Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments

<p>Abstract</p> <p>Background</p> <p>Empirical evidence demonstrates that informal patient payments are an important feature of many health care systems. However, the study of these payments is a challenging task because of their potentially illegal and sensitive nature. The aim of this paper is to provide a systematic review and analysis of key methodological difficulties in measuring informal patient payments.</p> <p>Methods</p> <p>The systematic review was based on the following eligibility criteria: English language publications that reported on empirical studies measuring informal patient payments. There were no limitations with regard to the year of publication. The content of the publications was analysed qualitatively and the results were organised in the form of tables. Data sources were Econlit, Econpapers, Medline, PubMed, ScienceDirect, SocINDEX.</p> <p>Results</p> <p>Informal payments for health care services are most often investigated in studies involving patients or the general public, but providers and officials are also sample units in some studies. The majority of the studies apply a single mode of data collection that involves either face-to-face interviews or group discussions.</p> <p>One of the main methodological difficulties reported in the publication concerns the inability of some respondents to distinguish between official and unofficial payments. Another complication is associated with the refusal of some respondents to answer questions on informal patient payments.</p> <p>We do not exclude the possibility that we have missed studies that reported in non-English language journals as well as very recent studies that are not yet published.</p> <p>Conclusions</p> <p>Given the recent evidence from research on survey methods, a self-administrated questionnaire during a face-to-face interview could be a suitable mode of collecting sensitive data, such as data on informal patient payments.</p

Monitoring cameras for traffic restricted area and separated bus’ lanes in Cracow

Artykuł opisuję drogę do stworzenia projektu System Kontroli Dostępu Do Strefy Ruchu Uspokojonego i Nadzoru Nad Pasami Komunikacji Zbiorowej, którego realizacja rozpocznie się w 2013 roku w Krakowie. Celem zadania jest objęcie monitoringiem strefy ograniczonego ruchu i pasów dla autobusów w centrum miasta. W tekście przedstawiono historię wprowadzania ograniczeń ruchu w Krakowie, rozwój rozwiązań promujących transport zbiorowy, w tym przede wszystkim wydzielone pasy dla autobusów. Następnie omówiono pierwsze próby stworzenia monitoringu wizyjnego rejestrującego pojazdy na podstawie odczytu tablic rejestracyjnych. Na koniec zaprezentowano najważniejsze założenia dotyczące projektu System Kontroli Dostępu Do Strefy Ruchu Uspokojonego i Nadzoru Nad Pasami Komunikacji Zbiorowej.Article describes way to the project System of Zone Access Control for Traffic Restricted Area and Public Transport’s Lines in Cracow which implementation starts in 2013 in Cracow. The aim of this task is to organize control in traffic restricted areas and over bus lines in the city centre. The history of implementation of traffic restrictions in Cracow, developments of solutions promoting public transport including separated bus’ lines has been presented in the article. Then first attempts of organizing vision control registrating vehicles on the basis of number plates have been presented. Finally the most important measures concerning the project System of Zone Access Control for Traffic Restricted Area and Public Transport’s Lines in Cracow have been discussed

Urban traffic control system and public transport priority in Cracow

Przedmiotem artykułu jest opis rozwoju Obszarowego Systemu Sterowania Ruchem na ulicach Krakowa, a także nadawanie priorytetu pojazdom komunikacji miejskiej na sygnalizacjach świetlnych. Autorzy w pierwszej kolejności podjęli próbę zaprezentowania podstaw tworzenia dobrych programów sygnalizacyjnych, określonych na podstawie własnych doświadczeń zawodowych. Następnie, przedstawiony został pierwszy wdrożony w Krakowie Obszarowy System Sterowania Ruchu, zrealizowany w ramach projektu Krakowski Szybki Tramwaj. Zaprezentowano również pierwsze wnioski i efekty realizacji tego projektu. W dalszej kolejności autorzy omówili kolejny wdrożony system, powstały przy okazji budowy linii tramwajowej na Mały Płaszów. Na koniec tej części artykułu zawarto listę projektów związanych z rozszerzeniem posiadanych systemów sterowania ruchem zarówno o zadania aktualnie realizowane, jak i przewidziane do wykonania w najbliższym czasie. W drugiej części artykułu autorzy skupili się na kwestii nadawania priorytetu dla pojazdów transportu zbiorowego. Przedstawiono podstawowe zasady realizacji priorytetu. Zaprezentowano przykłady zastosowania priorytetu na skrzyżowaniach z sygnalizacją świetlną w Krakowie. W końcu omówiono najbardziej charakterystyczne problemy pojawiające się w momencie wdrożenia priorytetu dla komunikacji miejskiej. Cały artykuł prezentuje pokaźną wiedzę dotyczącą funkcjonowania sygnalizacji świetlnych, tworzenia programów sygnalizacyjnych oraz wdrażania systemów sterowania ruchem, opartą przede wszystkim o doświadczenia autorów, realne sytuacje i problemy, z którymi się zetknęli.The paper describes development of the Urban Traffic Control System of Cracow’s street and giving priority to the vehicles of public transport at the traffic lights. At the beginning authors undertake an essay to present principles of traffic lights programs of high quality on the basis of their own professional experiences. Afterwards first Urban Traffic Control System implemented in Cracow in the framework of the project Cracow Rapid Tram has been described. First conclusions and results of this implementation have been presented as well. Then authors have described next implemented system connected with the new tram line construction with terminus at the Mały Płaszów. At the end of this part of the article authors have listed projects related to the expansion of existing systems both: with tasks being under implementation just now and designed for realization in the near future. In the second part of the article authors have focused on the issue of priority for vehicles of public transport. Basic principles of implementation of the priority as well as examples of these realizations at Cracow intersections with traffic lights have been presented. Finally the most typical problems appearing during public transport priority implementations have been discussed. The paper presents considerable knowledge on traffic light’s functioning, development of traffic lights programs and implementation of urban traffic control systems based mostly on author’s experiences, real situations and problems they have faced

Informal patient payments and public attitudes towards these payments: evidence from six cee countries

Informal patient payments are deeply rooted in Central and Eastern European countries. Despite the socio-political changes in the health care sectors after 1990s and the subsequent health care reforms, informal payments for health care services continue to serve patients` and physicians` interests. These payments also fill gaps in health care funding in this European region. Nevertheless, unofficial payments are not a desirable payment channel. They lack transparency and distort the efficiency and equity in health care provision. Still, the successful elimination of these payments will depend on the public attitude towards these payments. This study aims to compare public attitudes towards informal patient payments and payment experience in six Central and Eastern European: Bulgaria, Hungary, Lithuania, Poland, Romania, and Ukraine. The data have been collected in 2010 in nation-wide representative surveys using an identical standardized question- naire administrated via face-to-face interviews. We have collected about 1000 questionnaires in each country. The results show that a major group of respondents in each country expresses a negative attitude towards both informal cash payments and in-kind gifts. 208, 187, and 174 respondents paid informally for out-patient service in Ukraine, Romania, and Hungary respectively. We also analyse the relation between public attitudes and respondents` past experience with informal payments, e.g. whether they have paid informally payment for out-patient service used last year. In Bulgaria and Poland, negative attitude is mostly observed among those who have not paid informally. The existence of positive and indifferent attitudes towards informal pay- ments as reported in our study, indicates a challenge for policy makers in Central and Eastern European countries. The acceptance of government initiatives aimed at the elimination of informal payments will largely depend on the governments` ability to create a social resistance towards these payments

To pay or not to pay? A multicountry study on informal payments for health-care services and consumers' perceptions

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. DESIGN: We use data from a multicountry quantitative empirical research conducted in 2010. SETTING AND PARTICIPANTS: 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. MAIN VARIABLES STUDIED: 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

Preferences for physician services in Ukraine: a discrete choice experiment

Evidence on preferences of Ukrainian consumers for healthcare improvements can help to design reforms that correspond to societal priorities. This study aims to elicit and to place monetary values on public preferences for out-patient physician services in Ukraine. The method of discrete choice experiment is used on a sample of 303 respondents, representative of the adult Ukrainian population. The random effect logit model with interactions provides the best fit for the data and is used to calculate the marginal willingness to pay (MWTP) for quality and access improvements. At a sample level, there is no clear preference to pay formally rather than informally or vice versa. We also do not find that visiting a general practitioner is preferred over direct access to a medical specialist. However, there are differences between population groups. Quality-related attributes of physician services appear important to respondents, especially the attitude of medical staff. Thus, interpersonal aspects of out-patient care should be given priority in decisions about investments in quality improvements. Other aspects, that is social quality and access, are important as well but their improvement brings fewer social gains. Measures should be taken to eradicate the informal payment channels and to strengthen the gate-keeping role of primary care. Copyright (c) 2014 John Wiley & Sons, Ltd

Willingness and ability to pay for physician services in six Central and Eastern European countries

Patient charges for physician services are implemented in high-income countries and often are considered in the Central and Eastern Europe (CEE). However, there is no evidence on the potential consumption effects of service charges in these countries. This study provides evidence on the potential impact of patient charges on the consumption of specialized physician services in six CEE countries: Bulgaria, Hungary, Lithuania, Poland, Romania, and Ukraine. We apply a semi-parametric survival analysis to stated willingness and ability to pay (WATP) in order to identify potential demand pools and their price, income and age semi-elasticity. Data are collected through a survey held in 2010 among representative samples of about 1000 respondents in each country. Our results suggest that median WATP in the studied countries is comparable to the cost of the services. The obtained demand pools appear to be theoretically valid and externally consistent. They provide information on the shares of population that would be WATP certain fee levels, and their heterogeneity across socio-demographic groups gives an idea about the population groups that will need to be exempted. (C) 2014 Elsevier Ireland Ltd. All rights reserved

Informal payments for health care services - Corruption or gratitude? A study on public attitudes, perceptions and opinions in six Central and Eastern European countries

In this study we aim to compare the public perceptions towards informal patient payments in six central and eastern european countries (bulgaria, hungary, lithuania, poland, romania and ukraine). Overall, around 35–60% of the general public in each country has ever made informal payments, though informal cash payments are perceived negatively, mostly as corruption. In-kind gifts are often seen as a token of gratitude. However, significant differences among countries are observed. Despite the public support for the eradication of informal payments, there are population groups who favor their existence and this should be taken into account in policy-making