250028 Informal payments: The definition - a systematic review

Tuesday, November 1, 2011

Razvan Mircea Chereches, MD, PhD , Center for Health Policy and Public Health, University Cluj-Napoca, "Babes-Bolyai", Cluj-Napoca, Romania
Marius-Ionut Ungureanu, MD , Center for Health Policy and Public Health, "Babes-Bolyai" University Cluj-Napoca, Romania, Cluj-Napoca, Romania
Cristian Marius Litan, PhD , Center for Health Policy and Public Health, "Babes-Bolyai" University Cluj-Napoca, Romania, Cluj-Napoca, Romania
Ioana Andreea Rus , Center for Health Policy and Public Health, "Babes-Bolyai" University Cluj-Napoca, Romania, Cluj-Napoca, Romania
Anatolie Cosciug , Center for Health Policy and Public Health, "Babes-Bolyai" University Cluj-Napoca, Romania, Cluj-Napoca, Romania
Catalin Ovidiu Baba, VMD, PhD , Center for Health Policy and Public Health, "Babes-Bolyai" University Cluj-Napoca, Romania, Cluj-Napoca, Romania
Background: Starting with the `70s, more and more evidence came to show the geographical distribution of the informal payments phenomenon, as well as its complexity. Though, in order to have a clear image of the characteristics of informal payments both globally and in different settings, it is necessary to agree upon a definition of the term. Currently, there is no agreement about the definition terms. Hence, our systematic review aimed at investigating how informal payments are defined widely and what are the components of the act of paying informally. Methods: A systematic review of the literature, dealing with informal payments, was conducted, using a customized data collection tool. This allowed systemizing different paper features, including place and time of study, methods, and definitions of informal payments. Results: After filtering the initial 129 search results with inclusion and exclusion criteria, 60 papers were pinpointed as tempting or stating a definition. Their analysis revealed that informal payments are reported mainly in Central and Eastern Europe, South and East Asia and couple of countries from Africa. As for the distribution and type of methodologies, 85% of the papers were the results of cross-sectional surveys. After analyzing the existing definitions, we found a high degree of heterogeneity. Its sources came mainly from the positioning of informal payments within the milieu of illegality and comprehensibility. Conclusion: Even though informal payments have been pandemic for long period of time, within a considerable number of developing health systems, our results showed that there are striking differences in the manner informal payments are defined. This can alter on results of comparative studies which intend to reveal the impact of informal payments on the system, as a whole. Hence, it is highly recommended that the concept is defined as clear as possible and used by consensus when exploring informal payments. A tentative overall definition was attempted as a result of the systematic review.

Learning Areas:
Provision of health care to the public

Learning Objectives:
1. Name the components of a comprehensive definition of informal payments. 2. List the countries where informal payments are highly prevalent

Keywords: Healthcare Costs, Barriers to Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the executive director of the Center for Health Policy and Public Health, Cluj-Napoca, having as main research interest fields health systems, health policy and healthcare management.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Medical Care Section Poster Session #5: Economics and Services
See more of: Medical Care