Patients’ perspective on Romanian physicians’ performance as related to informal payments Ioana A. Rus Marius I. Ungureanu Răzvan M. Chereche Center for

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

Ioana A. Rus

Marius I. Ungureanu

Răzvan M. Cherecheș

Center for Health Policy and Public Health

Babeș-Bolyai University, Cluj-Napoca

Background Informal 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 provided

TEMPUS 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


Background Informal 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


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 aims To 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 payments


Methods The 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


Methods The instrument used was a 5-part questionnaire,

developed by the research team, collecting information about the following issues:

Socio-demographic characteristics Health services accessed during previous 12 months Informal payments offered to health professionals Attitudes towards informal payments Perceptions about Romanian physicians’

performance


Results


How would you rate Romanian physicians’ activity?

%

Very good 13.1

Good 43.8

Nor good or bad 27.2

Bad 4.9

Very bad 3.4

Don’t know 6.5

Don’t answer 1.1

Significant correlations (p<0.05) have been found between the assessed physicians’ activity and respondent’s gender, age group and chronic disease status

Results


According to your opinion, which are the most important traits of a physician?

%

Competence 54.3

Empathy 30.2

Courteousness 28.9

Time with patient 19.1

Does not ask for informal payments

16.8

Good collaboration with nurses

3

Good collaboration with other physicians

2.7

Results


Who do you find responsible for the persistence of informal payments?

%

Ministry of Health, because of insufficient funding

51.5

Patients, for offering 33.1

Physicians, for accepting 16.7

Patients and physicians, equally

4.9

Discussion Ministry 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 policies


Discussion Although 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 performance


Conclusion

Our 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


Acknowledgement

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


Thank you!


Documents

Patients’ perspective on Romanian physicians’ performance as related to informal payments Ioana A. Rus Marius I. Ungureanu Răzvan M. Chereche Center for