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Fee-for-service or donation? Hungarian perspectives on informal payment for health care

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  • Gaal, Peter
  • McKee, Martin

Abstract

Informal payments are known to be widespread in the post-communist health care systems of Central and Eastern Europe. However, their role and nature remains contentious with the debate characterized by much polemic. This paper aims to make sense of this debate by reviewing and summarizing the main arguments of the theoretical debate in Hungary. The review examines the possible causes of informal payment, the motivation of the actors involved and the impact of informal payment on system performance, focusing on efficiency and equity. The lines of arguments are summarized in two contrasting hypotheses, which envisage informal payment as either a donation or a fee-for-service. Evidence pertaining to the scale of informal payments and the motivation of patients are reviewed, but found to be inconclusive to verify the hypotheses. Although focused on Hungary, accounts from other countries facing informal payments show similar threads of discussion and dilemmas. These theories should be tested further using evidence from existing studies and new empirical research, since the validity of the gratitude payment concept is a central dilemma of effective policy making in the area. To orient future research, a possible agenda is outlined, which links evidence to be obtained to the defining features of gratitude payments.

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  • Gaal, Peter & McKee, Martin, 2005. "Fee-for-service or donation? Hungarian perspectives on informal payment for health care," Social Science & Medicine, Elsevier, vol. 60(7), pages 1445-1457, April.
  • Handle: RePEc:eee:socmed:v:60:y:2005:i:7:p:1445-1457
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    References listed on IDEAS

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    1. Ensor, Tim, 2004. "Informal payments for health care in transition economies," Social Science & Medicine, Elsevier, vol. 58(2), pages 237-246, January.
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    Citations

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    Cited by:

    1. Márta Somogyvári, 2013. "The Costs of Organisational Injustice in the Hungarian Health Care System," Journal of Business Ethics, Springer, vol. 118(3), pages 543-560, December.
    2. Sonila Tomini & Wim Groot & Milena Pavlova, 2012. "Paying informally in the Albanian health care sector: a two-tiered stochastic frontier model," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(6), pages 777-788, December.
    3. Baji, Petra & Rubashkin, Nicholas & Szebik, Imre & Stoll, Kathrin & Vedam, Saraswathi, 2017. "Informal cash payments for birth in Hungary: Are women paying to secure a known provider, respect, or quality of care?," Social Science & Medicine, Elsevier, vol. 189(C), pages 86-95.
    4. Petra Baji & Milena Pavlova & László Gulácsi & Miklós Farkas & Wim Groot, 2014. "The link between past informal payments and willingness of the Hungarian population to pay formal fees for health care services: results from a contingent valuation study," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 853-867, November.
    5. Williams, Colin C. & Horodnic, Adrian V., 2017. "Rethinking informal payments by patients in Europe: An institutional approach," Health Policy, Elsevier, vol. 121(10), pages 1053-1062.
    6. 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.
    7. Colin WILLIAMS & Ioana HORODNIC & Adrian HORODNIC, 2016. "Who is making informal payments for public healthcare in East-Central Europe? An evaluation of socio-economic and spatial variations," Eastern Journal of European Studies, Centre for European Studies, Alexandru Ioan Cuza University, vol. 7, pages 49-61, June.
    8. Liaropoulos, Lycourgos & Siskou, Olga & Kaitelidou, Daphne & Theodorou, Mamas & Katostaras, Theofanis, 2008. "Informal payments in public hospitals in Greece," Health Policy, Elsevier, vol. 87(1), pages 72-81, July.
    9. Mæstad, Ottar & Mwisongo, Aziza, 2011. "Informal payments and the quality of health care: Mechanisms revealed by Tanzanian health workers," Health Policy, Elsevier, vol. 99(2), pages 107-115, February.
    10. Danyliv, Andriy & Groot, Wim & Gryga, Irena & Pavlova, Milena, 2014. "Willingness and ability to pay for physician services in six Central and Eastern European countries," Health Policy, Elsevier, vol. 117(1), pages 72-82.
    11. Ranson, Kent & Law, Tyler J. & Bennett, Sara, 2010. "Establishing health systems financing research priorities in developing countries using a participatory methodology," Social Science & Medicine, Elsevier, vol. 70(12), pages 1933-1942, June.
    12. Cherecheş, Răzvan M. & Ungureanu, Marius I. & Sandu, Petru & Rus, Ioana A., 2013. "Defining informal payments in healthcare: A systematic review," Health Policy, Elsevier, vol. 110(2), pages 105-114.
    13. Sonila M. Tomini & Wim Groot, 2013. "Paying informally for public health care in Albania: scarce resources or governance failure?," Applied Economics, Taylor & Francis Journals, vol. 45(36), pages 5119-5130, December.
    14. Tambor, Marzena & Pavlova, Milena & Golinowska, Stanisława & Sowada, Christoph & Groot, Wim, 2013. "The formal–informal patient payment mix in European countries. Governance, economics, culture or all of these?," Health Policy, Elsevier, vol. 113(3), pages 284-295.
    15. Habibov, Nazim & Cheung, Alex, 2017. "Revisiting informal payments in 29 transitional countries: The scale and socio-economic correlates," Social Science & Medicine, Elsevier, vol. 178(C), pages 28-37.
    16. Kaitelidou, Daphne Ch. & Tsirona, Christina S. & Galanis, Petros A. & Siskou, Olga Ch. & Mladovsky, Philipa & Kouli, Eugenia G. & Prezerakos, Panagiotis E. & Theodorou, Mamas & Sourtzi, Panagiota A. &, 2013. "Informal payments for maternity health services in public hospitals in Greece," Health Policy, Elsevier, vol. 109(1), pages 23-30.
    17. Tim Ensor & Robin Thompson, 2012. "Unofficial Payments in Low- and Middle-income Countries," Chapters, in: Andrew M. Jones (ed.),The Elgar Companion to Health Economics, Second Edition, chapter 15, Edward Elgar Publishing.
    18. Tomini, Sonila & Groot, Wim, 2012. "Paying informally for public health care in Albania: scarce resources or governance failure?," MERIT Working Papers 2012-070, United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (MERIT).

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