Reducing informal payments in the health care system: Evidence from a large patient satisfaction survey
Drawing on the body of literature on the effects of providing information on reducing corruption, Mokhtari and Ashtari empirically test the argument about the importance of transparency of patients’ entitlements and service prices for reduction of informal payments for healthcare services. Taking Moldova as their case study and using 2008 Patient Satisfaction Survey as their data source, the authors test a multivariate logistic regression model assessing the importance of a wide range of socio-demographic, attitudinal, and situational factors on the probability of leaving informal payments. Among the factors included by the authors in their model were age, sex, occupation, having or not having insurance, reasons for visiting healthcare facility, having or not having appointment, length of waiting for the visit, method of payment for services, observation of confidentiality, patient’s attitudes towards healthcare facility and healthcare staff, patients’ knowledge of their rights and responsibilities, and, finally, transparency of patients’ entitlements and services prices. As this study demonstrates, transparency is an important factor of not giving informal payments.
Transparency of patients’ entitlements and service prices was measured using three proxies. First proxy was respondents’ knowledge of the services they were entitled to (Moldova has a universal publicly-funded health insurance system, in the framework of which, however, not all the healthcare services are covered). Second proxy was patients’ knowledge of the prices of for-fee services, and third, whether lists of prices of for-fee services were visibly posted in those healthcare institutions where respondents received care. As the study shows, patients’ knowledge of their entitlements and the prices of services does represent a statistically significant factor of not giving informal payments. When controlled for all the above listed factors, the odds of leaving informal payments were 0.83 for the patients who knew the services they were entitled in comparison with those who did not know that. For the patients who knew the list of paid services, the odds of leaving informal payments were 0.88 in comparison with those who did know that list. And, finally, for patients in whose healthcare institutions the price lists of for-fee services were visibly displayed, the odds of making informal payments were 0.90 in comparisons with those who received treatment in the healthcare institutions where price lists were not displayed.
Citation: M. Mokhtari & M. Ahstari, “Reducing Informal Payments in the Health Care System: Evidence from a Large Patient Satisfaction Survey”, Journal of Asian Economics [online: December 2011]
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