Informal Out-of-Pocket Payments for Health Care in Russia
Опубликовано на портале: 28-07-2010
Москва: Транспечать, 2003, 160 с.
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On the basis of data from interviews with medical personnel in two Russian regions,
the extent to which informal payments in different kinds of medical institutions
and departments are spread has been analyzed. It is argued that informal payments
is a forced way of adaptation of the medical staff and their patients to the transition
period. Rules of informal payments were described, and various models of such payments
were built. On this basis, an evaluation is made of the possible outcomes of the
legalization of informal payments for medical services.
Authors: Tatiana V. BOGATOVA, Coordinator of Research Programs, Independent Institute for Social
Policy; Elena G. POTAPTCHIK, Ph.D./Economics, Senior Researcher, Institute for Transition Economy Studies; Vladimir A. TCHERNETZ, Head of Management Consulting Department, Principe PR Communicative Management Agency; Alla E. TCHIRIKOVA, Ph.D./Psychology, Leading Researcher, Institute of Social Studies, Russian Academy of Sciences; Lyudmila S. SHILOVA, Senior Researcher, Institute of Social Studies RAS; Sergey V. SHISHKIN, Dr./Economics, Director of Research Programs, Independent Institute for Social Policy. |
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INTRODUCTION ………………………………………………………………………………
SECTION 1. STATE GUARANTEES
AND POPULATION’S
PAYMENTS FOR HEALTH
CARE ……………………………………………………………..
1.1. State regulation
of economic conditions of health service provision……………………….
1.2. Residents’
health care expenses (an overview of accomplished surveys)………………….
SECTION 2. TYPES OF
OUT-OF-POCKET PAYMENTS FOR HEALTH CARE………….
2.1. Rules of payment
for health services: investigative tools used……………………………..
2.2. Chargeable health
services……………………………………………………………………
2.3. Payments for drugs
by patients obtaining services at public health care institutions…….
2.4. Informal payments
for health services……………………………………………………….
2.4.1.
What do people pay for?……………………………………………………………..
2.4.2.
Causes of informal payments………………………………………………………...
2.5. Prevalence of informal
payments for health services……………………………………….
2.5.1.
Centers of informal payments in hospitals…………………………………………….
2.5.2.
Informal payments in outpatient settings……………………………………………..
2.5.3.
Physicians’ professional qualification and informal payments……………………….
2.5.4.
The size of health professionals’ “shadow” incomes…………………………………
SECTION 3. RULES OF
INFORMAL PAYMENTS FOR HEALTH SERVICES……………..
3.1. Informal payment
models……………………………………………………………………….
3.2. Redistribution
of informal revenues among medical staff……………………………………
3.2.1.
Vertical redistribution of informal payments: do physicians share with
administrators?…………………………………………………………………………………………
3.2.2.
Horizontal redistribution of informal revenues: do surgeons share with their team
members
and nurses?……………………………………………………………………………………
3.2.3.
Regulation of informal payments distribution among mid-level and junior medical
staff……………………………………………………………………………………………………….
SECTION 4. HEALTH PROFESSIONALS’
ATTITUDES TOWARDS INFORMAL
PAYMENTS ……………………………………………………………………………………………
4.1. Physicians’
and nurses’ attitudes towards informal payments ………………………………..
4.1.1.
Physician groups with different attitudes towards informal payments…………………..
4.1.2.
How do physicians justify informal payments………………………………………….
4.1.3.
Cases in which physicians consider informal payments unjustified……………………
4.1.4.
Justification of informal payments by mid-level and junior medical staff………………
4.2. Group norms regulating
informal payment practices……………………………………………
4.2.1.
Discussion of informal payment practices by health care facilities’ staff……………….
4.2.2.
Can health professionals influence informal payment practices and do they want it?…
4.2.3.
Can existing group norms be used to regulate informal payments?……………………..
4.3. Health authorities’
and health financiers’ attitudes towards informal payments …………….
4.3.1.
Social policy-makers’ awareness of informal payment practices………………………..
4.3.2.
Justification of informal payments by health authorities and financiers…………………
4.3.3.
Can informal payments be controlled?…………………………………………………..
4.3.4.
Models of informal payment control…………………………………………………….
4.4. Health professionals’
attitudes towards legalization of payments for health care…………….
CONCLUSION ………………………………………………………………………………………….
About authors ……………………………………………………………………………………………
Ключевые слова
informal economy public health здравоохранение здравоохранение в России неформальные платежи в медицине
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