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

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

The perception of outpatient care quality by healthcare users in Ukraine

Background: Ukraine has been improving the quality of health care by reforming the health care system. Evidence on healthcare users' perceptions of quality is important for future system changes. This paper aims to analyze the aspects of quality that outpatient care users find most important.Methods: Data from a longitudinal household survey 'Health Index. Ukraine' in 2016-2019 were used. The survey had a sample size of over 10,000 participants per wave. Data were analyzed using descriptive statistics as well as binary regression analysis.Results: Our results showed the importance of quality attributes as 'effectiveness of treatment' and 'qualification of medical personnel' as well as changes in the perception of quality attributes connected with payment policies and general management of the facility (like working hours, setting and hygiene ensuring by medical personnel).Conclusions: Our study provides new insights into the importance of healthcare quality attributes for outpatient healthcare users in Ukraine, showing the need to develop in future a national policy on quality and a national quality strategy for health care that incorporates quality aspects important to patients to make the healthcare system more responsive to the needs and expectations of healthcare users

The validity and reliability of self-reported satisfaction with healthcare as a measure of quality: A systematic literature review

Purpose: The aim of this paper is to systematize the evidence on the validity and reliability of subjective measurements of satisfaction with healthcare. Data sources: In this qualitative systematic literature review, we searched for relevant publications in PubMed and JSTOR databases. Study selection: The key inclusion criteria included (i) original research articles in peer-reviewed journals, (ii) year of publication from 2008 onward and (iii) English language publications. Data extraction: We applied directed qualitative content analysis to the publications included in the review. Results of data synthesis: Overall, 1167 publications are found and screened. Of these, 39 publications that focus on the psychometric properties of the measurement of patient satisfaction are included. The majority of the studies validate the already existing instruments adapted to different contexts; the rest describe psychometric properties of self-developed tools. Psychometric properties are assessed by means of reliability and validity assessment. Reliability assessment is performed via Cronbach alpha and test-retest reliability. Overall, 94.9% of studies find that the satisfaction measures are reliable. Validation is performed by a variety of different methods, among which the most applicable are face validity and factor analysis. Overall, 71.8% of studies find that the satisfaction measures are valid. Conclusion: Because of the complexity of the studies, we cannot make strong recommendations on the application of self-reported satisfaction measures. We recommend the following key strategies: (i) developing of a unified standard toward satisfaction measurement and (ii) identifying a combination of tools to routinely measure satisfaction. We also suggest to further research the issue of subjectivity reduction

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

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

Coping with cancer in post-communist Europe: a systematic literature review

In the post-communist countries, limited access to treatment, lack of financial protection mechanisms, lack of information and low quality of health care frequently imposes an enormous burden on family's well-being when cancer is diagnosed. While many studies have explored barriers to cancer treatment, little attention is paid to the question how patients and their caregivers cope with cancer. In this paper, we systematically review the evidence on patients' coping strategies with cancer in post-communist countries. We performed a literature search in PubMed, JSTOR, Web of Science and EBSCO (CINAHL) to identify papers that describe patients' coping strategies because of organizational and financial barriers to cancer treatment. Papers published between January 1991 and January 2020 were included if they described individual experiences of patients at any stage of cancer treatment. We applied the Preferred Reporting Items for Systematic Literature Review as a guide for our review. In total, 28 publications from post-communist countries were included in this review. They presented evidence on coping strategies and barriers faced by patients when coping with poor access to cancer treatment, lack of finances, lack of information and low quality of health care services. Most sought coping strategies included using personal finances to pay for medical services, medicines and supplies, charitable contributions to the hospital and informal payments; visiting a private medical doctor; using personal connections and looking for additional information. We conclude that coping strategies are similar across post-communist countries and can be seen as an indicator of the shortcomings in cancer treatment. This evidence can be used to study and/or improve access to cancer treatment and improve health care policies. Research on the prevalence and quantification of coping strategies is needed to provide evidence-informed policies for countries that face gaps in cancer treatment

Coping with cancer in post-communist Europe: a systematic literature review

In the post-communist countries, limited access to treatment, lack of financial protection mechanisms, lack of information and low quality of health care frequently imposes an enormous burden on family's well-being when cancer is diagnosed. While many studies have explored barriers to cancer treatment, little attention is paid to the question how patients and their caregivers cope with cancer. In this paper, we systematically review the evidence on patients' coping strategies with cancer in post-communist countries. We performed a literature search in PubMed, JSTOR, Web of Science and EBSCO (CINAHL) to identify papers that describe patients' coping strategies because of organizational and financial barriers to cancer treatment. Papers published between January 1991 and January 2020 were included if they described individual experiences of patients at any stage of cancer treatment. We applied the Preferred Reporting Items for Systematic Literature Review as a guide for our review. In total, 28 publications from post-communist countries were included in this review. They presented evidence on coping strategies and barriers faced by patients when coping with poor access to cancer treatment, lack of finances, lack of information and low quality of health care services. Most sought coping strategies included using personal finances to pay for medical services, medicines and supplies, charitable contributions to the hospital and informal payments; visiting a private medical doctor; using personal connections and looking for additional information. We conclude that coping strategies are similar across post-communist countries and can be seen as an indicator of the shortcomings in cancer treatment. This evidence can be used to study and/or improve access to cancer treatment and improve health care policies. Research on the prevalence and quantification of coping strategies is needed to provide evidence-informed policies for countries that face gaps in cancer treatment