How do supply‐side factors influence informal payments for healthcare? The case of HIV patients in Cameroon

Abstract

SUMMARYDirect 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.

Rethinking informal payments by patients in Europe: An institutional approach

“…This has been identified in studies conducted in large geographical areas, such as in 35 European countries [26], Central Asia [30] as well as in 33 African countries [31], or in smaller studies comprising only one nation as, for example, Bulgaria [1,6,13,32,33], Poland [34,35], Hungary [2,[36][37][38][39][40], Greece [4,41], Lithuania [34,42], Russia [43,44]; Ukraine [34,45], Moldova [46], Serbia [47], Kazakhstan [48], Albania [5,49,50], Kosovo [8], Tajikistan [51,52], Kyrgyzstan [53], Taiwan [54], Cameroon [55], Tanzania [3,56] and Turkey [57]. Nevertheless, informal patient payments phenomenon is poorly examined at a cross-country level.…”

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

“…Informal payments, also referred to as unofficial, “enveloped”, under the counter or under the table payments, continue to represent a worldwide phenomenon, affecting both developed countries and developing or in transition economies . Studies concerning the subject have been conducted in countries from: Central and Eastern Europe, eg, Poland, Hungary, Bulgaria, Lithuania, Albania, Ukraine, Romania, Russia; Central, Eastern and Southern Asia; southern regions of America, and the African continent …”

Financial obligations and economic barriers to antiretroviral therapy experienced by HIV-positive women who participated in a job-creation programme in northern Uganda

“…Participants’ perceived need for informal payments are important as these perceptions may influence women’s interactions with healthcare providers and women’s satisfaction with the services received, all of which may influence ART adherence (Murphy et al 2000; Watt et al 2010; Campbell et al 2011). Recently, researchers have begun documenting the existence of informal payments for health services (Maestad and Mwisongo 2011; Wojczewski et al 2015; Kankeu et al 2014). Additional research is needed to understand the prevelance of informal payments and the contexts in which they occur.…”