Informal payments by patients in Croatia: benign custom or detrimental residue from socialism?

Almost three decades after the collapse of the socialist system, numerous informal practices inherited from that period have remained deeply entrenched in the Croatian economy and society. Faced with burdensome regulations and complicated procedures, many citizens and companies opt to resolve their problems using string-pulling, bribery and undeclared work. However, there are many other informal means of conduct, which have not been given adequate attention so far. One of them is the practice of giving gratuity and gifts to medical practitioners for services that are already covered by health insurance, whose roots and the exact function are still not sufficiently understood. To start filling the gap, this paper explores which groups of citizens give out-of-pocket payments to doctors and nurses, as well as what motivates them to do so. The logistic regression analysis applied on data from the Special Eurobarometer Survey No 470, which was conducted in October 2017 on a stratified sample of 1,038 Croatians, reveals that these payments by no means represent a benevolent custom of expressing gratitude for healing. Even though a certain portion of citizens exercises this practice out of choice, informal payments more commonly occur following a direct request by medical staff or simply because the patient feels a pressure to do so. As revealed by the analysis, the majority of such transactions in Croatia highly resemble standard forms of bribery. In line with this, it is recipients rather than donors of gifts and cash supplements who should be targeted in endeavours to eradicate the phenomenon.