Abstract:
The healthcare systems of many European post-communist and post-Soviet countries have been considerably affected by informal patient payments (also known as ‘under-the-table’ or ‘envelope’ payments) (Chawla et al., 1998; Gaal et al., 2006; Stepurko et al., 2010). The definition of informal patient payments usually includes a cash or in-kind supplement to the official payment for healthcare services (Belli, 2002; Gaal et al., 2010) as well as payments for commodities, such as pharmaceuticals (Lewis, 2000). Additionally, informal payments take place outside the official payment channels (Lewis, 2007), and payers may not even know that they are making an informal payment if they are not well informed about official fees (Thompson and Witter, 2000). Still, informal patient payments are not always perceived as illegal (Ensor, 2004; Gaal et al., 2006; Lewis, 2000) especially when the legislation and codes of ethics (even the moral codes) in the country fail to prescribe proper conduct and behaviour. As a result, informal patient payments are typically not prosecuted. Besides, the healthcare sector is not unique in such behaviour. Informal payments are also seen in other areas, for example in education, police, court and customs offices (Miller et al., 1998; Polese, 2008). Thus, general moral dispositions in society such as ‘everything that is not forbidden is allowed’ may well predispose to the existence of informal payments in the healthcare sector.
