Civil Servants and Non-Western Migrants’ Perceptions on Pathways to Health Care in Serbia—A Grounded Theory, Multi-Perspective Study

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.

“When a story gets a face…”: Visual elicitation of Serbian perspectives on Afghan refugee women’s maternity experiences in Serbia

“…To date, there is a dearth of literature pertaining specifically to maternity experiences for refugee women in Serbia. However, the health service overall is an under-funded post-socialist health service which was not set up to respond to the needs of migrants and refugees [ 38 , 39 ]. Some maternity service users engage with private care providers, enabling them to have a known caregiver and preferential treatment [ 40 ], but this requires sufficient financial means to pay for such a service, restricting this as an option for many refugees.…”

Investigating the Role of Intercultural Mediators in Enhancing Asylum-Seeking Migrants’ Access to Health Care Services in Serbia

“…Others believed it to be corruption that should be eradicated. Such beliefs resemble the academic discussion in the area, on whether they are forced or voluntary, whether they are a fee-for-service or out of gratitude, and what it constitutes when they are paid out of money or from gifts (e.g., drinks, flowers, sweets) (Aasland et al, 2012;Buch Mejsner & Eklund Karlsson, 2017;Gaal et al, 2006;Gaa´l et al, 2010;Gaal & McKee, 2005;Grødeland, 2013;Khodamoradi et al, 2018;Lewis, 2002;Polese, 2014;Stepurko et al, 2013;Vian, 2008Vian, , 2020. Regardless of the positive intention of patients, the informal patient payments are regarded as out-ofpocket payments and should be viewed as detrimental for the equal access to health care of vulnerable groups (WHO, 2000(WHO, , 2019.…”

“…The data for the current paper rests on a larger data collection about informal patient payments and facilitators and barriers to access care in Serbia (Buch Mejsner et al, 2021). Qualitative interviews were conducted in August and September of 2018 with civil servants (intercultural mediators and information workers, n = 8) working with various types of migrants.…”