Explaining informal payments in the Romanian public health care system

Informal payments in the public health care system represent one of the most sensitive topics in the medical world. It is also a subject of interest for many researchers. As evidenced by reports from various European institutions, a catalyst for their use was the COVID-19 pandemic. Among all the countries of the European Union, Romania was reported with the highest rate of use of these payments. With the support of parallel marketing research, carried out both among patients in Romania and among medical staff, it is demonstrated that they do not consider such practices natural. However, following the conclusions, in order to stop this trend, it is recommended, among other things, to reduce the institutional asymmetry, to tighten the penalties for the medical staff who accept such payments or to stimulate the medical staff, by increasing their salaries.

The Companion Pandemic to COVID-19: The Use of Informal Practices to Access Public Healthcare Services in the European Union

Objectives: The objective of this paper is to evaluate the use of informal payments and personal connections to gain preferential access to public health services during the COVID-19 pandemic and to propose effective policy measures for tackling this phenomenon. Methods: Using data from 25,744 patients in the European Union, six different scenarios are analyzed in relation to making informal payments and/or relying on personal connections to access public healthcare services. To evaluate the propensity to engage in informal practices in healthcare, probit regressions with sample selection and predicted probabilities are used. Robustness checks are also performed to test the reliability of the findings. Results: For each scenario, a statistically significant association is revealed between the propensity to make informal payments and/or rely on personal connections and the asymmetry between the formal rules and the patients’ personal norms and trust in public authorities. Conclusion: To tackle informal practices in healthcare, policy measures are required to reduce the asymmetry between the formal rules and personal norms by raising trust in public authorities.