Lessons from health financing reform in central and eastern Europe and the former Soviet Union

Rethinking informal payments by patients in Europe: An institutional approach

“…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.…”

“…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].…”

“…As previous studies reveal, these formal institutional imperfections include not only the existence of formal institutional voids, such as lower expenditures on healthcare [6] and inefficient resource allocation which results in a low range and reach of healthcare services [12,25,26,39,44,62], but also formal institutional inefficiencies, such as the poor quality of government, poorer performing healthcare systems and those concentrating on curative rather than preventative care [12,[24][25][26]33,34,43,61]. To test whether these formal institutional voids and inefficiencies are associated with greater levels of informal payment, the following hypotheses can be thus evaluated:…”

International models of health systems financing

“…This has resulted in variation in services in the regions in term of medical sophistication. The transition from the old to the new system of health financing were never established by Russian legislation and implementation of compulsory health insurance funds has been poorly controlled by central government authorities leading to much variation in the conscription of the population for health coverage [28,29] .…”

“…The Czech Republic re-introduced social health insurance after the fall of the Soviet Union in 1989 [28,30] .…”