Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-05T04:04:18.610Z Has data issue: false hasContentIssue false
  • English
  • Français

Informal Payments: A Side Effect of Transition or a Mechanism for Sustaining the Illusion of ‘Free’ Health Care? The Experience of Four Regions in the Russian Federation

Published online by Cambridge University Press:  01 October 2009

MARIANNA FOTAKI
MARIANNA FOTAKI*
Affiliation:
Organisation Studies Specialist Area Group, Manchester Business School, University of Manchester, Manchester email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Informal payments for health services are widespread in many transition economies in post-communist Europe and the former Soviet Union. Their existence complements and in some cases significantly contributes to the financing of their health systems. It has been suggested that they are the legacy of planned socialist economies and a temporary side effect of the transition from a planned to a market economy. This article discusses the findings of the study investigating the extent and nature of the informal payments and evaluates the policy options on offer. It asserts that despite the level of declared support for moderate cost-sharing by different population groups, it is unlikely that any legalised form of co-payment will affect or replace informal payments, as the government uses them to sustain the illusion of ‘free’ health care. The study argues that the utilitarian gain maximisation principle, calling for the greatest collective welfare in communitarian egalitarianism, and the satisfaction of individual preferences in libertarian economics enable the acceptance of informal payments as a viable policy option.

Type
Article
Information
Journal of Social Policy , Volume 38 , Issue 4 , October 2009 , pp. 649 - 670
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allin, S., Davaki, K. and Mossialos, E. (2006), ‘Paying for “free” health care: the conundrum of informal payments in post-communist Europe’, in Transparency International (ed.), Global Corruption Report 2006, London: Pluto Press, Chapter 4.Google Scholar
Arrow, K. J. (1963), ‘Uncertainty and welfare economics in health care’,American Economic Review, 53: 6, 941–73.Google Scholar
Balabanova, D. and McKee, M. (2002), ‘Understanding informal payments for health care: the example of Bulgaria’, Health Policy, 62: 243–73.CrossRefGoogle ScholarPubMed
Barr, N. (1994), Labor Markets and Social Policy in Central and Eastern Europe, Oxford: Oxford University Press.Google Scholar
Belli, P., Gotsadze, G. and Shahriari, H. (2004), ‘Out of pocket and informal payments in health sector: evidence from Georgia’, Health Policy, 70: 1, 109–23.CrossRefGoogle ScholarPubMed
Bentham, J. (1781)/2000) An Introduction to the Principles of Morals and Legislation, Kitchener, Ontario: Batoche Books, http://www.efm.bris.ac.uk/het/bentham/morals.pdf, accessed 25 November 2008Google Scholar
Bogetić, Z. and Hillman, A. (eds.) (1995), Financing Government in Transition: Bulgaria, The Political Economy of Tax Policies, Tax Bases, and Tax Evasion, Washington, DC: World Bank.CrossRefGoogle Scholar
Boikov, V., Feeley, F., Sheiman, I. and Shishkin, S. (1998), ‘Household health care and drug expenditure’, Economic Issues, 10: 101–17.Google Scholar
Boikov, V., Feeley, F., Sheiman, I. and Shishkin, S. (2000), ‘Participation of the population in health care financing’, Health Economics, 7: 45–50.Google Scholar
Bonilla-Chacin, M. E. (2003), Health and Poverty in Albania: Background Paper for the Albania Poverty Assessment, Washington, DC: World Bank.Google Scholar
Buchanan, J. and Tullock, G. (1962), The Calculus of Consent, Michigan: Michigan University Press.Google Scholar
Burger, E., Field, M. and Twigg, J. (1998), ‘From assurance to insurance in Russian health care: the problematic transition’, American Journal of Public Health, 88: 755–8.CrossRefGoogle ScholarPubMed
Chawla, M., Berman, P. and Kawiorska, M. (1998), ‘Financing health services in Poland’, Health Economics, 7: 337–46.3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
Chernichovsky, D., Gur, O. and Potapchik, E. (1996), ‘Health sector reform in Russia: the heritage and public private mix’, MOCT, 6: 125–52.CrossRefGoogle Scholar
Constitution of the Russian Federation (1998), Article 41, Moscow: Publishing House Legal Literature.Google Scholar
Eklof, B., Bushnell, J. and Zakharova, L. (eds.) (1994), Russia's Great Reforms, 1855–1881, Bloomington: Indiana University Press.Google Scholar
Ensor, T. (2004), ‘Informal payments for health care in transition economies’, Social Science and Medicine, 58: 2, 237–46.CrossRefGoogle ScholarPubMed
Ensor, T. and Savelyeva, L. (1998), ‘Informal payments for health care in the Former Soviet Union: some evidence from Kazakhstan’, Health Policy and Planning, 13: 1, 41–9.CrossRefGoogle Scholar
Etzioni, A. (1995), Rights and the Common Good: The Communitarian Perspective, New York: St Martin's Press.Google Scholar
Falkingham, J. (2004), ‘Poverty, out of pocket payments and access to health care: evidence from Tajikstan’, Social Science and Medicine, 58: 247–58CrossRefGoogle Scholar
Field, M. (1989), ‘The position of the Soviet physician: the bureaucratic professional’, Milbank Quarterly, 66: 2 (Suppl.), 182–201.CrossRefGoogle Scholar
Field, M. (1994), ‘Post-communist medicine: morbidity, mortality and the deteriorating health situation’, in Millar, J. R. and Wolchik, S. L. (eds.), The Social Legacy of Communism, Cambridge: Cambridge University Press.Google Scholar
Fotaki, M. (2006), ‘Users’ perceptions of health care reforms: quality of care, patients’ rights and satisfaction with health insurance system in four regions in the Russian Federation’, Social Science and Medicine, 63: 6, 1637–47.CrossRefGoogle Scholar
Friedman, M. and Friedman, R. (1980), Free to Choose, London: Secker & Warburg.Google Scholar
Fukuyama, F. (1992/2006), The End of History and the Last Man, New York: Free Press (reprint).Google Scholar
Gaál, P. and McKee, M. (2004), ‘Informal payments for health care and theory of “inxit”’, International Journal of Health Planning and Management, 19: 1–16.Google ScholarPubMed
Gaál, P. and McKee, M. (2005), ‘Fee for service or donation? Hungarian perspectives on informal payments for health care’, Social Science and Medicine, 60: 7, 1445–57.CrossRefGoogle ScholarPubMed
Gaál, P., Belli, P. C., McKee, M. and Szócska, M. (2006), ‘Informal payments in health care: definitions, distinctions and dilemmas’, Journal of Health Politics, Policy and Law, 31: 2, 251–93.CrossRefGoogle Scholar
Gotsadze, G., Bennett, S., Ranson, K. and Gzirishvili, D. (2005), ‘Health care seeking behaviour and out of pocket payments in Tbilisi, Georgia’, Health Policy and Planning, 20: 4, 232–42.CrossRefGoogle ScholarPubMed
Hare, R. M. (1981), Moral Thinking, Oxford: Clarendon Press.CrossRefGoogle Scholar
Hayek, F. A. (1944), The Road to Serfdom, London: Routledge & Kegan Paul.Google Scholar
Ibragimova, D., Krasilnikova, M. and Ovcharova, L. (2000), ‘Russian residents' payments for health and educational services’ (in Russian), Public Monitoring: Economic and Social Changes, 2: 46, 38.Google Scholar
Jordan, B. (2006), ‘Public services and the service economy: individualism and the choice agenda’, Journal of Social Policy, 35: 1, 143–62.CrossRefGoogle Scholar
Kaser, M. (1976), Health Care in the Soviet Union and Eastern Europe, London: Croom Helm.Google Scholar
Kornai, J. and Eggleston, K. (2001), ‘Choice and solidarity: the health care sector in Eastern Europe and proposals for reforms’, International Journal for Health Finance and Economics, 1: 59–84.Google Scholar
Lewis, M. (2002), ‘Informal health payments in central and eastern Europe and former Soviet Union: issues, trends and policy implication’, in Mossialos, E., Dixon, A., Figueras, J. and Kutzin, J. (eds.), Funding Health Care: Options for Europe, Buckingham: Open University Press/Copenhagen: WHO.Google Scholar
Morozova, Y. and Kulibakin, Y. (1998), ‘Urban health care systems: public survey findings’ (in Russian), Sociology Center, Kemerovo State University, Kemerovo.Google Scholar
Narayan, D. (2000), Voices of the Poor: Can Anyone Hear Us?, Oxford: Oxford University Press.CrossRefGoogle Scholar
Preker, A., Jakab, M. and Schneider, M. (2002), ‘Health financing reforms in Central and Eastern Europe and the former Soviet Union’, in Mossialos, E., Dixon, A., Figueras, J. and Kutzin, J. (eds.), Funding Health Care: Options for Europe, Buckingham: Open University Press/Copenhagen: WHO.Google Scholar
Risse, M. (2005), ‘Critical note: should citizens of a welfare state be transformed into “queens”?’, Economics and Philosophy, 21: 291–303.CrossRefGoogle Scholar
Rose, R. (2006), ‘Corruption is bad for your health: findings from Central and Eastern Europe’, Global Corruption Report 2006, London: Pluto Press, Chapter 2.Google Scholar
Rowland, D. and Telyukov, A. (1991), ‘Soviet health care from two perspectives’, Health Affairs, Fall, 71–86.CrossRefGoogle Scholar
Rybakov, M. (2005), ‘Shadow cost-sharing in the Russian health care’, Central European University, Political Science Department, Budapest.Google Scholar
Sheiman, I. (1994), ‘The development of market approaches in Russia’, International Journal of Health Planning and Management, 9: 39–56.Google ScholarPubMed
Shishkin, S. (1998), ‘The challenges for the Russian health care reforms’, Eurohealth, 4: 6 (special issue), 59–60.Google Scholar
Shishkin, S. (1999), ‘Problems of transition from tax-based system of health finance to mandatory health insurance model in Russia’, Croatian Medical Journal, 40: 2.Google ScholarPubMed
Shishkin, S. V., Bogatova, T. V., Potapchik, Y. G., Chernets, V. A., Chirikova, A. Y. and Shilova, L. S. (2003), Informal and Out-of-Pocket Payments for Health Care in Russia, Moscow: Moscow Public Scientific Foundation and Independent Institute for Social Policy.Google Scholar
Sidorina, T. and Sergeyev, N. (2000), ‘State social policy and Russian's health comments to the household health expenditure survey’ (in Russian), Russian World, 2.Google Scholar
TACIS (2000), ‘Governance of health insurance’, report submitted to the Ministry of Labour and Social Security of the Russian Federation, TACIS, Moscow.Google Scholar
Tanzi, V. (1998), Corruption Around the World: Causes, Consequences, Scope, and Cures, IMF Staff Papers, 45, No. 4, Washington, DC: International Monetary Fund.Google Scholar
Thompson, R. and Witter, S. (2000), ‘Informal payments in transitional economies: implications for health sector reforms’, International Journal of Health Planning and Management, 15: 169–87.Google Scholar
Twigg, J. (1998), ‘Balancing the state and the market: Russia's adoption of Obligatory Medical Insurance’, Europe-Asia Studies, 50: 4, 583–602.CrossRefGoogle Scholar
Vian, T. and Burak, L. (2006), ‘Beliefs about informal payments in Albania’, Health Policy and Planning, 21: 5, 392–401.CrossRefGoogle ScholarPubMed
Vian, T., Grybosk, K., Sinoimeri, Z. and Hall, R. (2006), ‘Informal payments in government health facilities in Albania: results of qualitative study’, Social Science and Medicine, 62: 4, 877–87.CrossRefGoogle ScholarPubMed
Vlachoutsicos, C. (1998), Russian Collectivism: The Invisible Fist in the Transformation of Russia, ELIAMEP Research Paper OP97.08, Athens: ELIAMEP.Google Scholar
Vlachoutsicos, C. and Lawrence, P. (1996), ‘How managerial learning can assist economic transformation’, Organization Studies, 17: 2, 311–15.CrossRefGoogle Scholar
von Mises, L. (1949), Human Action: A Treatise on Economics, London: Hodge.Google Scholar
World Bank (1997), Health Sector Support Strategy: Russia, Washington, DC: World Bank.Google Scholar
World Bank (2000), Making Transition Work for Everyone: Poverty and Inequality in Eastern Europe and Central Asia, Washington, DC: World Bank.Google Scholar
World Bank (2008), Better Outcomes Through Health Care Reforms in the Russian Federation: The Challenge in 2008 and Beyond, Washington, DC: World Bank.Google Scholar