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Framing of sensitive topics in surveys measuring corruption in healthcare

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  • Parvanova, Iva
  • Lagarde, Mylene

Abstract

Corruption is a costly, consequential and complex phenomenon facing healthcare systems globally. Measuring the prevalence of petty corruption, such as bribery and informal payments, is challenging due to the hidden and sensitive nature of these exchanges. This paper explores how question framing influences estimates of informal payment prevalence in doctor-patient relationships in two steps. We analyze the responses from the Eurobarometer survey and then conduct a novel survey experiment in Bulgaria and the UK, comparing the effect of ‘neutral’ (avoiding corruption-related terms) versus ‘loaded’ (using corruption-related terms) question wording on individuals' reports of experiences with informal payments. Data from the Special Eurobarometer 397 survey (N = 16,051) fielded in 2013 reveals a notable framing effect: respondents report higher prevalence of informal payments when questions are neutrally framed, as opposed to using corruption-related language. This result is confirmed by a survey experiment we ran between November 2023 and February 2024 in with participants in Bulgaria (N = 428) and the UK (N = 424). Respondents exposed to neutral framing were significantly more likely to admit making informal payments compared to those in the loaded treatment group. The difference in response rates between countries suggests that cultural and normative specificities play a role in willingness to report healthcare corruption. Our results underscore the trade-off between using culturally contextualized terminology to elicit responses on sensitive topics and adopting a universal approach that facilitates cross-country comparisons. We further discuss the behavioral and normative implications of using neutral versus corruption-related language when investigating informal practices in healthcare settings.

Suggested Citation

  • Parvanova, Iva & Lagarde, Mylene, 2025. "Framing of sensitive topics in surveys measuring corruption in healthcare," Social Science & Medicine, Elsevier, vol. 364(C).
  • Handle: RePEc:eee:socmed:v:364:y:2025:i:c:s0277953624009754
    DOI: 10.1016/j.socscimed.2024.117521
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    1. Lambsdorff, Johann Graf & Frank, Björn, 2010. "Bribing versus gift-giving - An experiment," Journal of Economic Psychology, Elsevier, vol. 31(3), pages 347-357, June.
    2. Dincer, Oguzhan & Teoman, Ozgur, 2019. "Does corruption kill? Evidence from half a century infant mortality data," Social Science & Medicine, Elsevier, vol. 232(C), pages 332-339.
    3. Klaus Abbink & Heike Hennig-Schmidt, 2006. "Neutral versus loaded instructions in a bribery experiment," Experimental Economics, Springer;Economic Science Association, vol. 9(2), pages 103-121, June.
    4. Balabanova, Dina & McKee, Martin, 2002. "Understanding informal payments for health care: the example of Bulgaria," Health Policy, Elsevier, vol. 62(3), pages 243-273, December.
    5. Currie, Janet & Lin, Wanchuan & Meng, Juanjuan, 2013. "Social networks and externalities from gift exchange: Evidence from a field experiment," Journal of Public Economics, Elsevier, vol. 107(C), pages 19-30.
    6. Bo Rothstein, 2014. "What is the opposite of corruption?," Third World Quarterly, Taylor & Francis Journals, vol. 35(5), pages 737-752, May.
    7. Li, Mingqiang & Li, Zhihui & Yip, Chi-Man (Winnie), 2022. "Informal payments and patients’ perceptions of the physician agency problem: Evidence from rural China," Social Science & Medicine, Elsevier, vol. 298(C).
    8. Levin, Irwin P. & Schneider, Sandra L. & Gaeth, Gary J., 1998. "All Frames Are Not Created Equal: A Typology and Critical Analysis of Framing Effects," Organizational Behavior and Human Decision Processes, Elsevier, vol. 76(2), pages 149-188, November.
    9. Hunt, Jennifer, 2010. "Bribery in health care in Uganda," Journal of Health Economics, Elsevier, vol. 29(5), pages 699-707, September.
    10. Vian, Taryn & Grybosk, Kristina & Sinoimeri, Zamira & Hall, Rachel, 2006. "Informal payments in government health facilities in Albania: Results of a qualitative study," Social Science & Medicine, Elsevier, vol. 62(4), pages 877-887, February.
    11. Margit Sommersguter-Reichmann & Claudia Wild & Adolf Stepan & Gerhard Reichmann & Andrea Fried, 2018. "Individual and Institutional Corruption in European and US Healthcare: Overview and Link of Various Corruption Typologies," Applied Health Economics and Health Policy, Springer, vol. 16(3), pages 289-302, June.
    12. Mavisakalyan, Astghik & Otrachshenko, Vladimir & Popova, Olga, 2021. "Can bribery buy health? Evidence from post-communist countries," Journal of Comparative Economics, Elsevier, vol. 49(4), pages 991-1007.
    13. Gaal, Peter & Evetovits, Tamas & McKee, Martin, 2006. "Informal payment for health care: Evidence from Hungary," Health Policy, Elsevier, vol. 77(1), pages 86-102, June.
    14. Abigail Barr & Danila Serra, 2009. "The effects of externalities and framing on bribery in a petty corruption experiment," Experimental Economics, Springer;Economic Science Association, vol. 12(4), pages 488-503, December.
    15. Kristyna Chabova, 2017. "Erratum to: Measuring corruption in Europe: public opinion surveys and composite indices," Quality & Quantity: International Journal of Methodology, Springer, vol. 51(4), pages 1901-1901, July.
    16. Kristyna Chabova, 2017. "Measuring corruption in Europe: public opinion surveys and composite indices," Quality & Quantity: International Journal of Methodology, Springer, vol. 51(4), pages 1877-1900, July.
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