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Room: Helsinki Hall
Time: Thu 10:15 AM-11:30 AM

Formal and informal patient payments: Substitutes or complements?

Chair: Wim Groot (Maastricht University)

Session Description

Informal patient payments are reported in many European countries. Evidence suggests that these payments affect the overall functioning of the health care system in a very complex and interrelated manner. On the one hand, these payments usually exist in a context of limited resources for health care where informal compensations to providers are necessary to ensure adequate treatment. On the other hand, these payments are a threat to public health since those who cannot afford to pay informally might not seek or delay seeking treatment. Moreover, informal patient payments may introduce undesirable incentives for providing less cost-effective services if patients are willing or accept to pay informally. Thus, informal patient payments can jeopardize efficiency, equity, and quality of health care provision.
There are various explanations for the existence of informal patient payments, including cultural perceptions, fraud, insufficient funding of the health care sector and/or lack of control and accountability in the health care system. There are also various proposals on how to deal with these payments at a policy level although it is broadly recognized that there is no single universal solution. However, the issue of informal patient payments becomes especially relevant when official patient charges are being introduced. There is an overall concern that the implementation of official patient charges does not have the ability to replace informal patient payments but they rather impose a double financial burden to consumers. However, this issue has not yet been adequately studied.
This session includes four studies on the scope and scale of informal patient payments in Europe, and their relation to official patient charges. In particular the session aims to conceptualize the term “informal patient payments” and to provide an operational definition. The session also presents a cross-country comparison between formal and informal patient payments in European health care sectors, and outlines their dependence on institutional arrangements, both within health care and beyond. Two empirical studies dealing with the phenomenon of informal patient payments in Hungary and Albania are also included in this session.

Session Organizer: Wim Groot (Maastricht University) and Milena Pavlova (Maastricht University)

Presentations

1. Formal and informal patient payments in Europe

   Presenter: Marzena Tambor (Jagiellonian University Collegium Medicum)

2. Short-term effects of the introduction of official patient fees on the level of informal payments for health care services: The case of Hungary

   Presenter: Petra Baji (Budapesti Corvinus Egyetem)

3. Paying informally in the Albanian health care sector: A two-tiered stochastic frontier model

   Presenter: Sonila Tomini (Maastricht University)

4. The scope and scale of informal patient payments in Europe: a re-examination of empirical evidence

   Presenter: Tetiana Stepurko (National University of Kyiv-Mohyla Academy)