title: To pay or not to pay? A multicountry study on informal payments for health-care services and consumers' perceptions.
abstract: BACKGROUND
  Although the literature offers various theoretical explanations for the existence of informal patient payments, empirical research has mostly focused on socio-demographic features as determinants of these payments. The role of health-care users' perceptions on informal payments are rarely taken into account especially in multicountry surveys.
  
  
  OBJECTIVE
  Our aim is to examine the association between informal payments for health-care services and perceptions of health-care consumers about paying informally as well as socio-demographic characteristics.
  
  
  METHODS
  We use data from a multicountry quantitative empirical research conducted in 2010.
  
  
  METHODS
  A national representative sample is drawn in six Central and Eastern European countries - Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine. In each country, about 1000 respondents are interviewed.
  
  
  METHODS
  Data related to informal payments for health-care services consumed during the preceding 12 months are analysed in addition to data on respondents' perceptions about paying informally and socio-demographic data.
  
  
  RESULTS
  Health-care users in Bulgaria and Poland are less inclined to make informal payments, while health-care users in Romania and Ukraine most often report such payments. The informal payment rates for Hungary and Lithuania fall between these two groups. In all six countries, individuals who feel uncomfortable when leaving the physician's office without a gratuity and who feel unable to refuse the request of medical staff to pay informally, more often make informal payments.
  
  
  CONCLUSIONS
  Such consumers' perceptions can undermine policy efforts to eradicate these payments; therefore, health policy measures should reinforce social resistance to informal payments.
authors.affiliation: School of Public Health, National University of 'Kyiv-Mohyla Academy', Kiev, Ukraine.|Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Tetiana
authors.initials: T
authors.lastname: Stepurko
authors.affiliation: Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Milena
authors.initials: M
authors.lastname: Pavlova
authors.affiliation: School of Public Health, National University of 'Kyiv-Mohyla Academy', Kiev, Ukraine.
authors.forename: Irena
authors.initials: I
authors.lastname: Gryga
authors.affiliation: Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.|Topinstitute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Groot
mesh_terms: D000328:Adult; D001294:Attitude to Health; D002031:Bulgaria; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics*; D006801:Humans; D006814:Hungary; D008097:Lithuania; D008297:Male; D011044:Poland; D012383:Romania; D014455:Ukraine
keywords: Central and Eastern Europe; health-care services; informal patient payments; perceived behaviour