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How Do Patient Characteristics Influence Informal Payments for Inpatient and Outpatient Health Care in Albania

This study represents one of the first attempts to make an empirical assessment of the three major theories that have been advanced to date explaining the phenomenon of informal payments for healthcare - the cultural model (informal payments as one of the expressions of the ‘culture of gifts’), economic model (informal payments as the result of a gap between demand and supply), and, what the authors call, governance model (informal payments as the result of a lack of control and accountability of healthcare systems). Using Albania as a case study, the authors demonstrate that that the cultural explanatory model appears to be substantially weaker than the economic and the governance ones.


While having quite limited theoretical generalisability (due to the fact that the design of Albania’s healthcare system, which is used by the authors as one of the explanatory factors, is not representative of the whole region) this study, however, could be of interest for those working on issues of informal payments/corruption in healthcare, especially, in CEE/CIS countries. First, the authors’ attempt to code different explanatory models using the available survey data is rigorous and could be further replicated with some adjustments (including, adjustments for differences in the design of healthcare systems). Second, comparative studies (whether cross-country, or historical, both) of similar design could potentially become a very solid basis for theoretical advancements in the field.


The official abstract of the paper is as follows:

 “Background: Informal payments for health care are common in most former communist countries. This paper explores the demand side of these payments in Albania. By using data from the Living Standard Measurement Survey 2005 we control for individual determinants of informal payments in inpatient and outpatient health care. We use these results to explain the main factors contributing to the occurrence and extent of informal payments in Albania.

Methods: Using multivariate methods (logit and OLS) we test three models to explain informal payments: the cultural, economic and governance model. The results of logit models are presented here as odds ratios (OR) and results from OLS models as regression coefficients (RC).

Results: Our findings suggest differences in determinants of informal payments in inpatient and outpatient care. Generally our results show that informal payments are dependent on certain characteristics of patients, including age, area of residence, education, health status and health insurance. However, they are less dependent on income, suggesting homogeneity of payments across income categories.

Conclusions: We have found more evidence for the validity of governance and economic models than for the cultural model.”


Citation: S. Tomini & H. Maarse, “How do patient characteristics influence informal payments for inpatient and outpatient health care in Albania: Results of logit and OLS models using Albanian LSMS 2005”, BMC Public Health, 11:375, 2011

Author : S. Tomini and H. Maarse

28 Nov 2011

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