Adrian V. Horodnic

Informal payments by patients for health services: prevalence and determinants

ABSTRACT The aim of this paper is to explain the prevalence of informal payments in the health services sector in Southern Europe using the lens of institutional theory. To evaluate whether informal payments prevail due to formal institutional failures which lead to an asymmetry between the laws and regulations (formal institutions) and the unwritten rules (informal institutions), an analysis is undertaken of 2013 Eurobarometer survey data on the propensity to make informal payments by patients in Southern Europe. A strong association is found between the extent to which formal and informal institutions are unaligned, and the prevalence of informal payments, and such payments are found to be more likely when there is a lack of modernisation of governance coupled with a low range and reach of health services provision, lower health outcomes and systems focus on curative rather than preventative health services. The theoretical and policy implications are then explored.

Rethinking informal payments by patients in Europe: An institutional approach

The aim of this paper is to explain informal payments by patients to healthcare professionals for the first time through the lens of institutional theory as arising when there are formal institutional imperfections and asymmetry between norms, values and practices and the codified formal laws and regulations. Reporting a 2013 Eurobarometer survey of the prevalence of informal payments by patients in 28 European countries, a strong association is revealed between the degree to which formal and informal institutions are unaligned and the propensity to make informal payments. The association between informal payments and formal institutional imperfections is then explored to evaluate which structural conditions might reduce this institutional asymmetry, and thus the propensity to make informal payments. The paper concludes by exploring the implications for tackling such informal practices.

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

ABSTRACT The aim of this paper is to propose and evaluate a new institutional theory explanation for patients making informal payments for health services in Central and Eastern Europe. This views informal payments by patients to healthcare professionals as arising when formal institutional failures lead to an asymmetry between the laws and regulations of formal institutions and the unwritten rules of informal institutions. Reporting a 2013 Eurobarometer survey of the prevalence of informal payments by patients in Central and Eastern European countries, a strong association is revealed between the level of asymmetry between the formal and informal institutions, and the propensity to make informal payments. The association between informal payments and various formal institutional imperfections is then explored to evaluate which structural conditions might reduce this institutional asymmetry, and thus the propensity to make informal payments. The paper concludes by exploring the implications for tackling such informal practices.

Evaluating the prevalence of informal payments for health services in Southeast Europe: an institutional approach

ABSTRACT The aim of this paper is to explain the prevalence of informal payments for health services in Southeast Europe through the lens of institutional theory as resulting from formal institutional failures which lead to an asymmetry between the laws and regulations (formal institutions) and the unwritten rules (informal institutions), making informal payments acceptable. Reporting on a 2013 Eurobarometer survey of the propensity to make informal payments for health services in Southeast Europe, a strong association is found between the degree to which formal and informal institutions are unaligned and the prevalence of informal payments. The relationship between informal payments and formal institutional imperfections is then explored to identify the structural conditions which lead to this institutional asymmetry, and thus the propensity to make informal payments. The paper concludes by exploring the theoretical and policy implications.

Rating healthcare services: consumer satisfaction vs. health system performance

ABSTRACT The complex healthcare services and the consumer’s lack of technical knowledge to assess them engender a debate over using consumer satisfaction ratings as a quality-of-care marker. This paper aims firstly to investigate the effect of socio-demographic, socio-economic and spatial characteristics on the perception of quality of healthcare and secondly to evaluate the relationship between consumer satisfaction and health system performance. Reporting a Eurobarometer survey and the scores of the Euro Health Consumer Index, the finding is that some socio-demographic groups are more likely to get unsatisfied with healthcare services than others (e.g. women, those over 24 years old, those who self-define themselves as working class). Moreover, a strong relationship is revealed between consumer satisfaction and health system performance. The higher the performance of a health system, the higher the propensity to have consumers with positive perception of the healthcare services (satisfied consumers). The implications of the findings are then discussed.

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

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.

Exploring the Practice of Making Informal Payments in the Health Sector: Some Lessons from Greece

This chapter explores the prevalence of informal payments in public healthcare services in Greece. To evaluate the relationship between extra payments or valuable gifts (apart from official fees) and the level of acceptability of corruption, as well as the socio-spatial variations in the tendency to offer informal payments, data from a 2013 Eurobarometer survey is reported. Using logistic regression analysis, the finding is that patients with a high acceptability of corruption, those considering corruption as a very widespread phenomenon and those located in rural areas are more likely to offer, apart from official fees, extra payments or valuable gifts for healthcare services. The chapter concludes by discussing the health policy implications.