Kristina Gryboski, PhD, PATH, 1800 K Street, NW, Suite 800, Washington, DC 20006, 410-537-1800, kgryboski@path-dc.org, Rachel Hall, MS, Department of Anthropology, Boston University, 232 Bay State Road, Boston, MA 02215, and Taryn Vian, MSc, Assistant Professor, Department of International Health, School of Public Health, Boston University, T4W, 715 Albany St, Boston, MA 02118.

In 2002, over 60% of Albanians who were hospitalized reported making out-of-pocket payments. Most of these payments were under-the-table payments for services that should have been provided free of charge in government facilities. Informal payments can have negative effects on access, equity, and health status by causing people to forgo or delay care, sell assets to pay for care, or lose faith in doctors. And where informal payments are made in lieu of formal fees, the health care system loses revenue. To help Albanian policy makers address the problem of informal payments, the Partners for Health Reform Plus Project conducted a qualitative study in 2003. Using focus groups and in-depth interviews, the researchers contacted 131 respondents, including doctors, nurses, administrators, and members of the general public. The study found that informal payments are not apparently being used to improve equipment or supplies, but to supplement providers' personal income. While many providers view informal payments as voluntary, and as having no effect on the quality of care given, members of the general public often see informal payments as a requirement to gain access to treatment. One surprising finding was the presence of “managers” in hospitals: private individuals who broker deals between patients and doctors concerning the informal payment amounts and distribution. This paper discusses Albanians’ views about the reasons for informal payments and the payment process. The paper suggests how qualitative data can inform the design of reforms such as strengthening official fee collection or initiating procedures to detect informal payments.

Learning Objectives:

• Describe the reasons given by Albanian citizens and government health providers for why informal payments take place, and their effect on access and quality of care.
• Explain the informal payment making process, including the role of the “manager,” how prices are determined, and how money or goods change hands.
• Describe several ways in which qualitative data can help policy makers and health planners to develop appropriate interventions to reduce the negative effects of informal payments.

Keywords: Accountability, Patient Perspective

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.