Informal patient payments in publicly financed healthcare facilities in Lithuania.

Abstract

Since the late 1990s Lithuania has had a mixed, solidary based healthcare system, predominantly funded from the National Health Insurance Fund through a compulsory health insurance scheme. The cultural tradition of informal payments in healthcare in Lithuania was inherited from the Soviet past and is still alive. This study reveals the extent and nature of informal patient payments, and identifies the motivation behind those payments occurring in publicly financed healthcare facilities in Lithuania. The quantitative household survey design was chosen for this study. The randomly selected sample was comprised of inhabitants aged 18 years and older, representing the entire population of Lithuania by county, place of residence (urban and rural), age and sex. The study sample consisted of 1067 participants interviewed in 2009 and 2010, and 1068 in 2011 (response rate ranged from 66.6% to 68.2%). Users of healthcare services usually made informal payments for the visit to, and consultation with, a general practitioner or physician specialist and for diagnostic services. Females and older citizens, the disabled, public/private sector employees, retirees, those with higher education and those in the highest household monthly income group were more prone to pay informally for health services. The majority of respondents were against formalization of informal patient payment. National health insurance payments for healthcare services from the formal public fund for healthcare are further augmented by informal payments from service consumers, used routinely for better access to and higher quality of healthcare service.