Informal payments in the health sector in Eastern Europe and Central Asia are emerging as a serious impediment to health care reform.
Private payments to public doctors, nurses, and other health personnel are essentially an informal market for health care occurring within the confines of public health care service networks. These expenditures are also outside the financial controls, policy rubric, and audits of countries' health care systems. Like the informal sector, it is often illegal and unreported, and despite the terminology, is a form of corruption.
Part of the problem can be traced to declining revenues without commensurate downsizing of buildings, hospital beds and health personnel, which has meant reductions in salaries and in some countries chronic arrears. Informal payments compensate for lost earnings. Reforms to modernize the Region's health systems must compete with the personal revenues from informal payments, making change difficult.
Informal payments have become a major impediment to health care, as access is either reduced on account unaffordable costs or requires the selling of personal assets to finance care.
This paper outlines the key policy issues of informal health payments, summarizes the available data on the scope and nature of such payments across ECA, and spells out policy implications. It also suggests possible strategies to address the problem.
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