Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments

Abstract

BackgroundEmpirical evidence demonstrates that informal patient payments are an important feature of many health care systems. However, the study of these payments is a challenging task because of their potentially illegal and sensitive nature. The aim of this paper is to provide a systematic review and analysis of key methodological difficulties in measuring informal patient payments.MethodsThe systematic review was based on the following eligibility criteria: English language publications that reported on empirical studies measuring informal patient payments. There were no limitations with regard to the year of publication. The content of the publications was analysed qualitatively and the results were organised in the form of tables. Data sources were Econlit, Econpapers, Medline, PubMed, ScienceDirect, SocINDEX.ResultsInformal payments for health care services are most often investigated in studies involving patients or the general public, but providers and officials are also sample units in some studies. The majority of the studies apply a single mode of data collection that involves either face-to-face interviews or group discussions.One of the main methodological difficulties reported in the publication concerns the inability of some respondents to distinguish between official and unofficial payments. Another complication is associated with the refusal of some respondents to answer questions on informal patient payments.We do not exclude the possibility that we have missed studies that reported in non-English language journals as well as very recent studies that are not yet published.ConclusionsGiven the recent evidence from research on survey methods, a self-administrated questionnaire during a face-to-face interview could be a suitable mode of collecting sensitive data, such as data on informal patient payments.

Informal Payments in Healthcare: A Case Study of Kerman Province in Iran

“…We have explored the phenomenon in the context of Iran's health system by involving three main stakeholders. Previous studies have reported that people make informal payments to express gratitude (3,24,25), to get additional or better services (3,26), or because of cultural norms ingrained in their tradition, and weak laws (25). This study indicates that all of the above mentioned factors affect patients' decisions to make such payments, although some of them seem to play a more important role.…”

“…Dabalen and Wane state that informal patient payments are a sensitive research topic due to their illegality in some countries. This implies that there may be difficulties in estimating their real scope and magnitude, and above all difficulties in determining the frequency of their occurrence (24).…”

Mit gondolnak a családorvos-rezidensek a hálapénzről?

“…Így összevetve jelen eredményeinkkel, elmondható, hogy a két évvel korábbi felméréshez képest nőtt a családorvos-rezidensek körében a hálapénzt elutasítók aránya (50% vs. 38,3%) [27]. Vizsgálati eredményeinket árnyalja, hogy a "hálapénz-problémában" nem a családorvoslás a leginkább érintett ágazat: mind a nemzetközi, mind pedig a hazai vizsgála-tok kimutatták, hogy a fekvőbeteg-ellátás a legjobban érintett terület [4,5,[28][29][30], így eredményeink nem ál-talánosíthatóak más szakmákra, szakterületekre. A Markusovszky-ösztöndíj megléte is finomíthatja eredménye-inket: ezen ösztönző minden bizonnyal enyhíti a fiatal orvosgeneráció financiális nehézségeit, és elviekben szigorú tiltás alá vonja a hálapénz elfogadásának gyakorlatát.…”

“…Elsősorban a posztszovjet országok sajátossága, de megjelenik az afrikai, a dél-amerikai és egyes ázsiai egészségügyi rendszerekben is, valamint ismert a fogalom Törökországban, Görögországban és Olaszországban [3][4][5][6][7]. A jelenség háttere, mozgatóru-gói, múltja, jelene és jövője számos szakterület tudományos diskurzusának kiemelt kérdése hazánkban is.…”

Beyond our labour pains: women experiences of informal payments and delivery room conditions at birth in the Bongo district of Ghana

“…Other studies in extending this definition define informal payments as cash or in-kind payments that may happen alongside formal official payment for health care services. 27,28 These payments when suspected to violate accountability mechanisms within the health system may create inefficiencies and inequity issues with the use of equal services by all patients. 27,29,30 …”