Paying informally for public health care in Albania: scarce resources or governance failure?

Abstract

Informal payments for health care are common in most former communist countries. This paper explores the demand side of these payments in Albania. Using tobit and Heckman selection models we control for individual determinants of informal payments in outpatient and inpatient health care. Propensity score matching techniques are used to investigate the changes in the characteristics of people paying informally over the different years. Our findings suggest that vulnerable groups in society remain less protected against such payments and policy measures have not reached the most deprived regions of the country.

Explaining informal payments for health services in Central and Eastern Europe: an institutional asymmetry perspective

“…This thesis can be tested not only on a cross-national level but also across various demographic and socio-economic groups. Previous studies reveal that the prevalence of informal payments for health services is greater among women (Baji et al, 2012b;Balabanova & McKee, 2002;Mokhtari & Ashtari, 2012;Riklikiene et al, 2014;Stepurko et al, 2015a;, younger people (Arsenijevic, Pavlova, & Groot, 2015;Balabanova & McKee, 2002;Danyliv et al, 2015;Tomini & Maarse, 2011;Tomini, Groot, & Pavlova, 2012a), those spending with more years in education (Arsenijevic et al, 2015;Baji et al, 2012b;Balabanova & McKee, 2002;Kaitelidou et al, 2013;Riklikiene et al, 2014;Stepurko et al, 2015a;Tomini et al, 2012a), the employed (Kaitelidou et al, 2013), married people (Tomini et al, 2012a), those living in smaller households (Baji et al, 2012b;Stepurko et al, 2015a;Tomini et al, 2012a;Tomini, Groot, & Pavlova, 2012b), rural populations (Danyliv et al, 2015;Tomini & Groot, 2013;Tomini & Maarse, 2011) and lower-income groups (Kankeu & Ventelou, 2016;Szende & Culyer, 2006;Tengilimoglu, Güzel, Toygar, Akinci, & Dziegielewski, 2015;Tomini & Groot, 2013). By testing this hypothesis, whether these populations also have a higher institutional asymmetry and therefore higher propensity to make informal payments can be evaluated.…”

“…Viewed through an institutional lens, therefore, the structural conditions identified in previous literature as associated with the greater prevalence of informal payments need to be evaluated as determinants of the level of institutional asymmetry. These formal institutional imperfections identified in previous literature as associated with the greater prevalence of informal payments include not only the existence of formal institutional voids, such as lower expenditures on healthcare (Balabanova & McKee, 2002;Tambor et al, 2013) and inefficient resource allocation which results in a low range and reach of healthcare services (Baji et al, 2013;Gaal & McKee, 2004;Gaal, Belli, McKee, & Szócska, 2006;Kutzin et al, 2010;Lewis, 2002;Tambor et al, 2013;Tomini & Groot, 2013), but also formal institutional inefficiencies, such as the poor quality of government, poorer performing healthcare systems and those concentrating on curative rather than preventative care (Cohen, 2012;Fotaki, 2009;Gaal & McKee, 2004;Lewis, 2002;Rechel et al, 2011;Stepurko et al, 2015b;Tambor et al, 2013;Tomini & Groot, 2013). Moreover, other theories explaining informal payments such as "inxit" theory (Gaal & McKee, 2004) or the "alternative politics" theory (Cohen, 2012) are also grounded in institutional failure and citizens dissatisfaction with healthcare services.…”

Rethinking informal payments by patients in Europe: An institutional approach

“…Indeed, most previous studies reveal that women are more likely to make informal payments for health care services [6,40,42,46,59], as do younger persons [6,45,47,49,60], better educated persons [6,[40][41][42]47,49], those having a job [41], those married [49], those living in a smaller household [40,49,50], those living in rural areas [45,60,61], and those with lower income [31,37,57,61]. By testing this hypothesis, whether these populations also have a higher institutional asymmetry can be evaluated.…”

“…As previous studies reveal, these formal institutional imperfections include not only the existence of formal institutional voids, such as lower expenditures on healthcare [6] and inefficient resource allocation which results in a low range and reach of healthcare services [12,25,26,39,44,62], but also formal institutional inefficiencies, such as the poor quality of government, poorer performing healthcare systems and those concentrating on curative rather than preventative care [12,[24][25][26]33,34,43,61]. To test whether these formal institutional voids and inefficiencies are associated with greater levels of informal payment, the following hypotheses can be thus evaluated:…”

Exploring the changes of physicians' behaviour toward informal payment based on Health Transformation Plan in Iran: A qualitative study

“…The with informal payments. 6,33,34 Appropriate payment to service providers, simultaneously with improving the quality of service, can gradually correct people's perception that IP is a necessary precondition to receiving better quality services. 13 In this regard, studies have pointed to various solutions, that is, increased incentives for providers through revision of payment structures, 33 increasing the income, 35 and improving the income status of staff.…”