Informal Payments in the Public Health Service of Elbasan, Albania

Abstract

For the purpose of securing access to quality health care services, policy makers in many countries are confronting the problem of informal payments by patients to medical personnel. This problem seems to be of high importance in transition countries like Albania. This paper presents research into the nature of informal payments and the intentions or reasons of those paying them (patients). Hence, this paper seeks to investigate informal payments in public health care through the patients perceptions. Previous research on informal payments in Albania did not give an overview of patients' reasons for give informal payments. One hundred people participated in this research through a structured interview administered by the researcher. The survey was carried out post-treatment with a non-randomly selected sample of patients from five public hospitals in Elbasan, Albania's second biggest city. Findings show that 93% of participants have given informal payments to the health personnel, where the perception exists that giving informal payments allows patients to receive a more professional service, to speed up care and to receive a friendlier and more qualitative service than patients who do not give informal payments. This is remarkable because all participants in this research had received treatment that was officially free of charge. Findings also show patients perceive a tendency for doctors to refer patients towards certain private hospitals and pharmacies. My main conclusion is that fear for sub-standard care provision among patients was the main cause that makes patients to give informal payments. The paper concludes with a discussion of the areas which Albanian public health organisations need to focus on in order to reduce the occurrence of informal payments.

Key words Albania, bribery, corruption, integrity, public health service, transition economy