Abstract
BackgroundInformal payments for health care services can impose financial hardship on households. Many studies have found that the position within the household can influence the decision on how much is spent on each household member. This study analyses the intra-household differences in spending on informal payments for health care services by comparing the resources allocated between household heads, spouses and children.MethodsPooled data from two cross sectional surveys, the Albanian Living Standard Measurement Survey 2002 and 2005, are used to analyse both the probability and the amount paid in inpatient and outpatient health care services. A generalised Hausman specification test is used to compare the coefficients of probit and OLS models for nuclear and extended households.ResultsWe find that due to the widespread informal payments there are no significant differences between households in the incidence of informal payments for households' members, but there are more differences in the amount paid informally. Results suggest that households strategically allocate their resources on health care by favouring individuals with higher earning potential who have invested more in human capital. Extended households pay higher amounts for spouses with higher education compared to nuclear households. On the other hand, nuclear households choose to pay higher amounts for children with a higher level of education compared to extended households.ConclusionsThe differences between households should be taken into account by public policies which should compensate this by redistribution mechanisms targeting disadvantaged groups. Governments should implement effective measures to deal with informal patient payments.JEL Codes: I10, I19, D10
Highlights
Informal payments for health care services can impose financial hardship on households
Patients pay approximately 55 times more per visit for inpatient than for outpatient care. This shows that such informal payments are implicit payments imposed by medical staff
Contrary to what we have found for informal payments, education of the spouse increases the amount of out-ofpocket paid for nuclear households
Summary
Informal payments for health care services can impose financial hardship on households. This study analyses the intra-household differences in spending on informal payments for health care services by comparing the resources allocated between household heads, spouses and children. We analyse the effect characteristics of household heads, spouses and children have on the probability or the amounts paid informally, and test for differences between these members of households. For this purpose, we use data from the Albanian Living Standards Measurement Survey 2002 and 2005. The article contributes to the existing literature on intra-household allocation of resources by providing insights on how households cope with unregulated payments in health care when the government policies fail and little is known about the actual prices
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