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GREYPAY

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White Coats, Grey Payments:

Explaining and Tackling Informal Payments in the Health Sector

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A research project supported by a grant of the Ministry of Research, Innovation and Digitization, CNCS/CCCDI—UEFISCDI, project number PN-III-P1-1.1-TE-2019-0163, within PNCDI III

January 2021 - December 2022

ABOUT

Since the turn of the millennium, a growing literature reveals how patients make direct contributions in cash or in-kind, to health care providers for services to which they are entitled, that are in addition to any official contribution that is required. Informal payments in healthcare (IPH) are not a minority practice and thus tackling the phenomenon has become a core issue on the policy agendas of supra-national agencies and governments. Until now, however, few studies have sought to deeply explain informal payments beyond identifying a range of motives and/or systemic determinants, and even fewer to use some broader theorisation to explain this phenomenon. Aiming to advance knowledge, this project reflects and develops new cutting-edge theorisations of IPH by further advancing the new institutional asymmetry thesis towards IPH, promulgated in 2017 by the project leader and one of his co-authors. Seen through this lens, informal payments arise because the norms, practices and values of patients and healthcare professionals are not in symmetry with the formal rules - codified laws and regulations (‘vertical trust’). Here, this new theory will be advanced firstly, by integrating the issue of ‘horizontal trust’ (the influence of social norms) and secondly, by identifying the causes of institutional asymmetry and consequently the high prevalence of IPH. Methodological, data, theory and investigator triangulations will be ensured. As such, secondary data will be used as well as primary data collected through in-depth-interviews, laboratory experiments and surveys. For the first time, experimental designs will be used for exploring IPH and two scales will be developed for evaluating the degree of institutional asymmetry. Aiming to create and consolidate a first-class research team with expertise on informal payments in healthcare, the project will also provide evidence-based policy-relevant results.

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About

OBJECTIVES

Objective 1
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To evaluate the influence of social norms regarding informal payments by patients.

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Objective 2
To identify the motives (informal institutions: norms, values, beliefs and practices) for a) making and b) accepting informal payments.

 

Objective 3
To evaluate the effectiveness of different policy measures and combinations of policy measures in tackling informal payments by patients.
Objectives

RESEARCH TEAM

Project Leader
Dr. Adrian Vasile HORODNIC
Postdoc Researcher
Dr. Claudia Ioana CIOBANU
Researcher
Dr. Daniela DRUGUȘ
Postdoc Researcher
Dr. Cristian ÎNCĂLȚĂRĂU
PhD Student
Răzvan Ionuț DRUGĂ
Research Team

RESULTS

Results (summary, text): | Download English | | Download Romanian |

Scientific Reports: | Download 2021 Scientific Report I | | Download 2022 Scientific Report II - final |


Articles in peer-reviewed academic journals
  • Horodnic AV, Williams CC, Drugă RI, Incaltarau C. Informal Payments by Patients in Central and Eastern Europe during the COVID-19 Pandemic: An Institutional Perspective. International Journal of Environmental Research and Public Health. 2021; 18(20): 10914. doi: 10.3390/ijerph182010914 | Link Abstract |  | Link full text | | ISI Q1 journal (by IF or AIS), Clarivate Analytics, JCR 2021 | 
  • Horodnic AV. Trends in Informal Payments by Patients in Europe: A Public Health Policy Approach. Frontiers in Public Health - Health Economics (section). 2021; 9: 780337. doi: 10.3389/fpubh.2021.780337 | Link Abstract |  | Link full text | | ISI Q1 journal (by IF or AIS), Clarivate Analytics, JCR 2021 |
  • Incaltarau C, Horodnic AV, Williams CC, Oprea L. Institutional Determinants of Informal Payments for Health Services: An Exploratory Analysis across 117 Countries. International Journal of Environmental Research and Public Health. 2021; 18(23): 12421. doi: 10.3390/ijerph182312421 | Link Abstract |  | Link full text | | ISI Q1 journal (by IF or AIS), Clarivate Analytics, JCR 2021 |
  • Horodnic AV, Williams CC, Drugă RI, The companion pandemic to Covid-19: the use of informal practices to access public healthcare services in the European Union. International Journal of Public Health. 2022; 67: 1604405. doi: 10.3389/ijph.2022.1604405 | Link Abstract |  | Link full text | | ISI Q1 journal (by IF or AIS), Clarivate Analytics, JCR 2021 | 
  • Horodnic AV, Williams CC, Ciobanu CI, Druguș D. Informal payments by patients, institutional trust and institutional asymmetry. Frontiers in Psychology. 2022; 13: 1015208. doi: 10.3389/fpsyg.2022.1015208 | Link Abstract |  | Link full text | | ISI Q1 journal (by IF or AIS), Clarivate Analytics, JCR 2021 |
  • Drugă RI. Explaining informal payments in the Romanian public health care system. CES Working Papers Journal. 2022 (accepted; to be published in December 2022).
 
       Under review papers:
  • Horodnic IA, Williams CC, Apetrei A, Mațcu M, Horodnic AV. Services purchase from the informal economy using digital platforms. Service Industries Journal. (2022, under review, minor revision). | ISI Q1 journal (by IF or AIS), Clarivate Analytics, JCR 2021 |
       Working papers (drafts):

  • Horodnic AV, Incaltarau C. Wages and informal payments in healthcare: a health policy approach.

  • Arezzo M, Horodnic AV, Guagnano G. Towards a new way of estimating the share of informal payments in healthcare.

Policy Briefs
  • Drugă RI, Horodnic AV. Explaining informal payments by patients - Policy Brief. GREYPAY. November, 2021. | Download | 
  • Drugă RI, Horodnic AV. Explaining and Tackling Informal Payments by Patients. The case of Romania. Policy REPORT. GREYPAY. November, 2022. | Download |
Mobilities (research/documentation, scientific events - e.g., conferences, summer schools, workshops etc.)
  • Horodnic AV - Research visit - University of Bucharest (26.10.2021 – 09.11.2021, Bucharest, Romania)
  • Incaltarau C - Research visit - Catholic University of Valencia San Vicente Martir (21.11.2021 – 30.12.2021, Valencia, Spain)
  • Drugă RI - course/training/workshop “Erasmus Academic Writing and Presentation Skills AMPM”, Atlantic Language Galway (22.11.2021-26.11.2021, Galway, Ireland)
  • Ciobanu CI - Research visit - Bucharest University of Economic Studies (22.11.2021 – 26.11.2021, Bucharest, Romania)
  • Horodnic AV - Research visit - Catholic University of Valencia San Vicente Martir (19.08.2022 – 06.09.2022, Valencia, Spain)
  • Ciobanu CI - Research visit - The Universitat Politècnica de València (22.09.2022 – 02.10.2022, Valencia, Spain)
  • Horodnic AV - Research visit - Sapienza University of Rome (18.10.2022 – 11.11.2022)
  • Incaltarau C - Research visit - The University of Porto (21.10.2022 – 31.10.2022, Porto, Portugal)
Conference (organized, presentations)
  • GREYPAY Conference: Informal Payments in the Health Sector, 4 July 2022, Iasi | Organizing Committee: Horodnic AV,  Incaltarau C, Ciobanu CI, Drugă RI | ONSITE: "GRIGORE T. POPA" University of Medicine and Pharmacy from Iaşi, “Nicolae Leon” Building (Floor 9, Room 4) – Grigore Ghica Vodă Street, no. 13, Iași & ONLINE:  Microsoft Teams meeting (details in the attached Conference Program | Poster - Conference program (ENG) | Poster - Conference program (RO) |
Results

CONTACT

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