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Informal payments for health care services in Russia: old issue in new realities

  • Vladimir S. Gordeev (a1), Milena Pavlova (a1) and Wim Groot (a1)

Informal payments can be found across Europe, Africa, Asia and South America. Despite its hidden nature, they pose an important policy issue. Reported as being widespread, the true scale and scope of informal payment are unknown, and estimations differ among studies. We look at the Russian health care sector where the existence of informal payments has persisted for decades. We present the scale and scope of informal payments, as well as patterns of informal payments and their determinants. We discuss the reasons for discrepancies in estimations and implications for the ongoing reforms.

Corresponding author
*Correspondence to: Vladimir S. Gordeev, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200MD Maastricht, The Netherlands. Email:
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Aarva P., Ilchenko I., Gorobets P.Rogacheva A. (2009), ‘Formal and informal payments in health care facilities in two Russian cities, Tyumen and Lipetsk’, Health Policy and Planning, 24(5): 395405.
Allin S., Davaki K.Mossialos E. (2006), ‘Paying for ‘Free’ health care: the conundrum of informal payments in post-communist Europe’, in J. Kotalik and D. Rodriguez (eds), Global Corruption Report 2006: Special Focus on Corruption and Health, London: Transparency International, 6271.
Angulo A. M., Barberán R., Pilar Egea P.Mur J. (2011), ‘An analysis of health expenditure on a microdata population basis’, Economic Modelling, 28(1–2): 169180.
Atanasova E., Pavlova M., Moutafova E., Rechel B.Groot W. (2012), ‘Out-of-pocket payments for health care services in Bulgaria: financial burden and barrier to access’, European Journal of Public Health, first published online December 7, 2012. doi:10.1093/eurpub/cks169.
Atkinson A. B., Rainwater L.Smeeding T. M. (1995), ‘Income Distribution in OECD Countries. Evidence from the Luxembourg Income Study (LIS)’, OECD Social Policy Studies No. 18, Paris: OECD.
Baji P., Pavlova M., Gulácsi L.Groot W. (2012), ‘Informal payments for health care services and short-term effects of the introduction of visit fee on these payments in Hungary’, International Journal of Health Planning and Management, 27(1): 6379.
Balabanova D.McKee M. (2002), ‘Understanding informal payments for health care: the example of Bulgaria’, Health Policy, 62(3): 243273.
Baschieri A.Falkingham J. (2006), ‘Formalizing informal payments: the progress of health reform in Kyrgyzstan’, Central Asian Survey, 25: 120.
Belli P., Gotsadze G.Shahriari H. (2004), ‘Out-of-pocket and informal payments in health sector: evidence from Georgia’, Health Policy, 70(1): 109123.
Besstremyannaya G. (2007), ‘Out-of-pocket health care expenditures by Russian consumers with different health status’, Transition Studies Review, 14(2): 331338.
Blam I.Kovalev S. (2003), Commercialization of Medical Care and Household Behavior in Transitional Russia, Geneva: United Nations Research Institute for Social Development (UNRISD),
Boikov V. E., Feeley F. G., Sheiman I. M., Shishkin S. V. (1997), ‘Russian household expenditures on drugs and medical care: results of a December 1997 Survey of 3000 Households’, [20 November 2011].
Cameron A. C.Trivedi P. K. (2009), Microeconometrics Using Stata, College Station, TX: Stata Press.
Cohen N. (2011), ‘Informal payments for health care – the phenomenon and its context’, Health economics, Policy, and Law, 5: 124.
Ensor T. (2004), ‘Informal payments for health care in transition economies’, Social Science and Medicine, 58(2): 237246.
Ensor T.Witter S. (2001), ‘Health economics in low income countries: adapting to the reality of the unofficial economy’, Health Policy, 57(1): 113.
Falkingham J. (2004), ‘Poverty, out-of-pocket payments and access to health care: evidence from Tajikistan’, Social Science & Medicine, 58(2): 247258.
Feeley F. G., Sheimann I. M.Shiskin S. V. (1999), Health Sector Informal Payments in Russia, Boston: Boston University Department of International Health.
Fotaki M. (2009), ‘Informal payments: a side effect of transition or a mechanism for sustaining the illusion of ‘Free’ Health Care? The experience of four regions in the Russian federation’, Journal of Social Policy, 38(4): 649670.
Gaal P.McKee M. (2004), ‘Informal payment for health care and the theory of “Inxit”’, The International Journal of Health Planning and Management, 19(2): 163178.
Gaal P., Belli P. C., McKee M.Szócska M. (2006a), ‘Informal payments for health care: definitions, distinctions, and dilemmas’, Journal of Health Politics, Policy and Law, 31(2): 251293.
Gaal P., Evetovits T.McKee M. (2006b), ‘Informal payment for health care: evidence from Hungary’, Health Policy, 77(1): 86102.
Gordeev V. S., Pavlova M.Groot W. (2011), ‘Two decades of reforms. Appraisal of the financial reforms in the Russian public healthcare sector’, Health Policy, 102(2–3): 270277.
Government of the Russian Federation (1993), Constitution of the Russian Federation.
Government of the Russian Federation (2010), ‘Federal Law No. 326. About compulsory social health insurance in the Russian Federation’,;base=LAW;n=133398 [29 November 2010].
Government of the Russian Federation (2011), Federal Law No. 323. About the bases for protection of health of the citizens of the Russian Federation,;base=LAW;n=131658 [21 November 2011].
Hirschman A. O. (1980), ‘“Exit, Voice, and Loyalty:” further reflections and a survey of recent contributions’, The Milbank Memorial Fund Quarterly. Health and Society, 58(3): 430453.
Lewis M. (2000), Who is Paying for Health Care in Eastern Europe and Central Asia?, Washington, DC: Human Development Sector Unit, Europe and Central Asia Region, The World Bank.
Lewis M. (2002), ‘Informal health payments in central and eastern Europe and the former Soviet Union: issues, trends and policy implications’, in E. Mossialos, A. Dixon, J. Figueras and J. Kutzin (eds), Funding Health Care: Option for Europe, Buckingham, UK: Open University Press, 184205.
Lewis M. (2007), ‘Informal payments and the financing of health care in developing and transition countries’, Health Affairs, 26(4): 984997.
Liaropoulos L., Siskou O., Kaitelidou D., Theodorou M.Katostaras T. (2008), ‘Informal payments in public hospitals in Greece’, Health Policy, 87(1): 7281.
Mæstad O.Mwisongo A. (2011), ‘Informal payments and the quality of health care: mechanisms revealed by Tanzanian health workers’, Health Policy, 99(2): 107115.
Masuk E. 2010. ‘Oborotni V Belih Halatah’. Moskovskij komsomolez no. 25419, [2 December 2011].
Mihaylova B., Briggs A., O'Hagan A.Thompson S. G. (2011), ‘Review of statistical methods for analyzing healthcare resources and costs’, Health Economics, 20: 897916.
Özgen H., Sahin B., Belli P., Tatar M.Berman P. (2010), ‘Predictors of informal health payments: the example from Turkey’, Journal of Medical Systems, 34(3): 387396.
Pavlova M., Tambor M., Stepurko T., van Merode G. G.Groot W. (2012), ‘Assessment of patient payment policy in CEE countries: from a conceptual framework to policy indicators’, Society and Economy in Central and Eastern Europe, 34(2): 193220.
Powers C. A., Meyer C. M., Roebuck M. C.Vaziri B. (2005), ‘Predictive modeling of total healthcare costs using pharmacy claims data: a comparison of alternative econometric cost modeling techniques’, Medical Care, 43(11): 10651072.
RLMS-HSE (2011), [1 July 2011].
Saratov G. (2001), ‘Diagnosing Russian corruption: a sociological analysis’. Moscow: The INDEM Foundation Report. [4 December 2011].
Shishkin S. V., Bogatova T. V., Potapchik Y. G., Chernets V. A., Chirikova A. Y.Shilova L. S. (2003), Informal Out-of-Pocket Payments for Health Care in Russia, Moscow: Moscow Public Scientific Foundation, Independent Institute for Social Policy.
Stepurko T., Pavlova M., Gryga I.Groot W. (2010), ‘Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments’, BMC Health Services Research, 10(1): 273.
Stepurko T., Pavlova M., Gryga I.Groot W. (2011), ‘Informal patient payments and public attitudes towards these payments: evidence from six CEE countries’, Scripta Scientifica Medica, 43(7): 143146.
Thompson R.Witter S. (2000), ‘Informal payments in transitional economies: implications for health sector reform’, The International Journal of Health Planning and Management, 15(3): 169187.
Tomini S.Maarse H. (2011), ‘How do patient characteristics influence informal payments for inpatient and outpatient health care in Albania: results of Logit and Ols models using Albanian Lsms 2005’, BMC Public Health, 11(1): 375.
Twigg J. L. (2002), ‘Health care reform in Russia: a survey of head doctors and insurance administrators’, Social Science & Medicine, 55(12): 22532265.
Vian T. (2008), ‘Review of corruption in the health sector: theory, methods and interventions’, Health Policy and Planning, 23(2): 8394.
Vian T.Burak L. J. (2006), ‘Beliefs about informal payments in Albania’, Health Policy and Planning, 21(5): 392401.
The World Bank (2011), [5 July 2011].
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Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
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