Publication: Institutional Issues in Informal Health Payments in Poland : Report on the Qualitative Part of the Study
Loading...
Published
2001-02
ISSN
Date
2013-05-30
Author(s)
Editor(s)
Abstract
A growing pattern within the ECA (East Europe and Central Asia) region is informal payments to doctors, hospital administrators, nurses and others connected with health service delivery. These payments have implications for governance of health systems and for equity and access, as well as for incentives for both health providers and managers. According to the research findings, informal payments are widespread in the Polish health sector. They include both cash and in-kind contributions. The study reinforces the existing anecdotal evidence as well as evidence from studies in other countries of the ECA Region and shows that the phenomenon has, if anything, become more widespread over the last few years. Informal payments are both paid voluntarily and coerced by providers in one way or another. As this paper shows, the main reasons for paying for medical services are to ensure quality care, to buy future care, and to jump queues. Providers are also paid to show gratitude and appreciation. In addition, users contribute in-kind for ancillary services. For instance, they bring their own sheets, food, or even medicines to the hospital because the hospital is not providing them. Building on the existing literature, this research is aimed at: (1) identifying the nature, extent, and economic dynamics (mechanisms of collection and revenue distribution among different actors) of informal payments; (2) understanding the leading causes of informal payments; (3) identifying the consequences of informal payments on accessibility and quality of care, and (4) articulating policy options to reduce the size and negative impact of such payments.
Link to Data Set
Citation
“Shahriari, Helen; Belli, Paolo; Lewis, M.. 2001. Institutional Issues in Informal Health Payments in Poland : Report on the Qualitative Part of the Study. HNP discussion paper series;. © World Bank. http://hdl.handle.net/10986/13679 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Related items
Showing items related by metadata.
Publication Integrating the Poor into Universal Health Coverage in Vietnam(World Bank, Washington DC, 2013-01)This case study is aimed at providing a descriptive assessment of the key features of Vietnam's Social Health Insurance (SHI), focusing on the impediments to integrating the poor into universal coverage. The trajectory of SHI in Vietnam is similar to that of many other countries in the East Asia and Pacific region. The poor were covered under a separate Health Care Fund for the Poor to begin with. The 2009 Law on Health Insurance merged all of the different programs into one. Health insurance premiums for the poor were fully subsidized by the government and enrolment became mandatory, resulting in almost complete enrollment of the poor by 2011. Vietnam has combined elements of contributory social health insurance with substantial levels of tax financing to provide coverage for the poor and informal sector. The case study is structured as follows. Section 2 describes the institutional structure and system characteristics of Vietnam's SHI. Section 3 addresses the main topic of the case study - the impediments to integrating the poor. Section 4 concludes by addressing the pending agenda.Publication Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Turkey(World Bank Group, Washington, DC, 2014-09)Turkey is an upper middle-income country that has seen rapid economic growth and development over the last decade. In a relatively short period, it has essentially achieved universal health insurance (UHI) coverage of the population, high levels of financial protection and equity, and high and rising levels of consumer satisfaction, while significantly improving health outcomes. The universal health coverage (UHC) strategy, embedded in its Health Transformation Program (HTP), was initiated in 2003 to improve the effectiveness of the health system through improved governance, efficiency, and user and provider satisfaction.Publication Massachusetts Health Reform : Approaching Universal Coverage(World Bank, Washington DC, 2013-01)The commonwealth of Massachusetts, one of the 50 states in the United States of America, has achieved near universal health coverage of its 6.6 million residents after a landmark reform made health insurance mandatory for all residents in 2006. The reform was only the latest step in a sequence of national and state programs that successively enrolled more people in private and public health insurance programs over a period of four decades. Massachusetts passed chapter 58 of the acts of 2006, the Massachusetts health care reform law, on April 12, 2006, and over a five-year period, more than 400,000 previously uninsured residents were provided with comprehensive health benefits. As of 2012, 98.2 percent of the population is covered, including 99.8 percent of children. Massachusetts has the highest rate of health insurance coverage of any state in the country. The program has widespread popular support, and it served as a model for the design of President Obama's affordable care act, which established a plan for mandatory coverage on a national basis for the first time in the United States. This report will briefly describe the reform and its context, but will focus for purposes of simplicity on the operational details of the mass health program of health insurance for the poor. A discussion of the administration and management of Mass Health can offer a glimpse into the inner workings of all other insurance plans in the commonwealth. Mass health, private insurance, and Commonwealth Care share similar tools, controls, and strategies.Publication Brazil’s Primary Care Strategy(World Bank, Washington, DC, 2013-01)This case study summarizes the responses to the questionnaire on The Nuts and Bolts of the Program Expanding Health Coverage to the Poor, developed within the framework of the World Bank's UNICO - Universal Challenge Program. By so doing, it assesses the key features and the achievements and challenges of Brazil s Primary Care Strategy (PCS) and analyzes the contribution of this strategy to the establishment and implementation of universal coverage. Section 2 provides context for the discussion by summarizing key reforms and the impact of the PCS and describes Brazil s health care delivery and financing system. The institutional architecture and interaction of the health care program (HCP), in this case the PCS, is discussed in section 3. Sections 4 through 8 outline the main features of the strategy, including the identification and targeting of beneficiaries, management of public funds, services covered, and the information environment. The case study concludes with a discussion of lessons learned (section 9) and the pending agenda (section 10).Publication Sustaining Universal Health Coverage in France : A Perpetual Challenge(World Bank Group, Washington, DC, 2014-06)While universal health coverage (UHC) offers a powerful goal for a nation, all countries-irrespective of income are struggling with achieving or sustaining UHC. France is a high-income country where HC is in effect universal. Health-related costs are covered by a mix of mandatory social health insurance (SHI) and private complementary schemes, while benefit packages are comprehensive, uniform, and of good quality. France provides some of the highest financial protection among countries in the Organization for Economic Co-operation and Development (OECD). Still, under pressure to sustain UHC without compromising equity of access, the system has been fine-tuned continually since inception. Much can be learned from France's experience in its reforms toward better fiscal sustainability, equity, and efficiency. The main purpose of the study is to assess major challenges that France has faced for sustaining UHC, and to share its experiences and lessons in addressing system bottlenecks to benefit less developed countries as they embark on the path to UHC.
Users also downloaded
Showing related downloaded files
Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication Direct and Indirect Impacts of Transport Mobility on Access to Jobs: Evidence from South Africa(Washington, DC: World Bank, 2025-11-12)Access to jobs is essential for economic growth. In Africa, unemployment rates are notably high. This paper reexamines the relationship between transport mobility and labor market outcomes, with a particular focus on the direct and indirect effects of transport connectivity. As predicted by theory, wages are influenced by the level of commuting deterrence. Generally, higher earnings are associated with longer commute times and/or higher commuting costs. Local accessibility is also important, especially for individuals with time constraints. Both direct and indirect impacts are found to be significant in South Africa, where job accessibility has been challenging since the end of apartheid. For the direct impact, the wage elasticity associated with commuting costs is significant. Returns on commute are particularly high for women. Local accessibility to socioeconomic facilities, such as shops and health services, is also found to have a significant impact, consistent with the concept of mobility of care. To enhance employment, therefore, it is crucial to connect people not only to job locations but also to various socioeconomic points of interest, such as markets and hospitals, in an integrated manner. This integration will enable individuals to spend more time working and commuting longer distances.Publication Taxes, Spending, and Equity: International Patterns and Lessons for Developing Countries(Washington, DC: World Bank, 2025-11-17)Taxes and public spending underpin the basic administration of government and finance the human capital and infrastructure investments needed for economic growth. They can also have a significant and immediate impact on poverty and inequality. The question of how public finance can support longer-term growth objectives while promoting equity has become even more important in recent years, given the high fiscal deficits and debt levels most countries emerged with in the aftermath of the COVID-19 pandemic. These included the increasing cost of debt and the need to restart environmentally sustainable growth while helping households address the learning losses and other social scars caused by the pandemic. This paper examines the global evidence on which households pay which taxes and who benefits from what spending, and critically, the net effect on different households across the income distribution. The aim is to identify the patterns and lessons that emerge for designing progressive fiscal policies. A global dataset of 96 countries is assembled, spanning all regions of the world and all national income levels, grounded in the Commitment to Equity (CEQ) approach to fiscal incidence.Publication Kyrgyz Republic Country Climate and Development Report(Washington, DC: World Bank, 2025-11-03)This Country Climate and Development Report (CCDR) on the Kyrgyz Republic aims to support the country’s development goals amid a changing climate. The CCDR considers two policy scenarios up to 2050: the business-as-usual (BAU) and high-growth scenarios. As it quantifies the likely impacts of climate change on the Kyrgyz economy between now and 2050, the report highlights key government actions to best prepare for and adapt to climate impacts (referred to as “with adaptation” measures), with a particular focus on the time horizon up to 2030. The CCDR also outlines a path to net zero emissions by 2050 (referred to as “with mitigation” measures, “decarbonization,” or, simply, “net zero 2050”), highlighting associated development co-benefits.Publication Continental Drying: A Threat to Our Common Future(Washington, DC: World Bank, 2025-11-04)Grounded in new evidence from satellite data, “Continental Drying: A Threat to Our Common Future” presents the first global assessment of freshwater reserves over the past two decades. The findings expose an alarming trend of “continental drying,” a persistent long-term decline in freshwater availability across vast landmasses. Not only are droughts and deluges becoming more unpredictable, but the total amount of freshwater available for use has also significantly declined. Continental drying, driven by global warming, worsening droughts, and unsustainable water and land use, is a silent but accelerating crisis—largely unknown to the public—that reshapes the global water narrative. Continental drying raises profound risks. This report reveals new empirical evidence showing how freshwater depletion leads to major job losses, reduced incomes, wildfires, and biodiversity threats. In the long term, the combined effects of drying and warming could push societies toward a tipping point where damage accelerates rapidly and adaptation becomes increasingly difficult. Against the backdrop of continental drying, global water consumption rose by 25 percent between 2000 and 2019, with about a third of this increase occurring in regions already experiencing drying. Compounding the pressure, a substantial share of water use in drying regions remains inefficient. Continental Drying identifies hot spots where rising demand and declining supply converge and explores where and how water savings can be realized. This report recommends a three-pronged approach to address the crisis: managing demand, augmenting water supply, and improving water allocation. Five cross-cutting levers—strengthening institutions, reforming water tariffs and repurposing subsidies, adopting water accounting, leveraging data and technological innovations, and valuing water in trade—are essential for effective implementation and to attract private investment to finance the approach. Beyond water, addressing trade barriers, investing in education and skills development, and improving access to markets and financial services are critical for strengthening job and livelihood resilience amid a continental drying crisis.