Patients’ perspective on Romanian physicians’ performance as related to informal payments

Patients perspective on Romanian physicians performance as related to informal paymentsIoana A. Rus

Marius I. UngureanuRzvan M. Chereche

Center for Health Policy and Public HealthBabe-Bolyai University, Cluj-Napoca

BackgroundInformal payments are payments to individuals or institutions in cash or in kind made outside official payment channels for services that are meant to be covered (without direct charge) by the public health care system (Killingsworth, 2002)

Informal payments are offered to health professionals before (ex-ante payments) or after (ex-post payments) care has been providedTEMPUS Project Master Programs in Public Health and Social ServicesConference, June 27th, 2012

Background Informal payments are a symptomatic phenomenon especially for countries in Central and Eastern Europe (generally, ex-communist countries) and Central Asia

Informal payments have also been reported in countries outside these two regions, such as Peru, Uganda, Tanzania, Lithuania, Latvia and Estonia

TEMPUS Project Master Programs in Public Health and Social ServicesConference, June 27th, 2012

BackgroundInformal payments are not distributed equally among different health care professionals categories or even among different degrees within the same category

Physicians are generally on the top of the list of health professionals receiving informal payments

TEMPUS Project Master Programs in Public Health and Social ServicesConference, June 27th, 2012

Why research on informal payments?In Romania, little research has been carried out on informal payments

A World Bank study in 2004 evaluated the yearly amount of money in informal payments as being 300,000,000

A comparative study in 2002 demonstrated that informal payments in Romania influence negatively access to care and equity of services

..but exploring informal payments is similar to breaking a taboo

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012

Study aimsTo explore patients views on the entities responsible for the persistence of informal payments in the Romanian health care system

To analyze the patients image of a good physician in the context of informal paymentsTEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012

MethodsThe study followed a quantitative strategy of inquiry

We interviewed a nationally representative sample of individuals (n=1,500)

Data was collected through Computer-Assisted Telephonic Interviews (CATI) by trained operators

After the collection process, data was analyzed using the SPSS software

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012

MethodsThe instrument used was a 5-part questionnaire, developed by the research team, collecting information about the following issues:

Socio-demographic characteristicsHealth services accessed during previous 12 monthsInformal payments offered to health professionalsAttitudes towards informal paymentsPerceptions about Romanian physicians performance

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012

ResultsTEMPUS Project Master Programs in Public Health and Social ServicesConference, June 27th, 2012

According to your opinion, which are the most important traits of a physician?%Competence54.3Empathy30.2Courteousness28.9Time with patient19.1Does not ask for informal payments16.8Good collaboration with nurses3Good collaboration with other physicians2.7

ResultsTEMPUS Project Master Programs in Public Health and Social ServicesConference, June 27th, 2012

Who do you find responsible for the persistence of informal payments?%Ministry of Health, because of insufficient funding51.5Patients, for offering33.1Physicians, for accepting16.7Patients and physicians, equally4.9

DiscussionMinistry of Health should address the topic of informal payments more thoroughly through policy measures

However, multiple targets have identified by the participants in our study (patients themselves, health professionals, Ministry of Health) and this information will be useful for drafting and implementing the policiesTEMPUS Project Master Programs in Public Health and Social ServicesConference, June 27th, 2012

DiscussionAlthough a large proportion of respondents identify physicians as being responsible for the persistence of informal payments, more than half of all respondents rate physicians performance good or very good

This results may seem contradictory, but it may be an indicator of patients degree of familiarity with informal payments, who don not find a discrepancy between a physician who receives informal payments and his/her overall performanceTEMPUS Project Master Programs in Public Health and Social ServicesConference, June 27th, 2012

ConclusionOur results are useful to support the policy making process tackling informal payments, in terms of identifying the target groups and the most suitable mechanisms to approach them

TEMPUS Project Master Programs in Public Health and Social ServicesConference, June 27th, 2012

AcknowledgementThis work was supported by CNCSIS-UEFISCSU, project number PN II-RU 319 /2010, contract no.47/29.07.2010.

TEMPUS Project Master Programs in Public Health and Social ServicesConference, June 27th, 2012

Thank you!TEMPUS Project Master Programs in Public Health and Social ServicesConference, June 27th, 2012