Drivers behind widespread informal payments in the Romanian public health care system: From tolerance to corruption to socio‐economic and spatial patterns

Abstract

In order to explain informal payments in public health care services in Romania, this paper evaluates the relationship between extra payments or valuable gifts (apart from official fees) and the level of tolerance to corruption, as well as the socio-economic and spatial patterns across those individuals offering informal payments. To evaluate this, a survey undertaken in 2013 is reported. Using logistic regression analysis, the findings are that patients with a high tolerance to corruption, high socio-economic risk (those divorced, separated, or with other form of marital status, and those not working), and located in rural or less affluent areas are more likely to offer (apart from official fees) extra payments or valuable gifts for health care services. The paper concludes by discussing the health policy implications.

Informal Payments and Performance in the Health Care Sector: Possible Relationships in a Sub-National Perspective

“…This confirms the research hypothesis H4. Moreover, these research findings appear consistent with those studies that show that informal payments can deter access to health services for people with less ability to pay (Allin, Davaki & Mossialos, 2006;Azfar & Gurgur, 2008;Belli Gotsadze & Shahriari, 2004;Falkingham, 2004;Lewis, 2000;Rose, 2006;Habibov & Cheung, 2017;Horodnic, Mazilu & Oprea, 2018).…”

“…Surprisingly, there are only a handful of studies that have systematically analysed the relation between corruption and these different performance dimensions. Some studies have focused on the effect of petty corruption on the equity of access or on the quality of the health service delivery (Azfar and Gurgur, 2008;Belli Gotsadze & Shahriari, 2004;Falkingham, 2004;Lewis, 2002;Maestad & Mwisongo, 2011;Balabanova & McKee, 2002;McPake, Asiimwe, Mwesigye, Ofumbi, Ortenblad, StreeflandP &Turinde, 1999;Gaal & McKee, 2005;Habibov & Cheung, 2017;Horodnic, Mazilu & Oprea, 2018). But to date, no study has jointly considered the relation of corruption with the above-mentioned performance dimensions, nor has any study conducted a sub-national level analysis.…”

“…At the same time, there is little evidence of the impact of petty corruption on equity of access or on the quality of health services. In regards to equity of access, informal payments increase patients' costs and may thus induce them to forego or delay care (Azfar & Gurgur, 2008;Belli Gotsadze & Shahriari, 2004;Falkingham, 2004;Lewis, 2000;Rose, 2006;Habibov & Cheung, 2017;Horodnic, Mazilu & Oprea, 2018). Their impact on quality is uncertain.…”

“…Finally, most of the studies carried out concern the countries of Central Eastern Europe (Hungary, Bulgaria, Albania, Romania, Poland) and of the former Soviet Union. Few analyse the phenomenon of informal payments in Southern European countries (Horodnic, Mazilu & Oprea, 2018;Horodnic & Williams, 2018;Liaropoulos, Siskou, Kaitelidou, Theodorou & Katostaras, 2008).…”

Patients' attitude toward informal payments in Iran: an application of the cluster analysis method

“…From the equity perspective, IPs can reduce patients' access to essential treatments because only people with high financial strength can pay for treatment services. 11 The findings of this study showed that most patients in all three attitude groups opposed cash IPs and gifts to medical staff as a compensation for their low salary. The findings of some studies in Central and Eastern Europe reported that most people agreed with cash IPs and gifts to medical staff for compensating the health care -697 providers for their low salaries, which findings are inconsistent with the findings of our study.…”