Attitudes towards informal health care payments in Romania: Implications on the health sector reform process

Background: Romanian health care system is currently undergoing the most substantial process of reformation in the recent twenty years. Within the process, services funding characteristics are of utmost importance. However, informal payments, demonstrated to contribute to a high extent to the funding sources, have not been properly tackled. The present study aims at providing additional information on informal health care payments and related people's attitudes. Methods: Data was collected from a nationally representative sample of individuals (N=1,500) over 18 years old, through telephonic questionnaires. For the study purpose, a subsample comprising of people who stated having attended the doctor during previous 12 months, whether having an illness or not (N=833), was selected. Descriptive statistics was employed to provide subsample characteristics. Associations between reported attitudes towards informal payments and socio-economic indicators were tested using Chi-square statistics. Results: 55.2% of the respondents declared to be against or totally against informal payments. However, 44% of the participants believe informal payments improve the quality of health care services, while 6.5% of them stated that informal payments lead to a decrease in quality. Statistically significant correlations were found between the attitudes and residence area (χ2=9.594, p-value<0.05), occupational status (χ2=26.149, p-value<0.1), and income category (χ2=22.514, p-value<0.05). There was no significant connection between attitudes and age categories, existence of a chronic illness, education or the perceived effect of informal payments over the quality of the received care. Conclusion: Attitudes towards informal payments are correlated to selected socio-economic indicators, suggesting that these indicators will eventually also impact individuals' availability to pay. In order for the reform process to achieve its expected outcomes in terms of funding sources and equal access to care, we suggest that solid mechanisms to address informal payments should be put in place in Romania.