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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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Mohos A, Frese T, Kolozsvári L, Rinfel J, Varga A, Hargittay C, Csatlós D, Torzsa P. Earning opportunities and informal payment as influencing factors in medical students' speciality choice. BMC FAMILY PRACTICE 2021; 22:258. [PMID: 34969365 PMCID: PMC8716841 DOI: 10.1186/s12875-021-01608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/07/2021] [Indexed: 11/21/2022]
Abstract
Background The Hungarian primary care system faces a severe shortage of family physicians. Medical students’ perceptions of family medicine need to be known and medical students need to be given appropriate and comprehensible information about this speciality. The expected future salary is an important factor in career choice. Most of the family doctors are self-employed and the practices have a corrected capitation-type financing. Although the majority of health care services are covered by social health insurance and are provided for the insured patients free of charge, informal payment is an existing phenomenon with different motivations and consequences. This study aimed to investigate medical students’ knowledge about their future earning opportunities and their attitudes towards informal payment. Methods A cross sectional survey with a self-administered questionnaire was conducted. Each of the four Hungarian medical universities were represented by their medical students who attended family medicine lectures in person from December 2019 to April 2020. The students were asked about their career plans, about their estimations of current and ideal expected salaries and about the effect of expected income for the choice of specialisation. Their attitudes towards informal payment were assessed. Results Response rate was 67.3% (N = 465/691). Almost two-thirds of the participants were women. Only 5% of the respondents (N = 23/462) plan to work as a family doctor in the future. The vast majority (91.9%) of the students had already thought about their future income. On a 10-point Likert scale (1 = ‘no influence’, 10 = ‘very big influence’) 76% answered that the expected future income exerts a considerable (≥5 Likert points) influence on their career choice in general. The mean of the ideal expected monthly income of the residents, GPs and other specialists was €1154 ± 648, €1696 ± 904 and €2174 ± 1594, respectively. The mean of the monthly income for a GP, as estimated by the studenst, was €1140 in rural and €1122 in urban settings. More than four-fifths of the students (N = 375/453) rejected the practice of informal payment. Conclusions Expected salaray is one important aspect in the career choice of medical students, students wish to have more information on this topic. The reported ideal incomes are higher than those expected. This points to a relevant gap. However, most of the students do not accept informal payment as a possibility to close this gap. The expected and the ideal income differ from the real incomes of Hungarian GPs – this indicates the need of bringing objectoive information to the students to enhance attractivity of GP as a carer choice.
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Affiliation(s)
- András Mohos
- Faculty of Medicine, Department Family Medicine, University of Szeged, 6725 Tisza Lajos krt. 109, Szeged, Hungary.
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle/Saale, Germany
| | - László Kolozsvári
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, 4028 Kassai út 26, Debrecen, Hungary
| | - József Rinfel
- Institute of Primary Care, University of Pécs, 7623 Rákoczi St. 2, Pécs, Hungary
| | - Albert Varga
- Faculty of Medicine, Department Family Medicine, University of Szeged, 6725 Tisza Lajos krt. 109, Szeged, Hungary
| | - Csenge Hargittay
- Department of Family Medicine, Semmelweis University, 1085 Stáhly u. 9, Budapest, Hungary
| | - Dalma Csatlós
- Department of Family Medicine, Semmelweis University, 1085 Stáhly u. 9, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, 1085 Stáhly u. 9, Budapest, Hungary
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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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Zarei E, Nikkhah A, Khodakarim S, Pavlova M. Patients' attitude toward informal payments in Iran: an application of the cluster analysis method. Int J Health Plann Manage 2021; 36:689-702. [PMID: 33471968 DOI: 10.1002/hpm.3110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 11/13/2020] [Accepted: 12/20/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Attitude is a factor affecting the behaviour of consumers. In the literature, the effect of health care consumer's attitude on making informal payments has been highlighted. The purpose of this study was to investigate the attitude of Iranian patients regarding informal payments and socio-demographic factors associated with it. METHODS In this cross-sectional study, conducted in 2017 in Tehran, 450 patients who were admitted to the clinics of four public hospitals for post-surgical care and follow-up, were invited to participate in the study. The data collection tool was a questionnaire, which validity and reliability were confirmed. Cluster analysis was used to identify the main attitudinal groups. To investigate the effect of socio-demographic factors on patients' attitudes, generalized linear model regression analysis was carried out in SPSS 22. RESULTS Our findings showed that 57.3% of patients had agreeing attitude, 24.2% indifferent attitude, and 18.4% opposing attitude toward informal payments. Patients from rural areas and those from the high-income group had higher odds of having an agreeing attitude. There was a significant association between informal payment history and attitude. The odds of having agreeing attitude among patients with a history of informal payment were two times higher than among patients who did not have an informal payment history (p ≤ 0.05). CONCLUSION A positive attitude towards informal payments is an obstacle to the fight against this phenomenon. Therefore, changes in public attitudes regarding informal payments will be an essential strategy, among other strategies, for eradicating these payments. This could be achieved through public campaigns for raising people's awareness and knowledge.
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Affiliation(s)
- Ehsan Zarei
- Department of Health Economic, Management and Policy, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Adeleh Nikkhah
- Department of Health Economic, Management and Policy, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Khodakarim
- Department of Epidemiology and Biostatistics, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milena Pavlova
- Department of Health Services Research; CAPHRI; Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences Maastricht University, Maastricht, The Netherlands
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Sakha MA, Zahirian Moghadam T, Ghobadi H, Zandian H. Exploring the changes of physicians' behaviour toward informal payment based on Health Transformation Plan in Iran: A qualitative study. Int J Health Plann Manage 2020; 35:1127-1139. [PMID: 32666608 DOI: 10.1002/hpm.3020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/01/2020] [Accepted: 06/05/2020] [Indexed: 11/09/2022] Open
Abstract
By implementation of the Health Transformation Plan (HTP), a revised tariff system for healthcare services was executed in Iran. This study explores the changes in physicians' behaviour in facing informal payment (IP) based on HTP implementation in Iran. We conducted in-depth semi-structured interviews with 15 purposefully selected physicians and policy makers to explore the changes (positive, negative and no) in physicians' behaviours with and without the implementation of HTP. The interviews were conducted individually and face to face. The conventional content analysis for data analysis by MAXQDA ver.10 was used. Based on the results, regardless of the HTP implemented, market competitiveness could control physicians' demand for IP. However, unreal tariffs, irregular payments, inflation, expensive healthcare and comparing income with other occupations increase physicians' demand for IP as negative behaviour. This study explored three patterns of physicians' behavioural change because of HTP implementation: 1-positive behavioural change with four factors; 2-negative behavioural changes with two factors; and 3-no behavioural change with four factors. Various factors influenced physicians' behaviour towards IP with and without the HTP. To combat IP more efficiently, we recommend strengthening the HTP's positive interventions, compensation of physicians' target income, enhancing supervision, reducing the gap among various medical specialities and taking a systematic approach with law offenders.
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Affiliation(s)
| | - Telma Zahirian Moghadam
- Health Policy, Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hassan Ghobadi
- Pulmonary Diseases, Digestive Diseases Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hamed Zandian
- Health Policy, Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
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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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Huang CH, Wu HH, Lee YC, Li L. What Role Does Patient Gratitude Play in the Relationship Between Relationship Quality and Patient Loyalty? INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019868324. [PMID: 31422704 PMCID: PMC6700843 DOI: 10.1177/0046958019868324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The environment in health care organizations is becoming increasingly competitive. Therefore, to improve patient return rates, health care organizations need to examine how to enhance the physician-patient relationship. In particular, the role of patient gratitude on the physician-patient relationship in health care organizations is still ambiguous. The specific role of patient gratitude in the medical service industry needs to be identified. Therefore, this study aimed to investigate physician-patient interactions with reference to relationship marketing and to further understand the relationships among relationship quality, patient gratitude, and patient loyalty. The potential effects of patient gratitude on the physician-patient relationship were examined by testing mediation effect. The results demonstrated that patient gratitude had a notable effect on the association between relationship quality and patient loyalty. To improve the physician-patient relationship in the medical service industry, health care managements should not ignore the 3 relationship quality tactics perceived by patients, specially the role of the potential effect of patient gratitude on relational building.
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Affiliation(s)
- Chih-Hsuan Huang
- Hubei University of Economics, Wuhan City, China
- Institute for Development of Cross-Strait Small and Medium Enterprise, Wuhan City, China
| | - Hsin-Hung Wu
- National Changhua University of Education, Changhua City, Taiwan
- Asia University, Taichung City, Taiwan
| | - Yii-Ching Lee
- Hungkuang University, Taichung City, Taiwan
- Ben Tang Cheng Ching Hospital, Taichung City, Taiwan
- Yii-Ching Lee, Department of Health Business Administration, Hungkuang University, No. 1018, Sec. 6, Taiwan Boulevard, Shalu District, Taichung City 43302, Taiwan.
| | - Li Li
- Law & Business College of Hubei University of Economics, Wuhan City, China
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Bíró A, Prinz D. Healthcare spending inequality: Evidence from Hungarian administrative data. Health Policy 2020; 124:282-290. [PMID: 32014334 DOI: 10.1016/j.healthpol.2020.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 01/23/2023]
Abstract
Using administrative data on a random 50% of the Hungarian population, including individual-level information on incomes, healthcare spending, and mortality for the 2003-2011 period, we develop new evidence on the distribution of healthcare spending and mortality in Hungary by income and geography. By linking detailed administrative data on employment, income, and geographic location with measures of healthcare spending and mortality we are able to provide a more complete picture than the existing literature which has relied on survey data. We compute mean spending and 5-year and 8-year mortality measures by geography and income quantiles, and also present gender and age adjusted results. We document four patterns: (i) substantial geographic heterogeneity in healthcare spending; (ii) positive association between labor income and public healthcare spending; (iii) geographic variation in the strength of the association between labor income and healthcare spending; and (iv) negative association between labor income and mortality. In further exploratory analysis, we find no statistically significant correlation between simple county-level supply measures and healthcare spending. We argue that taken together, these patterns suggest that individuals with higher labor income are in better health but consume more healthcare because they have better access to services. Our work suggests new directions for research on the relationship between health inequalities and healthcare spending inequalities and the role of subtler barriers to healthcare access.
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Affiliation(s)
- Anikó Bíró
- Centre for Economic and Regional Studies, Health and Population "Lendület" Research Group, Hungary.
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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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Kohler JC. I Know It When I See It: The Challenges of Addressing Corruption in Health Systems Comment on "We Need to Talk About Corruption in Health Systems". Int J Health Policy Manag 2019; 8:563-566. [PMID: 31657180 PMCID: PMC6815984 DOI: 10.15171/ijhpm.2019.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/08/2019] [Indexed: 11/09/2022] Open
Abstract
In this commentary, I argue that corruption in health systems is a critical and legitimate area for research in order to strengthen health policy goals. This rationale is based partly on citizen demand for more accountable and transparent health systems, along with the fact that the poor and vulnerable suffer the most from the presence of corruption in health systems. What is more, there is a growing body of literature on the impact of corruption in the health system and best practices in terms of anti-corruption, transparency and accountability (ACTA) strategies and tactics within the health system. Still, we need to support ACTA integration into the health system by having a common definition of corruption that is meaningful for health systems and ensure that ACTA strategies and tactics are transparent themselves. The 2019 Consultation on a proposed Global Network on ACTA in Health Systems is promising for these efforts.
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Affiliation(s)
- Jillian Clare Kohler
- WHO Collaborating Center for Governance, Accountability and Transparency in the Pharmaceutical Sector and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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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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Informal Payments for Inpatient Services and Related Factors: A Cross-Sectional Study in Tehran, Iran. HEALTH SCOPE 2018. [DOI: 10.5812/jhealthscope.62319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rubashkin N, Szebik I, Baji P, Szántó Z, Susánszky É, Vedam S. Assessing quality of maternity care in Hungary: expert validation and testing of the mother-centered prenatal care (MCPC) survey instrument. Reprod Health 2017; 14:152. [PMID: 29145863 PMCID: PMC5689156 DOI: 10.1186/s12978-017-0413-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022] Open
Abstract
Background Instruments to assess quality of maternity care in Central and Eastern European (CEE) region are scarce, despite reports of poor doctor-patient communication, non-evidence-based care, and informal cash payments. We validated and tested an online questionnaire to study maternity care experiences among Hungarian women. Methods Following literature review, we collated validated items and scales from two previous English-language surveys and adapted them to the Hungarian context. An expert panel assessed items for clarity and relevance on a 4-point ordinal scale. We calculated item-level Content Validation Index (CVI) scores. We designed 9 new items concerning informal cash payments, as well as 7 new “model of care” categories based on mode of payment. The final questionnaire (N = 111 items) was tested in two samples of Hungarian women, representative (N = 600) and convenience (N = 657). We conducted bivariate analysis and thematic analysis of open-ended responses. Results Experts rated pre-existing English-language items as clear and relevant to Hungarian women’s maternity care experiences with an average CVI for included questions of 0.97. Significant differences emerged across the model of care categories in terms of informal payments, informed consent practices, and women’s perceptions of autonomy. Thematic analysis (N = 1015) of women’s responses identified 13 priority areas of the maternity care experience, 9 of which were addressed by the questionnaire. Conclusions We developed and validated a comprehensive questionnaire that can be used to evaluate respectful maternity care, evidence-based practice, and informal cash payments in CEE region and beyond.
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Affiliation(s)
- Nicholas Rubashkin
- Departments of Global Health Sciences and Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, Mission Hall, Box 1224, 550 16th Street, Third Floor, San Francisco, California, 94158, USA.
| | - Imre Szebik
- Institute of Behavioral Sciences, Semmelweis University, VIII. Nagyvárad tér 4. XX. Em, Budapest, H-1089, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8. Main Building Room E113, Budapest, 1093, Hungary
| | - Zsuzsa Szántó
- Institute of Behavioral Sciences, Semmelweis University, VIII. Nagyvárad tér 4. XX. Em, Budapest, H-1089, Hungary
| | - Éva Susánszky
- Institute of Behavioral Sciences, Semmelweis University, VIII. Nagyvárad tér 4. XX. Em, Budapest, H-1089, Hungary
| | - Saraswathi Vedam
- The Birth Place Lab, Faculty of Medicine, The University of British Columbia, Vancouver, Canada.,Midwifery Program
- Department of Family Practice, Suite 320 - 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
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Informal cash payments for birth in Hungary: Are women paying to secure a known provider, respect, or quality of care? Soc Sci Med 2017; 189:86-95. [DOI: 10.1016/j.socscimed.2017.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 07/09/2017] [Accepted: 07/20/2017] [Indexed: 01/09/2023]
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Vafaei Najar A, Ebrahimipour H, Pourtaleb A, Esmaily H, Jafari M, Nejatzadegan Z, Taleghani YM. At first glance, informal payments experience on track: why accept or refuse? Patients' perceive in cardiac surgery department of public hospitals, northeast of Iran 2013. BMC Health Serv Res 2017; 17:205. [PMID: 28292289 PMCID: PMC5351263 DOI: 10.1186/s12913-017-2108-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 02/22/2017] [Indexed: 11/29/2022] Open
Abstract
Background Patient’s Informal payments is among the main source of health care financing in some countries. This paper aimed at determining the patient informal payments and relative factors in Cardiac Surgery Departments (CSD) in hospitals affiliated to Mashhad University of Medical Sciences (MUMS) in 2013. Methods In this cross-sectional study, 316 discharged patients were selected using multi-stage sampling. Data gathering tool was a questionnaire which was filled by structured telephone interviews. We used quantitative content analysis for open-ended questions besides descriptive statistics and nonparametric tests by SPSS 16 at 0.05 Sig level. Results Sixteen (5.93%) patients made voluntary informal payments. The purpose of payment was: “gratitude” (43.75%), satisfaction with health services provided” (31.25%) and (18.75%) for better quality of services. About 75% of the payments were occurred during receiving health care services. The main causes were “no request for informal payments” (98.14%), “not affording to pay for informal payments” (73.33%) and “paying the hospital expenses by taking out a loan” (55.91%). Responders said they would pay informally in demand situation (51.85%) just for patient’s health priority, 40.71% would also “search for other alternative solutions” and 27.33% “accepted the demand as a kind of gratitude culture”. Twenty four patients (8.9%) had experienced mandatory informal payments during the last 6 months. The minimum amount of payment was 62.5$ and the maximum was 3125$. There was a significant relationship between the way of referring to medical centers and informal patient's payment (P ≤0.05). Conclusion Despite the widespread prevalent belief about informal payments in public hospitals —particularly to the well-known physicians — such judgment cannot be generalized. The main reasons for the low informal payments in the current study were the personality characteristics of the physicians and hospital staff, their moral conscience and commitment to professional ethics, cultural factors and social-economic status of the patients. Health care system should notify people about their rights specially the payments calculation mechanism and methods. Better communication with the public and especially the media can help to correct attitude toward these payments.
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Affiliation(s)
- Ali Vafaei Najar
- Department of Management Sciences and Health Economics, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Ebrahimipour
- Department of Management Sciences and Health Economics, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arefeh Pourtaleb
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran. .,School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Habibollah Esmaily
- Biostatics and Epidemiology Department, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Jafari
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.,School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Zohre Nejatzadegan
- Department of Management Sciences and Health Economics, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yasamin Molavi Taleghani
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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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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Stepurko T, Pavlova M, Gryga I, Groot W. Making Patients Pay: Informal Patient Payments in Central and Eastern European Countries. Front Public Health 2015; 3:192. [PMID: 26301214 PMCID: PMC4528095 DOI: 10.3389/fpubh.2015.00192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 07/23/2015] [Indexed: 11/23/2022] Open
Affiliation(s)
- Tetiana Stepurko
- School of Public Health, National University of Kyiv-Mohyla Academy , Kiev , Ukraine
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht , Netherlands
| | - Irena Gryga
- School of Public Health, National University of Kyiv-Mohyla Academy , Kiev , Ukraine
| | - Wim Groot
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht , Netherlands ; Topinstitute Evidence-Based Education Research (TIER), Maastricht University , Maastricht , Netherlands
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18
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Vian T, Feeley FG, Domente S, Negruta A, Matei A, Habicht J. Barriers to universal health coverage in Republic of Moldova: a policy analysis of formal and informal out-of-pocket payments. BMC Health Serv Res 2015; 15:319. [PMID: 26260324 PMCID: PMC4531477 DOI: 10.1186/s12913-015-0984-z] [Citation(s) in RCA: 25] [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: 08/19/2014] [Accepted: 08/02/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Universal Health Coverage seeks to assure that everyone can obtain the health services they need without financial hardship. Countries which rely heavily on out-of-pocket (OOP) payments, including informal payments (IP), to finance total health expenditures are not likely to achieve universal coverage. The Republic of Moldova is committed to promoting universal coverage, reducing inequities, and expanding financial protection. To achieve these goals, the country must reduce the proportion of total health expenditures paid by households. This study documents the extent of OOP payments and IP in Moldova, analyses trends over time, and identifies factors which may be driving these payments. METHODS The study includes analysis of household budget survey data and previous research and policy documents. The team also conducted a review of administrative law intended to control OOP payments and IPs. Focus groups, interviews, and a policy dialogue with key stakeholders were held to validate and discuss findings. RESULTS OOP payments account for 45% of total health expenditures. Sixteen percent of outpatients and 30% of inpatients reporting that they made OOP payments when seeking care at a health facility in 2012, more than two-thirds of whom also reported paying for medicines at a pharmacy. Among those who paid anything, 36% of outpatients and 82% of inpatients reported paying informally, with the proportion increasing over time for inpatient care. Although many patients consider these payments to be gifts, around one-third of IPs appear to be forced, posing a threat to health care access. Patients perceive that payments are driven by the limited list of reimbursable medicines, a desire to receive better treatment, and fear or extortion. Providers suggested irrational prescribing and ordering of tests as drivers. Providers may believe that IPs are gifts and do not cause harm for patients and the health system in general. CONCLUSIONS Efforts to expand financial protection should focus on reducing household spending on medicines and hospital-based IPs. Reforms should consider ways to reduce medicine prices and promote rational use, strengthen administrative controls, and increase incentives for quality health care provision.
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Affiliation(s)
- Taryn Vian
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Building 3rd floor, Boston, MA, 02118, USA.
| | - Frank G Feeley
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Building 3rd floor, Boston, MA, 02118, USA.
| | - Silviu Domente
- World Health Organization Country Office in Republic of Moldova, Sfatul Tarii Str. 29, MD-2012, Chisinau, Republic of Moldova.
| | - Ala Negruta
- National Bureau of Statistics, 106 Grenoble Str., MD-2019, Chisinau, Republic of Moldova.
| | - Andrei Matei
- World Health Organization Country Office in Republic of Moldova, Sfatul Tarii Str. 29, MD-2012, Chisinau, Republic of Moldova.
| | - Jarno Habicht
- World Health Organization Country Office in Republic of Moldova, Sfatul Tarii Str. 29, MD-2012, Chisinau, Republic of Moldova.
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Baji P, Pavlova M, Gulácsi L, Groot W. Does the Implementation of Official User Charges Help to Eradicate Informal Payments - Lessons to be Learnt from the Hungarian Experience. Front Public Health 2015; 3:181. [PMID: 26236705 PMCID: PMC4505068 DOI: 10.3389/fpubh.2015.00181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/06/2015] [Indexed: 12/02/2022] Open
Affiliation(s)
- Petra Baji
- Department of Health Economics, Corvinus University of Budapest , Budapest , Hungary ; Center for Economic Research and Graduate Education - Economics Institute (CERGE-EI) , Prague , Czech Republic
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht University , Maastricht , Netherlands
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest , Budapest , Hungary
| | - Wim Groot
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht University , Maastricht , Netherlands ; Topinstitute for Evidence-Based Education Research (TIER), Maastricht University , Maastricht , Netherlands
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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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Riklikiene O, Jarasiunaite G, Starkiene L. Informal patient payments in publicly financed healthcare facilities in Lithuania. Scand J Public Health 2014; 42:488-96. [DOI: 10.1177/1403494814538125] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Since the late 1990s Lithuania has had a mixed, solidary based healthcare system, predominantly funded from the National Health Insurance Fund through a compulsory health insurance scheme. The cultural tradition of informal payments in healthcare in Lithuania was inherited from the Soviet past and is still alive. Aim: This study reveals the extent and nature of informal patient payments, and identifies the motivation behind those payments occurring in publicly financed healthcare facilities in Lithuania. Methods: The quantitative household survey design was chosen for this study. The randomly selected sample was comprised of inhabitants aged 18 years and older, representing the entire population of Lithuania by county, place of residence (urban and rural), age and sex. The study sample consisted of 1067 participants interviewed in 2009 and 2010, and 1068 in 2011 (response rate ranged from 66.6% to 68.2%). Results: Users of healthcare services usually made informal payments for the visit to, and consultation with, a general practitioner or physician specialist and for diagnostic services. Females and older citizens, the disabled, public/private sector employees, retirees, those with higher education and those in the highest household monthly income group were more prone to pay informally for health services. The majority of respondents were against formalization of informal patient payment. Conclusions: National health insurance payments for healthcare services from the formal public fund for healthcare are further augmented by informal payments from service consumers, used routinely for better access to and higher quality of healthcare service.
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Affiliation(s)
- Olga Riklikiene
- Department of Nursing and Care, Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gabija Jarasiunaite
- Department of Theoretical Psychology, Faculty of Social Sciences, Vytautas Magnus University, Kaunas, Lithuania
| | - Liudvika Starkiene
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
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