
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Affiliation(s)
- Tetiana Stepurko
- School of Public HealthNational University of ‘Kyiv‐Mohyla Academy’KievUkraine
- Department of Health Services ResearchCAPHRI, Maastricht University Medical CenterFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Milena Pavlova
- Department of Health Services ResearchCAPHRI, Maastricht University Medical CenterFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Irena Gryga
- School of Public HealthNational University of ‘Kyiv‐Mohyla Academy’KievUkraine
| | - Wim Groot
- Department of Health Services ResearchCAPHRI, Maastricht University Medical CenterFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
- Topinstitute Evidence‐Based Education Research (TIER)Maastricht UniversityMaastrichtThe Netherlands
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Arsenijevic J, Pavlova M, Groot W. Out-of-pocket payments for health care in Serbia. Health Policy 2015; 119:1366-74. [DOI: 10.1016/j.healthpol.2015.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 03/02/2015] [Accepted: 07/19/2015] [Indexed: 11/26/2022]
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Tomini SM, Groot W, Pavlova M, Tomini F. Paying Out-of-Pocket and Informally for Health Care in Albania: The Impoverishing Effect on Households. Front Public Health 2015; 3:207. [PMID: 26380252 PMCID: PMC4551817 DOI: 10.3389/fpubh.2015.00207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 08/12/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sonila M Tomini
- Maastricht Graduate School of Governance, United Nations University-MERIT (UNU-MERIT), Maastricht University , Maastricht , Netherlands ; Department of Economics, University of Liege , Liege , Belgium
| | - Wim Groot
- Top Institute Evidence Based Education Research (TIER), Maastricht University , Maastricht , Netherlands ; Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht , Netherlands
| | - Milena Pavlova
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht , Netherlands
| | - Florian Tomini
- Top Institute Evidence Based Education Research (TIER), Maastricht University , Maastricht , Netherlands ; Amsterdam School of Economics, University of Amsterdam , Amsterdam , Netherlands
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Baji P, Pavlova M, Gulácsi L, Farkas M, Groot W. The link between past informal payments and willingness of the Hungarian population to pay formal fees for health care services: results from a contingent valuation study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2014; 15:853-67. [PMID: 23989982 DOI: 10.1007/s10198-013-0531-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 08/14/2013] [Indexed: 05/12/2023]
Abstract
We examine the willingness of health care consumers to pay formal fees for health care use and how this willingness to pay is associated with past informal payments. We use data from a survey carried out in Hungary in 2010 among a representative sample of 1,037 respondents. The contingent valuation method is used to elicit the willingness to pay official charges for health care services covered by the social health insurance if certain quality attributes (regarding the health care facility, access to the services and health care personnel) are guaranteed. A bivariate probit model is applied to examine the relationship between willingness to pay and past informal payments. We find that 66% of the respondents are willing to pay formal fees for specialist examinations and 56% are willing to pay for planned hospitalizations if these services are provided with certain quality and access attributes. The act of making past informal payments for health care services is positively associated with the willingness to pay formal charges. The probability that a respondent is willing to pay official charges for health care services is 22% points higher for specialist examinations and 45% points higher for hospitalization if the respondent paid informally during the last 12 months. The introduction of formal fees should be accompanied by adequate service provision to assure acceptance of the fees. Furthermore, our results suggest that the problem of informal patient payments may remain even after the implementation of user fees.
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Affiliation(s)
- Petra Baji
- Health Economics and Health Technology Assessment Research Centre, Corvinus University of Budapest, Budapesti Corvinus Egyetem, Fővám tér 8, 1093, Budapest, Hungary,
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Kankeu HT, Boyer S, Fodjo Toukam R, Abu-Zaineh M. How do supply-side factors influence informal payments for healthcare? The case of HIV patients in Cameroon. Int J Health Plann Manage 2014; 31:E41-57. [PMID: 25130179 DOI: 10.1002/hpm.2266] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/11/2014] [Accepted: 06/11/2014] [Indexed: 11/09/2022] Open
Abstract
Direct out-of-pocket payments for healthcare continue to be a major source of health financing in low-income and middle-income countries. Some of these direct payments take the form of informal charges paid by patients to access the needed healthcare services. Remarkably, however, little is known about the extent to which these payments are exercised and their determinants in the context of Sub-Saharan Africa. This study attempts therefore to shed light on the role of supply-side factors in the occurrence of informal payments while accounting for the demand-side factors. The study relies on data taken from a nationally representative survey conducted among people living with HIV/AIDS in Cameroon. A multilevel mixed-effect logistic model is employed to identify the factors associated with the incidence of informal payments. Results reveal that circa 3.05% of the surveyed patients incurred informal payments for the consultations made on the day of the survey. The amount paid informally represents up to four times the official tariff. Factors related to the following: (i) human resource management of the health facilities (e.g., task shifting); (ii) health professionals' perceptions vis-à-vis the remunerations of HIV care provision; and (iii) reception of patients (e.g., waiting time) significantly influence the probability of incurring informal payments. Also of note, the type of healthcare facilities is found to play a role: informal payments appear to be significantly lower in private non-profit facilities compared with those belonging to public sector. Our findings allude to some policy recommendations that can help reduce the incidence of informal payments.
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Affiliation(s)
- Hyacinthe Tchewonpi Kankeu
- Aix-Marseille University (Aix-Marseille School of Economics), CNRS and EHESS, Centre de la Vieille Charité, 13236, Marseille, Cedex 2, France
| | - Sylvie Boyer
- INSERM-IRD-Aix-Marseille University, Faculty of Medicine, Aix-Marseille School of Economics (AMSE), SESSTIM-UMR 912, 13006, Marseille, France
| | | | - Mohammad Abu-Zaineh
- INSERM-IRD-Aix-Marseille University, Faculty of Medicine, Aix-Marseille School of Economics (AMSE), SESSTIM-UMR 912, 13006, Marseille, France
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