Assessing the frequency of informal payments for health services in Lithuania

LTReikšminiai žodžiai: Gydytojų vokeliai; Motyvuoti gydytojus; Neoficialūs mokėjimai; Sveikatos paslaugos; Sveikatos priežiūros reforma; Sveikatos priežiūros sektorius; Health services; Healthcare reform; Healthcare sector; Informal payments; Lithuania; Motivating doctors.

ENThis paper has sought to examine the reasons that drive individuals to engage in informal payments in the healthcare sector in Lithuania. This paper has analyzed the association between making such extra payments or valuable gifts (besides official fees) and the tolerance of corruption, along with how making informal payments varies in terms of socio-economic and spatial factors. Based on 1029 interviews carried out in Lithuania, the chapter highlights that 777 respondents had been to a public healthcare practitioner or institution in the last 12 months prior to survey and that 21% had made an informal payment. Therefore, the number of people who visit public healthcare services is higher in Lithuania compared to East-Central Europe (75% in comparison with 68%) and the making of informal payments is also much higher (21% in comparison with 9%). Moreover, this chapter reveals a strong connection between tolerance and informal payments. Patients who believe that corruption is acceptable are more likely to offer additional payments or valuable gifts when they deal with public care health services. Therefore, structural explanations driving informal patient payments appear to be valid when we analyze the case of Lithuania. However, one important outcome of this paper is that there is no significant association between socio-economic and socio-demographic characteristics and the likelihood of making informal payments, apart from the association with the age of the respondent (patients aged 15 -24 years are considerably less likely to make informal payments than patients over 24 years old).This might be justified by the neutral or even positive attitude that continues towards patients who make informal payments, and which makes it hard to find efficient ways for stopping the phenomenon. This homogenous diffusion of informal patient payments for healthcare public services across all examined groups remains unexplored. This begs the question: is it a consequence of patients’ appreciation of received health services, suggesting the "brighter" side of informal payments? Or is it an expression of caution and fear, arising from the unethical behaviour of the medical personnel involved? To answer such questions, further in-depth qualitative research in future studies would clearly be relevant. From a policy perspective, in order to seek to stop informal payments for healthcare services in Lithuania, there are two main policy approaches. Either deterrents or incentives (commonly known as "sticks or carrots") could be used in order to reduce the levels of informal payments for public healthcare provisioning. As a first approach, tougher penalties for people caught making informal payments might be applied or measures might be taken to amplify the risks of detection. This might considerably reduce the incidence of public healthcare professionals requesting informal payments.Another approach is to recognize what is maybe one of the major reasons for healthcare professionals demanding these extra payments. The state can offer higher salaries (i.e. an incentive) to the medical staff so that they would not need extra financial support to assure their standard of living. An alternative approach instead of using deterrents or incentives, is the usage of indirect controls. Indirect controls have been debated as a policy option for tackling the undeclared economy more widely. In the case of healthcare services, this might entail using campaigns for raising awareness among healthcare professionals and the wider population in regard to the negative impacts of making and receiving informal payments for healthcare services or may entail reforming the culture of the healthcare services in a manner through which procedural justice and fairness is promoted. These indirect controls can be used as additional measures to the traditional "sticks" and "carrots" approach through which deterrents and incentives are used. For instance, a government might first use campaigns for raising awareness, followed by incentives for the medical personnel and only after doing this, use punishments for the people who continue to claim such payments from their patients. [Extract, p. 84-85]

• Vadyba / Management
• Sociologija / Sociology