title: Patterns of informal patient payments in Bulgaria, Hungary and Ukraine: a comparison across countries, years and type of services.
abstract: Informal payments for health care are a well-known phenomenon in many health care systems around the world. While informal payments could be an important source of health care financing, they have an adverse impact on efficiency and access to care, and are a major impediment to ongoing health care reforms. This paper aims to study the scale and patterns of informal patient payments for out-patient and in-patient services in three former-socialist countries: Bulgaria, Hungary and Ukraine. The data are collected in 2010 and 2011 based on national representative samples and are analysed in pooled models to explain variations in payments. The results of the cross-country comparison suggest a relatively higher prevalence of informal patient payments in Ukraine and Hungary than in Bulgaria, where patients also have to pay formal user charges in the public sector. Nevertheless, informal payments for hospitalization in Bulgaria are quite extensive. We observe some differences in informal payments across the years. Variations in payment size are mainly explained by the nature, type and need for services, fee awareness and, on some occasions, by household income. Interpreted within the context of structural differences (e.g. reform paths, regulations, funding, user fees, anti-corruption policies), the findings of our study have implications on how to address informal payments for health care.
authors.affiliation: School of Public Health, National University of 'Kyiv-Mohyla Academy'; Ukraine, Skovorody street 2, Kiev, Ukraine.|Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, 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, The Netherlands.
authors.forename: Milena
authors.initials: M
authors.lastname: Pavlova
authors.affiliation: School of Public Health, National University of 'Kyiv-Mohyla Academy'; Ukraine, Skovorody street 2, Kiev, Ukraine.
authors.forename: Irena
authors.initials: I
authors.lastname: Gryga
authors.affiliation: Faculty of Health and Public Services, Semmelweis University, Budapest, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Gaál
authors.affiliation: Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands.|Top Institute Evidence-Based Education Research (TIER); Maastricht University, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Groot
mesh_terms: D002031:Bulgaria; D003695:Delivery of Health Care / Q000191:economics*; D005382:Financing, Personal / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D006814:Hungary; D007407:Interviews as Topic; D011795:Surveys and Questionnaires; D014455:Ukraine
keywords: Central and Eastern Europe; in-patient service; informal payments for health care; out-of-pocket payments; out-patient service