Informal patient payments
in Central and Eastern
European countries
Tetiana Stepurko
Public Health Administration PhD Programme
Scientific supervisors: Irena Gryga, MD, Associate
Professor
Prof.Dr.Wim Groot and Dr.Milena Pavlova
(Maastricht university)
ASSPRO CEE 2007
Collaborative Focused Research Project
FP7-SSH-2007 Grant Agreement No.: 217431
ІI PhD Conference
"Transparency and Accountability in Scientific Research"
Kyiv-Mohyla Academy Doctoral School
January 31, 2013 – February 4, 2013
Introduction
Chapter 1
Chapter 3 Chapter 2
Chapter 6 Chapter 5 Chapter 4
Discussion
WHY RESEARCH ON INFORMAL PAYMENTS?
• What are informal payments?
• Why are these payments a problem?
• Why should they be studied?
• To what extent are they studied?
• Lack of recent and comparable data on informal payments
RESEARCH QUESTION
What are the level, scope and
consumer’s perceptions of
informal patient payments
in Central and Eastern
European countries?
Introduction
Chapter 1
Chapter 3 Chapter 2
Chapter 6 Chapter 5 Chapter 4
Discussion
The most appropriate research
designs when IPP are examined?
• The definition of “informal
patient payments” is a challenging task
• Single country results,
• different units of analysis
• Variety of data collection modes,
sample units and design
Methods
Systematic literature
review:
Published in English
Empirical studies
31 publication is
analyzed qualitatively
Face-to-face or self-administrated data collection mode; special
attention to wording of the questions, recall period etc.
Introduction
Chapter 1
Chapter 3 Chapter 2
Chapter 6 Chapter 5 Chapter 4
Discussion
Do public attitude matter?
Cluster
Perceive
informal
What is 1:
your
attitudeboth
towards
Negative;
cash payments and in-kind gifts only
-informal
cash payments /
as
corruption
Indifferent;
Cluster
1: Negative towards both
informal
- gifts
cash in-kind
payments and in-kind giftsPositive
Cluster 2: Perceive both informal
to physicians,
medical
staffgifts
or other
cash
payments
and
in-kind
Cluster 2:
towards
cash
personnel
in Negative
health care
facilities?
mostly
as
corruption
payments but positive or indifferent
Methods
Face-to-face interviews
Multistage probability sample
National representative
survey
towards in-kind gifts
1st wave:
Cluster
3:
Perceive
informal
cash
-Informal cash payments/
1000 interviews *
-Informal cash payments/
payments
as
corruption
and
mixed
Cluster 3: Indifferent towards both
6 countries
-Gifts
in-kind
answers
for
in-kind
gifts.
informal cash payments and in-kind-Gifts
gifts in-kind
to physicians and medical staff
to physicians and medical staff
Cluster
4: 4:
Perceive
both informal
Cluster
Mostly positive
towards both
are
similar
to
No; gifts
are similar to
cash
payments
in-kind
informal
cash and
payments
and in-kind gifts
-Corruption
/
mostly
as gratitude
Somewhat
-Corruption /
-gratitude
Yes
-gratitude
Chapter 1
Chapter 3 Chapter 2
Chapter 6 Chapter 5 Chapter 4
Discussion
What are the patterns of IPP in CEE?
How much is
paid (total
and
informal)?
Type of
service?
Knowledge
of formal fee
size?
Who is
Annual and
Methods
Length of
initiator?
Country
last
the service?
Face-to-face interviews
visit/hospita specificity
Who pays?
Multistage probability sample
lization?
Payment for Payment for
pharmaceutic. med.supplies
What is the
purpose?
1st wave:
1000 interviews * 6 countries
2nd wave:
800 interviews * 3 countries
Introduction
Discussion
Chapter 6 Chapter 5 Chapter 4
Chapter 3 Chapter 2
Chapter 1
Informal patient payments for childbirth
• Virtually all patients “thank” medical
staff
• Individual vs Emergency room
patients
• Combination of informal payments
with other types of patient payments
• Payments range from $ 300 to $ 700
Methods
•Qualitative
ethnographic study
•20 semi-structured
interviews with
consumers, providers
and key informants
•Kiev, Ukraine
Introduction
Discussion
Chapter 6 Chapter 5 Chapter 4
Chapter 3 Chapter 2
Chapter 1
Discussion on policy implications
• Multidimensional policy strategies aimed to improve
transparency and accountability in public service
provision (to eradicate informal payments).
Precede-proceed model:
• Socio-cultural dimension (predisposing),
• Economic-labor (enabling),
• and political-regulatory dimension (reinforcing factors)
influence not only the behavior but also the environment (the
health care system) where the behavior takes place
Introduction
Chapter 1
Chapter 3 Chapter 2
Chapter 6 Chapter 5 Chapter 4
Discussion
Thank to EC for funding!
Thank you for unforgettable research experience!!!
Acknowledgement of funding:
The study is financed by the European Commission under the 7th
Framework Programme, Theme 8 Socio-economic Sciences and
Humanities, Project ASSPRO CEE 2007 (Grant Agreement no. 217431).
The views expressed in this publication are the sole responsibility of the
authors and do not necessarily reflect the views of the European
Commission or its services.