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
Project funded by the European Commission under FP7 the Socio-economic Sciences and Humanities theme
PROJECT ASSPRO CEE 2007
ASSPRO CEE 2007
Collaborative Focused Research Project FP7-SSH-2007 Grant Agreement No.: 217431
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
Project funded by the European Commission under FP7 the Socio-economic Sciences and Humanities theme 8
PROJECT ASSPRO CEE 2007
ASSPRO CEE 2007
Collaborative Focused Research Project FP7-SSH-2007 Grant Agreement No.: 217431
Source: http://ec.europa.eu/research/social-sciences/pdf/policy-briefs-asspro-cee-2007_en.pdf
Project funded by the European Commission under FP7 the Socio-economic Sciences and Humanities theme
PROJECT ASSPRO CEE 2007
ASSPRO CEE 2007
Collaborative Focused Research Project FP7-SSH-2007 Grant Agreement No.: 217431
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%.
Informal payments in Hungary
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
Informal payments in Hungary
Exploring attitudes towards informal payments in Hungary
Do you AGREE with the following statements? (yes/somewhat/no)
• Informal CASH payments to physicians and medical staff are similar to corruption.
• Gifts IN KIND to physicians and medical staff are similar to corruption.
• Informal CASH payments to physicians and medical staff are an expression of gratitude.
• Gifts IN KIND 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.
Exploring attitudes towards informal 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 without a gratitude cash payment or gift in kind.
• I would RECOGNISE the hint of physicians or medical staff for an informal cash payment or a gift in kind.
• I will REFUSE to pay if a physician or medical staff ask me to pay informally for a medical service.
• I will PREFER to use private medical services if I have to pay informally for public medical services.
• If I have SERIOUS PROBLEMS with my health, I will be ready to pay as much as 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
Attitudes towards informal payments in Hungary
Group 3 Corruption Not inavitable
Group 1 Gratitude Inevitable
Group 2
Rather corruption Prefer private
N=1037
Attitudes towards informal payments in 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 petra.baji@uni-corvinus.hu
