Formal and informal payments in health care facilities in two Russian cities, Tyumen and Lipetsk
Formal and informal payments in health care facilities in two Russian cities, Tyumen and Lipetsk
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DOI：
10.1093/heapol/czp029
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发表时间：
2009-09-01
影响因子：
3.2
通讯作者：
Rogacheva, Anastasiya
中科院分区：
文献类型：
--
作者：
Aarva, Pauliina;Ilchenko, Irina;Rogacheva, Anastasiya
在包括俄罗斯在内的许多转型期国家，非正式支付医疗保健服务的情况很普遍。虽然俄罗斯政府宣布其政策目标是改善免费医疗服务的可及性和质量，但它已批准了赋予地方当局有偿提供服务的权利的条例。本文报告了一项以人口为基础的调查（n = 2001）的结果，调查了在两个不同经济地位的地区首府，人们正式或非正式支付的医疗服务的使用率。这项研究的目的是揭示两个城市之间以及社会经济群体之间在付款形式和原因方面的任何差异。结果表明，正式支付在较富裕地区的首府秋明更为普遍，而非正式支付的流行率在较贫穷地区的首府利佩茨克更高。大约15%的受访者在过去3年中进行过非正式支付。女性（OR = 1.57）、慢性病患者（OR = 1.62）、退休人员（OR = 2.8）和愿意支付额外医疗信息费用（OR = 2.48）增加了非正式支付的可能性。该调查表明，在俄罗斯，由于目前不明确，不透明的财务规则，公共资助的医疗保健服务的获得和质量可能受到严重威胁。非正式支付的做法沿着着正式收费的政府服务的推出，这可能会妨碍政府加强卫生服务用户之间平等的努力。
Informal payments for health care services are common in many transition countries, including Russia. While the Russian government proclaims its policy goal of improving access to and quality of free-of-charge health services, it has approved regulations that give local authorities the right to provide services against payment. This paper reports the results of a population-based survey (n = 2001) examining the prevalence of the use of medical services for which people pay formally or informally in two regional capitals of different economic status. The purpose of the study was to reveal any differences in the forms of and reasons for payments between the two cities and between socio-economic groups. The results indicate that formal payments were more common in the capital of the wealthier region, Tyumen, while the prevalence of informal payments was higher in the capital of the poorer region, Lipetsk. Around 15% of respondents had made informal payments in the past 3 years. Being a female (OR = 1.57), having a chronic disease (OR = 1.62), being a pensioner (OR = 2.8) and being willing to pay for additional medical information (OR = 2.48) increased the probability of informal payments. The survey demonstrates that in Russia access to and quality of publicly funded health care services may be under serious threat due to the current unclear, non-transparent financial rules. The practice of informal payments exists along with the introduction of formal chargeable government services, which may hamper the government's efforts to enhance equality among health service users.