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The link between past informal payments and willingness of the Hungarian population to pay formal fees for health care services: results from a contingent valuation study

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Abstract

We examine the willingness of health care consumers to pay formal fees for health care use and how this willingness to pay is associated with past informal payments. We use data from a survey carried out in Hungary in 2010 among a representative sample of 1,037 respondents. The contingent valuation method is used to elicit the willingness to pay official charges for health care services covered by the social health insurance if certain quality attributes (regarding the health care facility, access to the services and health care personnel) are guaranteed. A bivariate probit model is applied to examine the relationship between willingness to pay and past informal payments. We find that 66 % of the respondents are willing to pay formal fees for specialist examinations and 56 % are willing to pay for planned hospitalizations if these services are provided with certain quality and access attributes. The act of making past informal payments for health care services is positively associated with the willingness to pay formal charges. The probability that a respondent is willing to pay official charges for health care services is 22 % points higher for specialist examinations and 45 % points higher for hospitalization if the respondent paid informally during the last 12 months. The introduction of formal fees should be accompanied by adequate service provision to assure acceptance of the fees. Furthermore, our results suggest that the problem of informal patient payments may remain even after the implementation of user fees.

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Notes

  1. Co-payments are currently applied for some services in dental and inpatient care (e.g., for hotel services, i.e., extra meals and accommodations) and when using specialist services without a referral, as well as in case of a free choice of the physician (excluding delivery and maternity care).

  2. ASSPRO CEE 2007 (FP7-SSH-2007 grant agreement no. 217431). More information and the list of related publications can be found on the project's webpage: http://assprocee2007.com/.

  3. “An interview is attempted with the adult in the household who has had the most recent birthday” (see Oldendick et al. 1988, p. 307 [26]).

  4. In the pre-test, we asked respondents about their willingness to pay fees to the local governments or the Insurance Fund for the improvement of the services. According to the debriefing, many respondents doubted that the fee would contribute to the improvement of the services. Thus, we rephrased the scenario in the current form in order to ensure the respondents that they can obtain the services with good quality and quick access as defined in the card if they pay an official fee to the provider. During the survey, the interviewers were instructed to ensure the respondents that they could obtain the services with good quality and quick access as defined in the card if they pay an official fee to the provider.

  5. In the pre-test, respondents had to answer open-ended questions about how much they would be willing to pay for such health care services as well as the reason for the unwillingness to pay.

  6. The exchange rate was 285 HUF = 1 euro (which was due at the time of the data collection).

  7. The “non-respondents” were more likely to live in the capital compared to respondents (t test = −2.17, p = 0.0303). We did not find any significant differences in terms of other sociodemographic features.

  8. The “non-responders” were more likely to live in the capital compared to responders (t test = −3.06, p = 0.0023). We did not find any significant differences in terms of other sociodemographic features.

  9. A significantly positive coefficient was found for those forgoing hospital admission because of inability to pay: three respondents; average amount: 50,167 HUF.

References

  1. Gaál, P., Szigeti, S., Csere, M., Gaskins, M., Panteli, D.: Hungary health system review. Health Syst. Transit. 13(5), 1–266 (2011)

    PubMed  Google Scholar 

  2. Boncz, I., Sebestyen, A.: Financial deficits in the health services of the UK and Hungary. Lancet 368(9539), 917–918 (2006)

    Article  PubMed  Google Scholar 

  3. Boncz, I., Nagy, J., Sebestyen, A., Korosi, L.: Financing of health care services in Hungary. Eur. J. Health Econ. 5(3), 252–258 (2004)

    Article  PubMed  Google Scholar 

  4. Gulácsi, L., Dávid, T., Dózsa, C.: Pricing and reimbursement of drugs and medical devices in Hungary. Eur. J. Health Econ. 3(4), 271–278 (2002)

    Article  PubMed  Google Scholar 

  5. Baji, P., Gulácsi, L.: ``Beteg önrész”–a lakosság fizetési hajlandósága az egészségügyi szolgáltatásokért. (Patient payments–Willingness of the Hungarian Population to Pay for Health Care Services). Esély 2010(4), 106–117 (2010)

    Google Scholar 

  6. Baji, P., Pavlova, M., Gulácsi, L., Groot, W.: User fees for public health care services in Hungary: expectations, experience, and acceptability from the perspectives of different stakeholders. Health Policy 102(2–3), 255–262 (2011)

    Article  PubMed  Google Scholar 

  7. Gaál, P., McKee, M.: Fee-for-service or donation? Hungarian perspectives on informal payment for health care. Soc. Sci. Med. 60(7), 1445–1457 (2005)

    Article  PubMed  Google Scholar 

  8. Gaál, P., Belli, P.C., McKee, M., Szócska, M.: Informal payments for health care: definitions, distinctions, and dilemmas. J. Health Politics Policy Law 1(2), 251–293 (2006)

    Article  Google Scholar 

  9. Baji, P., Pavlova, M., Gulácsi, L., Homolyáné Csete, Zs, Groot, W.: Informal payments for health care services and short-term effects of the introduction of visit fee on these payments in Hungary. Int. J. Health Care Plan. Manag. 27(1), 63–79 (2012)

    Article  Google Scholar 

  10. Gaál, P., Evetovits, T., McKee, M.: Informal payment for health care: evidence from Hungary. Health Policy 77(1), 86–102 (2006)

    Article  PubMed  Google Scholar 

  11. Szende, A., Culyer, A.J.: The inequity of informal payments for health care: the case of Hungary. Health Policy 75(3), 262–271 (2006)

    Article  PubMed  Google Scholar 

  12. Bognár, G., Gál, R., Kornai, J.: Hálapénz a magyar egészségügyben (Informal payments in the Hungarian Health Care System). Közgazdasági Szemle XL VII, 293–320 (2000)

    Google Scholar 

  13. Kőrösi, L., Kövi, R., Varga, Sz, Sebestyén, A., Kriszbacher, I., Betlehem, J., Brodszky, V., Kárpáti, K., Molnár, A., Boncz, I.: Effect of the introduction of visit fee on the number of visits to general practitioners in Hungary. Value Health 12(3), A85 (2009)

    Article  Google Scholar 

  14. Boncz, I., Nagy, J., Kőrösi, L., Kövi, R., Molnár, A., Kiss, Z., Kriszbacher, I., Varga, S., Sebestyén, A.: The effect of the introduction of visit fee on the number of patient-visits to outpatient care departments in Hungary. Value Health 11(6), A368–A369 (2008)

    Article  Google Scholar 

  15. Nagy, J., Kövi, R., Sebestyen, A., Kiss, Z., Molnár, A., Kőrösi, L., Kriszbacher, I., Betlehem, J., Boncz, I.: The effect of the introduction of hospital daily fee on the number of admissions to acute care hospital wards Hungary. Value Health 11(6), A368 (2008)

    Article  Google Scholar 

  16. Rechel, B., McKee, M.: Health reform in Central and Eastern Europe and the former Soviet Union. Lancet 374(9696), 1186–1195 (2009)

    Article  PubMed  Google Scholar 

  17. Hall, D.: Healthcare: rejection of privatization and patient fees in Central Europe. PSIRU, London. http://www.psiru.org/reports/healthcare-rejection-privatisation-and-patient-fees-central-europe (2009). Accessed 26 Sept 2012

  18. Tambor, M., Pavlova, M., Woch, P., Groot, W.: Diversity and dynamics of patient cost-sharing for physicians’ and hospital services in the 27 European Union countries. Eur. J. Public Health 21(5), 585–590 (2011)

    Article  PubMed  Google Scholar 

  19. Lewis, M.: Informal health payments in Central and Eastern Europe and the former Soviet Union: issues, trends and policy implications. In: Mossialos, E., Dixon, A., Figueras, J., Kutzin, J. (eds.) Funding Health Care, European Observatory on Health Care Systems Series, pp. 184–205. Open University Press, Buckingham (2002)

    Google Scholar 

  20. Ensor, T.: Informal payments for health care in transition economies. Health Policy 58(2), 237–246 (2004)

    Google Scholar 

  21. Gaál, P., Jakab, M., Shishkin, S.: Strategies to address informal payments for health care. In: Kutzin, J., Cashin, C., Jakab, M. (eds.) Implementing Health Financing Reform Lessons from countries in transition, pp. 327–360. World Health Organization Regional Office for Europe and the European Observatory on Health Systems and Policies, Copenhagen (2010)

    Google Scholar 

  22. Schneider, P.: Evidence on cost-sharing in health care: applications to Hungary. The World Bank. http://siteresources.worldbank.org/INTHSD/Resources/376278-1202320704235/SchneiderCoPaymentsHealthHungaryFeb152008.pdf (2008). Accessed 26 Sept 2012

  23. Stepurko, T., Pavlova, M., Gryga, I., Groot, W.: Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments. BMC Health Serv. Res. 19(10), 273–286 (2010)

    Article  Google Scholar 

  24. Atanasova, E., Pavlova, M., Velickovski, R., Nikov, B., Moutafova, E., Groot, W.: What have 10 years of health insurance reforms brought about in Bulgaria? Re-appraising the Health Insurance Act of 1998. Health Policy 102(2–3), 263–269 (2011)

    Article  PubMed  Google Scholar 

  25. Pavlova, M., Groot, W., van Merode, G.: Is there a place for an increased reliance on patient charges in Central and Eastern European countries? Scr. Sci. Med. 43(7), 137–141 (2011)

    Google Scholar 

  26. Oldendick, R.W., Bishop, G.F., Sorenson, S.B., Tuchfarber, A.J.: A comparison of the Kish and last-birthday methods of respondent selection in telephone surveys. J. Off. Stat. 4(4), 307–318 (1988)

    Google Scholar 

  27. Berki, S.E., Ashcraft, M.L.: HMO enrollment: who joins what and why: a review of the literature. Milbank. Mem. Fund. Q. Health Soc. 58(4), 588–632 (1980)

    Article  PubMed  CAS  Google Scholar 

  28. Donaldson, C., Thomas, R., Torgerson, D.: Validity of open-ended and payment scale approaches to eliciting willingness to pay. Appl. Econ. 29(1), 79–84 (1997)

    Article  Google Scholar 

  29. Ryan, M., Scott, D.A., Donaldson, C.: Valuing health care using willingness to pay: a comparison of the payment card and dichotomous choice methods. J. Health Econ. 23(2), 237–258 (2004)

    Article  PubMed  Google Scholar 

  30. Whynes, D.K., Frew, E.J., Wolstenholme, J.L.: Willingness-to-pay and demand curves: a comparison of results obtained using different elicitation formats. Int. J. Health Care Financ. Econ 5(4), 369–386 (2005)

    Article  Google Scholar 

  31. Greene, W.H.: Econometric Analysis, 6th edn. Prentice Hall, Upper Saddle River (2007)

    Google Scholar 

  32. Hanley, N., Ryan, M., Wright, R.: Estimating the monetary value of health care: lessons from environmental economics. Health Econ. 12(1), 3–16 (2003)

    Article  PubMed  Google Scholar 

  33. Ryan, M.: Using willingness to pay to assess the benefits of assisted reproductive techniques. Health Econ. 5(6), 543–558 (1996)

    Article  PubMed  CAS  Google Scholar 

  34. Lucas, M.E., Jeuland, M., Deen, J., Lazaro, N., MacMahon, M., Nyamete, A., Barreto, A., von Seidlein, L., Cumbane, A., Songane, F.F., Whittington, D.: Private demand for cholera vaccines in Beira, Mozambique. Vaccine 25(14), 2599–2609 (2007)

    Article  PubMed  Google Scholar 

  35. Ryan, M., Watson, V.: Comparing welfare estimates from payment card contingent valuation and discrete choice experiments. Health Econ. 18(4), 389–401 (2009)

    Article  PubMed  Google Scholar 

  36. De Bruin, A., Picavet, H., Nossikov, A.: Health Interview Surveys: Towards International Harmonization of Methods and Instruments. The World Health Organization, Copenhagen (1996)

    Google Scholar 

  37. Saris, W., Gallhofer, I.: Design, Evaluation and Analysis of Questionnaires or Survey Research. Wiley, New York (2007)

    Book  Google Scholar 

  38. Eris, M.: Improving Health Outcomes and System in Hungary, OECD Economics Department Working Papers, No. 961, OECD Publishing (2012)

  39. Becker, G.S.: Human capital and the Personal Distribution of Income: An analytical approach. University of Michigan, Institute of Public Administration, Ann Arbor (1967)

    Google Scholar 

  40. Mincer, J., Polachek, S.: Familiy investment in human capital: earnings of woman. J. Political Econ. 82(2), S76–S108 (1974)

    Article  Google Scholar 

  41. Tomini, S., Groot, W., Pavlova, M.: Paying informally in the Albanian health care sector: a two-tiered stochastic frontier model. Eur. J. Health Econ. 2011 Jun 21. [in press] (2011)

  42. Atella, V., Peracchi, F., Depalo, D., Rossetti, C.: Drug compliance, co-payment and health outcomes: evidence from a panel of Italian Patients. CEIS Working Paper No. 76. SSRN: http://ssrn.com/abstract=871395) (2005). Accessed 26 Sept 2012

  43. Austvoll-Dahlgren, A., Aaserud, M., Vist, G., Ramsay, C., Oxman, A.D., Sturm, H., Kösters, J.P., Vernby, A.: Pharmaceutical policies: effects of cap and co-payment on rational drug use. Cochrane Datab. Syst. Rev 23(1), CD007017 (2008)

    Google Scholar 

  44. Baji, P., Pavlova, M., Gulácsi, L., Groot, W.: Preferences of Hungarian consumers for quality, access and price attributes of health care services, result of a discrete choice experiment. Soc. Econ. 34(2), 293–311 (2012)

    Article  Google Scholar 

  45. Pavlova, M., Groot, W., van Merode, G.: The importance of quality, access and price to health care consumers in Bulgaria: a self-explicated approach. Int. J. Health Plan. Manag. 18(4), 343–361 (2003)

    Article  Google Scholar 

  46. Belicza, É.: Egyenlőtlenségek a szolgáltatások igénybevétele során a járóbeteg szakellátásban. Inequalities in the use of out-patient health care services. IME 4(10), 9–15 (2006)

    Google Scholar 

  47. Vitrai, J., Bakacs, M., Gémes, K., Kiss, N., Kövi, R., Uzzoli, A.: Egészségügyi ellátáshoz való hozzáférés egyenlőtlenségei Magyarországon. Kutatási jelentés. (Inequalities in the access of health care services in Hungary. Research Report.) EgészségMonitor Kutató és Tanácsadó Nonprofit Közhasznú Kft., Budapest (2011) http://www.egeszsegmonitor.hu/dok/Hozzaferes%20egyenlotlensege.pdf. Accessed 26 Sept 2012

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Acknowledgement

The study was financed by the European Commission under the 7th Framework Program, Theme 8 Socio-economic Sciences and Humanities, project ASSPRO CEE 2007 (grant agreement no. 217431). The content of the publication is the sole responsibility of the authors, and it in no way represents the views of the Commission or its services. We would like to thank to Prof. Peter Zweifel, Department of Economics, University of Zurich, for his valuable suggestions on our paper.

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Authors and Affiliations

  1. Health Economics and Health Technology Assessment Research Centre, Corvinus University of Budapest, Budapesti Corvinus Egyetem, Fővám tér 8, 1093, Budapest, Hungary

    Petra Baji & László Gulácsi

  2. Center for Public Affairs Studies Foundation, Corvinus University of Budapest, Budapesti Corvinus Egyetem, Fővám tér 8, 1093, Budapest, Hungary

    Petra Baji & László Gulácsi

  3. Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, CAPHRI, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands

    Petra Baji, Milena Pavlova & Wim Groot

  4. Department of Economics, Central European University, Nádor utca 9, 1051, Budapest, Hungary

    Miklós Farkas

  5. Topinstitute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands

    Wim Groot

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  1. Petra Baji
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  2. Milena Pavlova
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  3. László Gulácsi
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  4. Miklós Farkas
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  5. Wim Groot
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Correspondence to Petra Baji.

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Baji, P., Pavlova, M., Gulácsi, L. et al. The link between past informal payments and willingness of the Hungarian population to pay formal fees for health care services: results from a contingent valuation study. Eur J Health Econ 15, 853–867 (2014). https://doi.org/10.1007/s10198-013-0531-y

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