Informal Payments by Patients in Central and Eastern Europe during the COVID-19 Pandemic: An Institutional Perspective.

Adrian V Horodnic,Răzvan Ionuț Drugă,Colin C Williams,Cristian Incaltarau

doi:10.3390/ijerph182010914

Abstract

Confronted with a global pandemic, public healthcare systems are under pressure, making access to healthcare services difficult for patients. This provides fertile ground for using illegal practices such as informal payments to gain access. This paper aims to evaluate the use of informal payments by patients during the COVID-19 pandemic and the institutions that affect the prevalence of this practice. Various measurements of formal and informal institutions are here investigated, namely the acceptability of corruption, the level of trust, transparency, and performance of the healthcare system. To do so, a logistic regression of 10,859 interviews with patients conducted across 11 Central and Eastern Europe countries in October–December 2020 is employed. The finding is that there are large disparities between countries in the prevalence of informal payments, and that the practice is more likely to occur where there are poorer formal and informal institutions, namely higher acceptability of corruption, lower trust in authorities, lower perceived transparency in handling the COVID-19 pandemic, difficult access to, and poor quality of, healthcare services, and higher mortality rates due to the COVID-19 pandemic. These findings suggest that policy measures for tackling informal payments need to address the current state of the institutional environment.

Highlights

The COVID-19 pandemic represents one of the most important and disruptive events in the health sector for some decades
The aim of this paper is to evaluate for the first time the drivers of informal payments during the COVID-19 pandemic
As a result of its characteristics, the COVID-19 pandemic has proven to be a productive period for committing acts of corruption, especially in the use of informal payments

Summary

Introduction

The COVID-19 pandemic represents one of the most important and disruptive events in the health sector for some decades. Due to its rapid spread throughout the world, there has been a growing demand for access to health services. This has caused the growth in some countries of informal payments to gain preferential access to health services [1]. These informal payments are known by many different names including: ‘bribes/bribe payments’;. The requests for informal payments can be initiated by doctors, such as when they consider that their salaries are low [4] or by patients who consider that they will receive better care [5]. In 2020 in the European Union the highest rate of informal payments, used in the form of bribes, was encountered in the medical sector (6% of all respondents) [6], with 22% of patients in Romania making such payments and 19% in Bulgaria [6]

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