Informal payments for health care services –from gratitude

Petra Baji, PhD

Corvinus University of Budapest,

Maastricht University

February 12, Wednesday,

CPS Center for Policy Studies

Central European University

Informal payments for health care

services – from gratitude to corruption

Informal payments

Unofficial:

outside the official payment channels

not registered by the state

made without an official receipt of payment

Who initiates the payments?

Who receives the payment?

Who makes the payment?

What is the nature of the payment?

When the payment is made?

What is the purpose/motivation of these payments?

What is the legal status of informal payments?

Informal payments

Explanations:

socio-cultural

legal-ethical

economic

Assessment of patient payment

policies and projection of their

efficiency, equity and quality

effects.

The case of Central and Eastern

Europe

2008-2013

Coordinator: Maasticht University

Partner countries: Bulgaria, Hungary, Lithuania, Poland, Romania, Ukraine

http://assprocee2007.com/

Project funded by the European Commission under FP7 the Socio-economic Sciences and Humanities theme 6

PROJECT ASSPRO CEE 2007

Source: http://ec.europa.eu/research/social-sciences/pdf/policy-briefs-asspro-cee-

2007_en.pdf

ASSPRO CEE 2007

Collaborative Focused Research Project

FP7-SSH-2007 Grant Agreement No.: 217431



ASSPRO CEE 2007



Source: Pavlova P, Arsenijevic J., Goot W, van Merode GG. (2012): Projection of health service

consumption and patient payment revenues in CEE countries using system dynamics modeling.

Society and Economy in Central and Eastern Europe, 34(2): 359-378.

1,50%

Bulgaria

2,10%

Hungary

2,70%

Lithuania

0,60%

Poland

6,30%

Romania

6,70%

Ukraine

Informal payments as a percent of total health expenditure



ASSPRO CEE 2007



Source: http://ec.europa.eu/research/social-sciences/pdf/policy-briefs-asspro-cee-2007_en.pdf



ASSPRO CEE 2007



Source: http://ec.europa.eu/research/social-sciences/pdf/policy-briefs-asspro-cee-2007_en.pdf

Exploring attitudes towards informal

payments in Hungary

Baji P, Pavlova M, Gulácsi L, Groot W: Exploring consumers' attitudes towards informal

patient payments using the combined method of cluster and multinomial regression

analysis--the case of Hungary. BMC Health Serv Res. 2013 Feb 15;13:62.

Informal payments in Hungary

The overall magnitude of informal payments

was estimated to 235 million Euros, 2% of the total health

expenditures

Every 2nd patients pay for hospitalization, every 5th pay for

physician visits, on average 100 and 15 Euros

Relevant income for physicians

they earn 60 - 236% of their net official income from informal

payments in 2001 (Gál et. al 2006)

Unequally distributed

5% of the physicians get the 60%.


Legal status:

Since July 2012, the Labor Code in Hungary prohibits

receiving informal payments. BUT the employer has

the right to dispense the employees from this

decree.

Ethic Codex of the Hungarian Medical Chamber:

„…one of the explanations of the existence of

informal payments is the low salary of the physicians

and the dysfunction of the health care system.”

13/9



payments in Hungary

Do you AGREE with the following statements? (yes/somewhat/no)

• Informal CASH payments to physicians and medical staff are similar tocorruption.

• Gifts IN KIND to physicians and medical staff are similar to corruption.

• Informal CASH payments to physicians and medical staff are anexpression of gratitude.

• Gifts IN KIND to physicians and medical staff are an expression ofgratitude.

• Informal cash payments and gifts in kind to physicians and medical staffare INEVITABLE because of the low funding of the health care sector.

• Cash or gifts in kind, given informally to physicians and medical staff,should be ERADICATED.


payments in Hungary

Do the following statements apply to YOU PERSONALLY? (yes/somewhat/no)

• I will feel UNCOMFORTABLE if I leave the physician's office withoutagratitude cash payment or gift in kind.

• I would RECOGNISE the hint of physicians or medical staff for an informalcash payment or a gift in kind.

• I will REFUSE to pay if a physician or medical staff ask me to pay informallyfor a medical service.

• I will PREFER to use private medical services if I have to pay informallyforpublic medical services.

• If I have SERIOUS PROBLEMS with my health, I will be ready to pay as muchas I have in order to get better medical services.

Attitudes towards informal payments in

Hungary

0% 10%20%30%40%50%60%70%80%90%100%

Informal CASH payments to physicians

and medical staff are similar to

corruption.

Informal CASH payments to physicians

and medical staff are an expression of

gratitude.

Informal cash payments and gifts in

kind to physicians and medical staff are

INEVITABLE because of the low funding

of the health care sector.

Cash or gifts in kind, given informally to

physicians and medical staff, should be

ERADICATED.

No Somewhat Yes


Hungary

Group 3

Corruption

Not inavitable

Group 1

Gratitude

Inevitable

Group 2

Rather corruption

Prefer private

N=1037


Hungary

Group 3

Corruption

Not inavitable

Group 1

Gratitude

Inevitable

Group 2

Rather corruption

Prefer private

Attitudes towards informal payments

For some consumers the perceived “poor service quality and

low salary of physicians” legitimate the existence of

informal payments.

For them informal payments are an indication of the

solidarity of health care consumers with the medical

personnel.

= economic explanation

Those who oppose informal payments…

For further discussion

Should these paymenst be eradicated?

What is the role and task of the governements in the

eradication of informal payments?

How our results can be used in policy making?

What about other sectors? Is health care different?

Petra Baji

Out-of-pocket patient payments for health care

services in Hungary: Past experience and future

perspectives.

Tetiana Stepurko

Informal Patient Payments in Central and Eastern

European Countries

Suggested readings

References

Baji P, Pavlova M, Gulácsi L, Farkas M, Groot W: The link between past informal

payments and willingness of the Hungarian population to pay formal fees for health

care services: results from a contingent valuation study. Eur J Health Econ. 2013 Aug

30. [Epub ahead of print]

Baji P, Pavlova M, Gulácsi L, Groot W: Exploring consumers' attitudes towards informal

patient payments using the combined method of cluster and multinomial regression

analysis--the case of Hungary. BMC Health Serv Res. 2013 Feb 15;13:62. doi:

10.1186/1472-6963-13-62.

Baji P, Pavlova M, Gulácsi L, Groot W. (2012): Changes in equity in out-of-pocket

payments during the period of health care reforms: evidence from Hungary.

International Journal for Equity in Health, 11(1):36.

Baji P, Pavlova M, Gulácsi L, Homolyáné Csete Zs, Groot W. (2012): Informal payments

for health care services and short-term effects of the introduction of visit Fee on these

payments in Hungary. International Journal of Health Planning and Management,

27(1):63-79.

Baji P, Pavlova M, Gulácsi L, Groot W. (2011): User fees for public health care services

in Hungary: Expectations, experience, and acceptability from the perspectives of

different stakeholders. Health Policy, 102(2-3):255-262.

Suggested readings

References

ASSPRO Policy Briefs:

ASSPRO CEE 2007 - Informal patient payments for health care services:

policy challenges and solutions 2010

http://ec.europa.eu/research/social-sciences/pdf/policy-briefs-asspro-02_en.pdf

ASSPRO CEE 2007 - The price of a childbirth: out-of-pocket payments for maternity

care in Central and Eastern Europe (April 2013)

http://ec.europa.eu/research/social-

sciences/pdf/brief_asspro_maternity_care_in_cee_countries.pdf

ASSPRO CEE 2007 - Can patients in Central and Eastern European

countries cope with increased charges for public health care services? 2011

http://ec.europa.eu/research/social-sciences/pdf/policy-briefs-asspro-cee-

2007_en.pdf

Suggested readings

References

Ecorys

Study on Corruption in the Healthcare Sector 2013

http://ec.europa.eu/dgs/home-affairs/what-is-

new/news/news/2013/20131219_01_en.htm

Suggested readings

References

The study is financed by the European Commission under the 7th Framework Program,

Theme 8 Socio-economic Sciences and Humanities, Project ASSPRO CEE 2007 (Grant

Agreement no. 217431). The content of the publication is the sole responsibility of the

authors and it in no way represents the views of the Commission or its services.

Contact: Petra Baji, Department of Health Economics, Faculty of Economics, Corvinus

University of Budapest [email protected]

Acknowledgement

Documents

Informal payments for health care services –from gratitude