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

2. 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

3. Background  Informal payments are a symptomatic phenomenon especially for countries in Central and Eastern Europe (generally, ex-communist countries) and Central Asia  Informal payments have 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Results TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 How would you rate Romanian physicians’ activity? % Very good13.1 Good43.8 Nor good or bad27.2 Bad4.9 Very bad3.4 Don’t know6.5 Don’t answer1.1 Significant correlations (p<0.05) have been found between the assessed physicians’ activity and respondent’s gender, age group and chronic disease status

10. Results TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 According to your opinion, which are the most important traits of a physician? % Competence54.3 Empathy30.2 Courteousness28.9 Time with patient19.1 Does not ask for informal payments 16.8 Good collaboration with nurses 3 Good collaboration with other physicians 2.7

11. Results TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012 Who do you find responsible for the persistence of informal payments? % Ministry of Health, because of insufficient funding 51.5 Patients, for offering33.1 Physicians, for accepting16.7 Patients and physicians, equally 4.9

12. 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

13. 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

14. 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

15. Acknowledgement This work was supported by CNCSIS-UEFISCSU, project number PN II-RU 319 /2010, contract no.47/29.07.2010. TEMPUS Project Master Programs in Public Health and Social Services Conference, June 27th, 2012

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