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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.

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 ……………………………………………………………………………………………


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