CONCEPTUAL DELIMITATIONS OF INFORMAL PAYMENTS IN THE ROMANIAN HEALTH CARE SYSTEM
Keywords:informal payments, gift, gratitude, characteristics, outcomes.
AbstractInformal payments represent a controversial topic, analysed in the medical literature in the past few years, but also present in the Romanian daily reality. In this paper, I aim at presenting the preliminary findings within a qualitative research on informal payments, which focuses on definitions provided by patients for this phenomenon, as well as on its outcomes upon the health care system. Thirteen persons diagnosed with chronic diseases took part in my research; they are residents of Iaşi, and I interviewed them in the period November 2014 – January 2015. I used a semi-structured interview guide. The questions of the interviews to be analysed were as follows: How do patients define the notion of informal payment? and What are the (positive and negative) outcomes of informal payments upon the communities to which patients belong? Respondents believe that informal payments offered to physicians are mainly in cash or in kind. When it comes to money, they use words such as bribe, stimulus, “little something”, sign of gratitude, sales and purchase agreement or blackmail; when they refer to gifts, the respondents use words such as “little something”, gift, sign of gratitude, gratitude or protocol. The outcomes of informal payments are mainly negative upon patients, the health care system and the community; the positive ones refer mainly to physicians, in terms of increasing their incomes.
Bock, J.O. and Matschinger, H. (2014). Inequalities in out-of-pocket payments for health care services among elderly Germans - results of a population-based cross-sectional study. Int J Equity Health, 13(1), 3.
Chereches, R.M. and Ungureanu, M.I. (2013). Defining informal payments in health-care: a systematic review. Health Policy, 110(2-3), 105-114.
Chrismann, S. (2013). The impact of online health information on the doctor-patient relationship. Findings from a qualitative study. Media@LSE, London School of Economics and Political Science.
Fărcăşanu, D.O. (2010). Percepţia populaţiei asupra corupţiei, plăţilor informale şi introducere coplăţii în sistemul public de sănătate din România. Management în sănătate, XIV(1), 9-14.
Gaal, P. and Evetovits, T. (2006). Informal payment for health care: evidence from Hungary. Health Policy, 77(1), 86.
Iluţ, P. (1997). Abordarea calitativă a socioumanului. Concepte şi metode. Polirom, Iaşi.
Lewis, M. (2007). Informal payments and the financing of health care in developing and transition countries. Health Aff (Millwood), 26(4), 984-997.
Mæstad, O. and Mwisongo, A. (2011). Informal payments and the quality of health care: Mechanisms revealed by Tanzanian health workers. Health Policy, 99(2), 107-115.
Moldovan, A. and Van de Walle, S. (2013). Gifts or bribes? Attitudes on informal payments in Romanian healthcare. Public Integrity, 15(4), 383-399.
Nekoeimoghadam, M. and Esfandiari, A. (2013). Informal payments in healthcare: a case study of Kerman province in Iran. Int J Health Policy Manag, 1(2), 157-162.
Onah, M.N. and Govender V. (2014). Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: a gender perspective. PLoS One, 9(4), e93887.
Pitea, M., Cojocaru, D. and Oprea, L. (2014). Ethical aspects of informal payments in the healthcare system. Revista Română de Bioetică, 163-174.
Stepurko, T. and Pavlova, M. (2010). Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments. BMC Health Serv Res, 10, 273.
Stepurko, T. and Pavlova, M. (2013). Informal payments for health care services – Cor¬ruption or gratitude? A study on public attitudes, perceptions and opinions in six Central and Eastern European countries. Communist and Post-Communist Studies, 419-431.
Szende, A. and Culyer A.J. (2006). The inequity of informal payments for health care: the case of Hungary. Health Policy.
Tambor, M. and Pavlova, M. (2013). The formal-informal patient payment mix in European countries. Governance, economics, culture or all of these? Health Policy 113(3), 284-295.
Tambor, M. and Pavlova, M. (2014). The inability to pay for health services in Central and Eastern Europe: evidence from six countries. Eur J Public Health, 24(3), 378-385.
Tomini, S. and Maarse H. (2011). How do patient characteristics influence informal payments for inpatient and outpatient health care in Albania: results of logit and OLS models using Albanian LSMS 2005. BMC Public Health, 11, 375.
Vian, T. and Burak, L.J. (2006). Beliefs about informal payments in Albania. Health Policy Plan, 21(5), 392-401.
Zamfir, C. and Vlăsceanu, L. (1993). Dicţionar de sociologie. Babel, Bucureşti.