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Corruption in public health 103 service entity. Qualitative studies explore this in some depth. Consumer confusion about the official or unofficial nature of payments is common. Patients pay but they don’t always know why and they often do so at multiple locations or for different “services” (Belli, Shahriari and Gotzadze, 2004; Narayan, 2000; Killingsworth et al., 1999). Multivariate analysis sheds further light on some of the underlying motivations for informal payment as well as whether patient revenues are well spent. In Kazakhstan Thompson’s (2004) econometric analysis of patients discharged from three hospitals in Almaty City concluded that informal payments made in the admission department before treatment, and the amount paid subsequently at both admissions and hospital wards shortened admission time for surgery. He found longer lengths of stay associated with payments to both the admission department and directly to individual providers on the wards, and perceived patient quality increased with the amount paid informally. These results confirm the assumption that patients pay to receive more attentive and “higher quality” care as they perceive it. Longer lengths of stay do not necessarily mean better clinical care, but shorter waits, longer hospital stays and better treatment by medical staff tend to be valued by patients. In Kazakhstan paying ensures that health care meets the demands and perceived needs of patients. Of concern is the relative cost of the services to patients, and numerous studies point out the impact on the poor. Figure 7 summarizes the available data showing the average cost of an outpatient visit or hospital admission as a per cent of half monthly income, roughly equivalent to median income (source). The level of inpatient payments far exceeds the amounts paid out for outpatient services and numerous studies document the extent of hardship some households face in meeting these costs. Inpatient costs can exceed annual family income forcing the sale of assets or the accumulation of debt in order to afford care (Lewis 2000, 2002; Falkingham 2002, 2004; Killingsworth et al., 1999). Selected studies in China of “red packages” paid to providers report that payments
104 Fighting the Diseases of Poverty Figure 7 Average informal payments as percentage of halfmonthly per capita income, selected countries (int’l $ PPP) Albania (2002) Albania (2002)* Armenia (2001) Bangladesh (2002) Bolivia (2001) Bulgaria (2001) Cambodia (1999) China (1994) ‡ Ghana (2000) India (2002) India (2003) Kazakhstan (2002) † Krygyz (2001) Pakistan (2002) Peru (2001) Russia (2002) Sri Lanka (2001) Tajikistan (1999) Thailand (1999) Inpatient Outpatient 0 50 100 150 200 250 *Survey of 2,000 households in three Albanian provinces. †Based on hospital exit surveys. ‡Percent calculated as average across various studies. Striped bar indicates referral hospitals. Sources: World Bank LSMS; Murrugarra 2003; Falkingham 2000 and 2001; Transparency <strong>International</strong> 2002; World Bank 2000b, 2000d, 2001a; Phongpaichit 2000; Bloom, Han and Li 2001; Banerjee and Duflo (2005) average between 140–320 yuan per hospital visit (US$16–36), with referral hospitals averaging 400 yuan (US$44), roughly 90 per cent of half monthly income (Bloom, Han and Li, 2001). Two studies in Albania showed different aspects of the informal payment issue. The analysis of a three province survey showed that rural residents were more likely to pay for services though they paid
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About International Policy Network
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Fighting the Diseases of Poverty Ed
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The authors Johan Biermann is a pla
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The authors ix Maureen has publishe
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xii Fighting the Diseases of Povert
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The value of vaccination 215 In the
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The value of vaccination 217 the di
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The value of vaccination 221 Figure
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The value of vaccination 223 vaccin
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The value of vaccination 227 encour
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The value of vaccination 237 Table
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Notes Introduction 1 The UN Human D
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Notes 267 18 The decline in their G
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Notes 269 4 The diseases of poverty
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Notes 271 to high-levels of researc
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Notes 273 to register new products,
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Notes 275 2 Snow, B et al., “The
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Sources 277 Karoly, L., Greenwood,
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Sources 279 ——— . 2004. The S
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Sources 281 University, March 13. A
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Sources 283 Alcazar, L and Andrade,
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Sources 285 Di Tella, R. and Savedo
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Sources 287 La Forgia, G. 2005. Hea
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Sources 289 Shishkin, Sergey. 2003.
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Sources 293 Wofford, D., & Shanahan
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Sources 297 7 Counterfeit medicines
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The Campaign for Fighting Diseases
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Dr. Henry I. Miller joined the Food
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