Patients’ perspective on Romanian physicians’ performance as related to informal payments

Patients’ perspective on Romanian physicians’ performance as related to informal payments Ioana A. Rus Marius I. Ungureanu Răzvan M. Cherecheș Center for Health Policy and Public Health Babeș-Bolyai University, Cluj-Napoca

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 Background • Informal payments are “payments to individuals or institutions in cash or in kind made outside official payment channels for services that are meant to be covered (without direct charge) by the public health care system” (Killingsworth, 2002) • Informal payments are offered to health professionals before (ex-ante payments) or after (ex-post payments) care has been provided

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 Background • Informal payments are a symptomaticphenomenon especially for countries in Central and Eastern Europe (generally, ex-communist countries) and Central Asia • Informal paymentshave also been reported in countries outside these two regions, such as Peru, Uganda, Tanzania, Lithuania, Latvia and Estonia

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 Background • Informal payments are not distributed equally among different health care professionals categories or even among different degrees within the same category • Physicians are generally on the top of the list of health professionals receiving informal payments

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 Why research on informal payments? • In Romania, little research has been carried out on informal payments • A World Bank study in 2004 evaluated the yearly amount of money in informal payments as being € 300,000,000 • A comparative study in 2002 demonstrated that informal payments in Romania influence negatively access to care and equity of services • ..but exploring informal payments is similar to breaking a taboo

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 Study aims • To explore patients’ views on the entities responsible for the persistence of informal payments in the Romanian health care system • To analyze the patients’ image of a good physician in the context of informal payments

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 Methods • The study followed a quantitative strategy of inquiry • We interviewed a nationally representative sample of individuals (n=1,500) • Data was collected through Computer-Assisted Telephonic Interviews (CATI) by trained operators • After the collection process, data was analyzed using the SPSS software

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 Methods • The instrument used was a 5-part questionnaire, developed by the research team, collecting information about the following issues: • Socio-demographic characteristics • Health services accessed during previous 12 months • Informal payments offered to health professionals • Attitudes towards informal payments • Perceptions about Romanian physicians’ performance

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 Results Significant correlations (p<0.05) have been found between the assessed physicians’ activity and respondent’s gender, age group and chronic disease status

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 Results

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 Discussion • Ministry of Health should address the topic of informal payments more thoroughly through policy measures • However, multiple targets have identified by the participants in our study (patients themselves, health professionals, Ministry of Health) and this information will be useful for drafting and implementing the policies

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 Discussion • Although a large proportion of respondents identify physicians as being responsible for the persistence of informal payments, more than half of all respondents rate physicians’ performance good or very good • This results may seem contradictory, but it may be an indicator of patients’ degree of familiarity with informal payments, who don not find a discrepancy between a physician who receives informal payments and his/her overall performance

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 Conclusion • Our results are useful to support the policy making process tackling informal payments, in terms of identifying the target groups and the most suitable mechanisms to approach them

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 Acknowledgement This work was supported by CNCSIS-UEFISCSU, project number PN II-RU 319 /2010, contractno.47/29.07.2010.

TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 Thank you!

Patients’ perspective on Romanian physicians’ performance as related to informal payments