Informal Payments in Health Systems: Purpose and Occurrences in Turkey

Abstract

Informal payments constitute a significant portion of out-of-pocket payments in health systems, especially in developing countries. This study examined the current status of informal payments in Turkey and the opinions, attitudes, and behavior of individuals toward informal payments. To examine this concept, 1,033 residents in Ankara, the capital city of Turkey, were surveyed. The 28-item questionnaire used in data collection was developed based on previous research and expert opinions. The data analysis revealed that approximately 29% of the study participants made informal payments in return for the medical service they received. Three out of 4 people who made informal payments were from a low-income group. Informal payments were made in the form of cash prior to medical procedures and also as gifts following the procedures. Future recommendations for health policymakers include designing a new patient copay mechanism where informal payments can be effectively incorporated into the formal payment system, assistance to lowincome individuals, and improvement in current medical staff salaries that would discourage taking such payments.

Informal Payments for Inpatient Services and Related Factors: A Cross-Sectional Study in Tehran, Iran

“…The highest number of patients were exposed to informal payments in public hospitals (64.4%), which is consistent with the findings of previous studies (24,29,30). This can be attributed to the pattern of referrals and more utilization of public hospital services that increases the probability of frequency of informal payments.…”

“…The most common form of informal payments was in cash, which is in line with the findings of previous studies (6,9,10,24,(31)(32)(33). In some studies, most of the informal payments have been made in the form of non-monetary gifts (28,34,35).…”

Rethinking informal payments by patients in Europe: An institutional approach

“…Nevertheless, informal patient payments phenomenon is poorly examined at a cross-country level. Examining the prevalence of this informal practice, previous studies reveal considerable cross-national variations in the proportion of patients who make informal payments, ranging from 50% in Tajikistan [52], 43% in Bulgaria [13], 36% in Greece [4], 29% in Turkey [57], 25% in Moldova [46] and 23% in Russia [44].…”

“…Indeed, most previous studies reveal that women are more likely to make informal payments for health care services [6,40,42,46,59], as do younger persons [6,45,47,49,60], better educated persons [6,[40][41][42]47,49], those having a job [41], those married [49], those living in a smaller household [40,49,50], those living in rural areas [45,60,61], and those with lower income [31,37,57,61]. By testing this hypothesis, whether these populations also have a higher institutional asymmetry can be evaluated.…”

“…This has been identified in studies conducted in large geographical areas, such as in 35 European countries [26], Central Asia [30] as well as in 33 African countries [31], or in smaller studies comprising only one nation as, for example, Bulgaria [1,6,13,32,33], Poland [34,35], Hungary [2,[36][37][38][39][40], Greece [4,41], Lithuania [34,42], Russia [43,44]; Ukraine [34,45], Moldova [46], Serbia [47], Kazakhstan [48], Albania [5,49,50], Kosovo [8], Tajikistan [51,52], Kyrgyzstan [53], Taiwan [54], Cameroon [55], Tanzania [3,56] and Turkey [57]. Nevertheless, informal patient payments phenomenon is poorly examined at a cross-country level.…”