Out-of-pocket payments for health care services in Bulgaria: financial burden and barrier to access

Abstract

The high level of both formal and informal out-of-pocket payments for health care services in Bulgaria poses a considerable burden for households and undermines access to health services for poorer parts of the population.

Drivers behind widespread informal payments in the Romanian public health care system: From tolerance to corruption to socio‐economic and spatial patterns

“…Informal payments, also referred to as unofficial, “enveloped”, under the counter or under the table payments, continue to represent a worldwide phenomenon, affecting both developed countries and developing or in transition economies . Studies concerning the subject have been conducted in countries from: Central and Eastern Europe, eg, Poland, Hungary, Bulgaria, Lithuania, Albania, Ukraine, Romania, Russia; Central, Eastern and Southern Asia; southern regions of America, and the African continent …”

“…Informal payments, also referred to as unofficial, "enveloped", under the counter or under the table payments, continue to represent a worldwide phenomenon, affecting both developed countries 1 and developing or in transition economies. 2,3 Studies concerning the subject have been conducted in countries from: Central and Eastern Europe, eg, Poland, 4,5 Hungary, [6][7][8][9][10] Bulgaria, 5,[11][12][13][14] Lithuania, 4,5 Albania, 15 Ukraine, 4,5,16 Romania, 5,13,[17][18][19] Russia 3,20,21 ; Central, Eastern and Southern Asia 22 ; southern regions of America, 23 and the African continent. [24][25][26] Informal payments are widespread in many transition economies of post-communist Europe and the former Soviet Union, and constitute a feature of the unreformed Semashko systems (the health care model first introduced in the Soviet Union in 1930, and then replicated in other communist countries).…”

Socio-Economic Inequalities, Out-of-Pocket Payment and Consumers' Satisfaction with Primary Health Care: Data from the National Adult Consumers' Satisfaction Survey in Serbia 2009–2015

“…Between 2009 and 2015, the out-of-pocket payments as proportion of total health expenditure rose from 35.2 to 36.6% (World Health Organization, 2015). Though official co-payments represent a significant share of out-of-pocket payments in Serbia (Arsenijevic et al, 2014), they are much lower as compared with some neighboring countries (Atanasova et al, 2013). Co-payments for GP visits, specialist visits, diagnostic procedures and drugs are mandatory for all patients, with exceptions for children, pregnant woman, people who suffer from some chronic non-communicable diseases, disabilities, for members of the Roma population etc.…”

The incidence of high medical expenses by health status in seven developed countries

“…When high, OOP requirements can cause some to meet their health care needs only by sacrificing other essential purchases, such as on food, shelter and education. They may also require some to assume debt or liquidate assets intended for other purposes [8,9]. Not surprisingly, such ways of coping with high OOP requirements have been found to be more common among those in poor health and with chronic health problems [9,10].…”