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Institutional Issues in Informal Health Payments in Poland

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Institutional Issues in Informal Health Payments in Poland HNP DISCUSSION PAPER Institutional Issues in Informal Health Payments in Poland Report on the Qualitative Part of the Study About this series... This series is produced by the Health, Nutrition, and Population Family (HNP) of the World Bank’s Human Development Network. The papers in this series aim to provide a vehicle for publishing preliminary and Shahriari H, P Belli and M Lewis unpolished results on HNP topics to encourage discussion and debate. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations or to members of its Board of Executive Directors or the countries they represent. Citation and the use of material presented in this series should take into account this provisional character. For free copies of papers in this series please contact the individual authors whose name appears on the paper. Enquiries about the series and submissions should be made directly to the Editor in Chief Alexander S. Preker ([email protected]) or HNP Advisory Service ([email protected], tel 202 473-2256, fax 202 522-3234). For more information, see also www.worldbank.org/hnppublications. THE WORLD BANK 1818 H Street, NW Washington, DC USA 20433 Telephone: 202 477 1234 Facsimile: 202 477 6391 Internet: www.worldbank.org E-mail: [email protected] February 2001 ii INSTITUTIONAL ISSUES IN INFORMAL HEALTH PAYMENTS IN POLAND Report on the Qualitative Part of the Study Shahriari H., P. Belli and M. Lewis February 2001 Health, Nutrition and Population (HNP) Discussion Paper This series is produced by the Health, Nutrition, and Population Family (HNP) of the World Bank's Human Development Network (HNP Discussion Paper). The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations or to members of its Board of Executive Directors or the countries they represent. Citation and the use of material presented in this series should take into account this provisional character. For free copies of papers in this series please contact the individual authors whose name appears on the paper. Enquiries about the series and submissions should be made directly to the Editor in Chief. Submissions should have been previously reviewed and cleared by the sponsoring department which will bear the cost of publication. No additional reviews will be undertaken after submission. The sponsoring department and authors bear full responsibility for the quality of the technical contents and presentation of material in the series. Since the material will be published as presented, authors should submit an electronic copy in a predefined format as well as three camera-ready hard copies (copied front to back exactly as the author would like the final publication to appear). Rough drafts that do not meet minimum presentational standards may be returned to authors for more work before being accepted. The Editor in Chief of the series is Alexander S. Preker ([email protected]); For information regarding this and other World Bank publications, please contact the HNP Advisory Services ([email protected]) at: Tel (202) 473-2256; and Fax (202) 522-3234. ISBN 1-932126-42-2 © 2001 The International Bank for Reconstruction and Development / The World Bank 1818 H Street, NW Washington, DC 20433 All rights reserved. Table of Contents Chapter 1. Overview of the study.......................................................................................1 1.1 Introduction......................................................................................................................1 1.2 Brief summary of major research findings ......................................................................2 1.2.1 Nature and forms of informal payments .............................................................2 1.2.2 Causes of informal payments ..............................................................................2 1.2.3 Consequences of informal payments...................................................................3 1.3 Concluding remarks.........................................................................................................4 Chapter 2. General background.........................................................................................6 2.1 Historical background......................................................................................................6 2.2 Definition of informal payments .....................................................................................8 2.3 Scope of informal payments ............................................................................................9 2.4 Debates on the extent and mechanisms of informal payment in Poland .........................11 2.5 The study.........................................................................................................................13 2.5.1 Study objective....................................................................................................13 2.5.2 Methodology .......................................................................................................13 2.5.3 Brief description of the sites................................................................................13 Chapter 3: Informal payments, their nature and mechanisms .......................................15 3.1 Introduction......................................................................................................................15 3.2 Cash payments .................................................................................................................15 3.2.1 Types of payment................................................................................................15 3.2.2 Why people pay...................................................................................................16 3.2.3 Circumstances of payment ..................................................................................19 3.2.4 Sources of funds for payments............................................................................20 3.3 In-kind payments .............................................................................................................21 3.3.1 Types of payment................................................................................................21 3.3.2 Gifts.....................................................................................................................21 3.4 Other means to ensure access to quality care ..................................................................22 3.4.1 Social connections ...............................................................................................22 iii Chapter 4: Causes of Informal Payments .........................................................................23 4.1 Introduction......................................................................................................................23 4.2 Supply side Factors..........................................................................................................23 4.2.1 Insufficient funding of the health system............................................................23 4.2.1.1 Low collection rates and poor prioritizing of expenditures...............24 4.2.2 Bottlenecks in the supply system: demand and supply mismatch......................25 4.2.3 Doctors’ low salaries and wrong incentives........................................................27 4.2.4 Consequences of the 1999 reforms .....................................................................28 4.2.4.1 Incentives for hospital employees .....................................................28 4.2.4.2 Incentives for GPs..............................................................................29 4.2.4.3 Creating more bureaucracy................................................................31 4.2.5 Lack of accountability and transparency.............................................................31 4.2.6 Role of the Kasas in rationalizing the system.....................................................32 4.3 Demand side factors ........................................................................................................32 Chapter 5: Consequences of Informal Payments .............................................................35 5.1 Introduction......................................................................................................................35 5.2 Efficiency issues ..............................................................................................................35 5.3 Equity issues ....................................................................................................................36 5.3.1. Social status and perception of health services ..................................................37 5.4 Regional differences in access.........................................................................................37 5.5 Recommendations............................................................................................................38 iv 1. CHAPTER 1. OVERVIEW OF THE STUDY 1.1 INTRODUCTION A growing pattern within the
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