Informal Payments by Patients in Central and Eastern Europe during the COVID-19 Pandemic: An Institutional Perspective
Abstract
:1. Introduction
1.1. Acceptability of Corruption
1.2. Trust in Public Authorities
1.3. Perceived Transparency
1.4. Health System Performance
2. Materials and Methods
- Acceptability of Corruption Index—measures the acceptability of corrupt behaviour and records the answers on how ‘acceptable is it for the government to engage in corruption as long as it delivers good results’ (for testing Hypothesis 1) [6];
- Trust Index—a constructed index measuring the trust in public authorities based on patients self-assessed trust level in the national and local government (for testing Hypothesis 2) [6]; and
- Perceived Transparency Index—measures the perceived transparency by patients on how the government handled the COVID-19 pandemic (for testing Hypothesis 3) [6].
- Access and Quality Index—macro-level index constructed by two indicators: (a) access or the extent to which medical services can be accessed by those who need them, and (b) the quality in delivery healthcare services (for testing Hypothesis 4a) [42]; and
- COVID-19 Mortality Index—macro-level index measuring the mortality rate due COVID-19 deaths per 100,000 inhabitants (for testing Hypothesis 4b) [43].
3. Results
3.1. Descriptive Analysis
3.2. Multivariate Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Variable | Variable Type | Mode or Mean | Min, Max |
---|---|---|---|
Socio-demographic control variables | |||
Gender | Dummy | Female (56%) | 0, 1 |
Age | Numeric | 49 years | 18, 105 |
Education | Dummy | Primary, Secondary (67%) | 0, 1 |
Employment status | Categorical | Working full-time (52%) | 1, 7 |
Household income | Categorical | Having enough to buy what needed (45%) | 1, 3 |
Area | Categorical | Large town (36%) | 1, 3 |
Index | |||
Asymmetry Index | Normalized Index 0 to 1 (0 = high asymmetry level—formal-informal institutions; 1 = low asymmetry level − formal-informal institutions). | 0.72 | 0, 1 |
Trust Index | Normalized Index 0 to 1 (0 = low level of trust in public authorities (local and national government); 1 = high level of trust in public authorities (local and national government)). | 0.46 | 0, 1 |
Transparency Index | Normalized Index 0 to 1 (0 = low level of transparency in handling COVID-19 pandemic; 1 = high level of transparency in handling COVID-19 pandemic). | 0.49 | 0, 1 |
Access and Quality Index | Normalized Index 0 to 1 (0 = low health system performance in terms of access to and quality of public healthcare services; 1 = high health system performance in terms of access to and quality of public healthcare services). Access = extent to which medical services can be accessed by those who need them. Quality = quality in delivery healthcare services. | 0.54 | 0, 1 |
COVID-19 Mortality Index | Normalized Index 0 to 1 (0 = high COVID-19 mortality rate (COVID-19 deaths/100,000 inhabitants); 1 = low COVID-19 mortality rate (COVID-19 deaths/100,000 inhabitants). | 0.48 | 0, 1 |
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Region | Informal Payments | Informal Payments: | ||
---|---|---|---|---|
Once or Twice | A Few Times | Often | ||
Central and Eastern Europe | 12 | 56 | 29 | 15 |
Nordic Nations | 1 | 57 | 23 | 20 |
Southern Europe | 4 | 55 | 27 | 18 |
Western Europe | 3 | 66 | 23 | 11 |
EU-27 | 6 | 57 | 28 | 15 |
Country | Informal Payments | Informal Payments: | ||
---|---|---|---|---|
Once or Twice | A Few Times | Often | ||
Romania | 22 | 37 | 37 | 26 |
Bulgaria | 19 | 52 | 34 | 14 |
Hungary | 19 | 58 | 19 | 23 |
Lithuania | 19 | 57 | 37 | 6 |
Croatia | 15 | 56 | 20 | 24 |
Czechia | 10 | 69 | 26 | 5 |
Latvia | 10 | 48 | 33 | 19 |
Poland | 10 | 59 | 34 | 7 |
Slovakia | 10 | 66 | 28 | 6 |
Slovenia | 5 | 84 | 12 | 4 |
Estonia | 2 | 65 | 24 | 11 |
Central and Eastern Europe | 12 | 56 | 29 | 15 |
Index | Informal Payments | |
---|---|---|
Yes | No | |
Acceptability of Corruption Index | 0.67 | 0.72 |
Trust Index (Trust in public authorities) | 0.38 | 0.47 |
Transparency Index (In handling COVID-19 pandemic) | 0.37 | 0.50 |
Health system performance | ||
Access and Quality Index (For public healthcare services) | 0.52 | 0.54 |
COVID-19 Mortality Index (COVID-19 deaths/100,000 inhabitants) | 0.42 | 0.48 |
Model 1 | Model 2 | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Fixed Part | Coef. | SE | OR | (OR, 95% CI) | Coef. | SE | OR | (OR, 95% CI) | ||
Socio-demographic control variables | ||||||||||
Gender (R: Male) | ||||||||||
Female | 0.022 | 0.082 | 1.022 | (0.870–1.200) | 0.034 | 0.083 | 1.035 | (0.880–1.217) | ||
Age | −0.011 | *** | 0.004 | 0.989 | (0.982–0.996) | −0.009 | ** | 0.004 | 0.991 | (0.984–0.998) |
Education (R: Primary, Secondary) | ||||||||||
Tertiary | 0.207 | ** | 0.087 | 1.230 | (1.037–1.458) | 0.251 | *** | 0.088 | 1.285 | (1.082–1.527) |
Employments status (R: Working full-time) | ||||||||||
Working part-time | 0.129 | 0.188 | 1.138 | (0.787–1.647) | 0.170 | 0.189 | 1.185 | (0.819–1.716) | ||
Not working (seeking) | −0.181 | 0.212 | 0.835 | (0.551–1.264) | −0.179 | 0.211 | 0.836 | (0.553–1.265) | ||
Retired | −0.011 | 0.137 | 0.989 | (0.756–1.294) | −0.023 | 0.138 | 0.978 | (0.746–1.281) | ||
Not working (not seeking) | −0.210 | 0.317 | 0.811 | (0.436–1.508) | −0.270 | 0.327 | 0.764 | (0.402–1.449) | ||
Student | −0.125 | 0.232 | 0.883 | (0.561–1.390) | −0.037 | 0.232 | 0.964 | (0.611–1.520) | ||
Homemaker | −0.094 | 0.201 | 0.910 | (0.614–1.349) | −0.060 | 0.202 | 0.942 | (0.633–1.400) | ||
Household income (R: Enough to buy what wanted) | ||||||||||
Enough to buy what needed | 0.021 | 0.106 | 1.021 | (0.830–1.257) | −0.034 | 0.106 | 0.967 | (0.785–1.190) | ||
Facing difficulties | 0.420 | *** | 0.113 | 1.521 | (1.218–1.900) | 0.256 | ** | 0.116 | 1.291 | (1.029–1.621) |
Area (R: Rural area or village) | ||||||||||
Small, middle-sized town | 0.268 | ** | 0.105 | 1.307 | (1.064–1.606) | 0.237 | ** | 0.106 | 1.267 | (1.030–1.560) |
Large town | 0.186 | * | 0.103 | 1.205 | (0.985–1.474) | 0.165 | 0.104 | 1.179 | (0.962–1.445) | |
Tested Hypotheses | ||||||||||
Acceptability Index 1 | −0.270 | *** | 0.090 | 0.764 | (0.641–0.910) | −0.247 | *** | 0.091 | 0.782 | (0.654–0.934) |
Trust Index 2 | −1.492 | *** | 0.174 | 0.225 | (0.160–0.316) | |||||
Constant | −1.605 | *** | 0.201 | −1.010 | *** | 0.210 | ||||
Observations | 10,109 | 10,070 | ||||||||
F | 4.86 | 9.39 | ||||||||
Prob. > F | 0.000 | 0.000 | ||||||||
Model 3 | Model 4 | |||||||||
Fixed Part | Coef. | SE | OR | (OR, 95% CI) | Coef. | SE | OR | (OR, 95% CI) | ||
Socio-demographic control variables | ||||||||||
Gender (R: Male) | ||||||||||
Female | 0.019 | 0.083 | 1.019 | (0.865–1.200) | 0.008 | 0.084 | 1.009 | (0.856–1.190) | ||
Age | −0.008 | ** | 0.004 | 0.992 | (0.985–0.999) | −0.007 | ** | 0.004 | 0.993 | (0.986–1.000) |
Education (R: Primary, Secondary) | ||||||||||
Tertiary | 0.237 | *** | 0.089 | 1.267 | (1.064–1.509) | 0.276 | *** | 0.090 | 1.318 | (1.105–1.571) |
Employments status (R: Working full-time) | ||||||||||
Working part-time | 0.136 | 0.191 | 1.146 | (0.788–1.666) | 0.183 | 0.194 | 1.201 | (0.820–1.758) | ||
Not working (seeking) | −0.116 | 0.211 | 0.890 | (0.589–1.346) | −0.133 | 0.212 | 0.876 | (0.577–1.328) | ||
Retired | −0.022 | 0.140 | 0.978 | (0.744–1.287) | −0.060 | 0.140 | 0.941 | (0.715–1.239) | ||
Not working (not seeking) | −0.352 | 0.340 | 0.704 | (0.362–1.369) | −0.315 | 0.339 | 0.729 | (0.375–1.419) | ||
Student | −0.041 | 0.231 | 0.960 | (0.611–1.508) | 0.018 | 0.228 | 1.018 | (0.651–1.593) | ||
Homemaker | −0.124 | 0.211 | 0.883 | (0.584–1.336) | −0.138 | 0.209 | 0.871 | (0.579–1.312) | ||
Household income (R: Enough to buy what wanted) | ||||||||||
Enough to buy what needed | −0.047 | 0.107 | 0.954 | (0.773–1.177) | −0.034 | 0.108 | 0.966 | (0.782–1.193) | ||
Facing difficulties | 0.267 | ** | 0.117 | 1.306 | (1.039–1.641) | 0.209 | * | 0.118 | 1.233 | (0.979–1.553) |
Area (R: Rural area or village) | ||||||||||
Small, middle-sized town | 0.204 | * | 0.107 | 1.226 | (0.994–1.513) | 0.121 | 0.110 | 1.129 | (0.910–1.401) | |
Large town | 0.138 | 0.105 | 1.148 | (0.934–1.410) | 0.066 | 0.107 | 1.068 | (0.866–1.317) | ||
Tested Hypotheses | ||||||||||
Acceptability Index 1 | −0.284 | *** | 0.093 | 0.752 | (0.628–0.902) | −0.323 | *** | 0.093 | 0.724 | (0.603–0.869) |
Trust Index 2 | −1.235 | *** | 0.195 | 0.291 | (0.198–0.426) | −1.027 | *** | 0.196 | 0.358 | (0.244–0.526) |
Transparency Index 3 | −0.403 | *** | 0.104 | 0.668 | (0.545–0.819) | −0.419 | *** | 0.106 | 0.657 | (0.534–0.809) |
Health system Performance | ||||||||||
Access and Quality Index 4 | −1.437 | *** | 0.195 | 0.238 | (0.162–0.349) | |||||
COVID-19 Mortality Index 5 | −1.823 | *** | 0.211 | 0.161 | (0.107–0.244) | |||||
Constant | −0.923 | *** | 0.213 | 0.637 | ** | 0.279 | ||||
Observations | 9794 | 9794 | ||||||||
F | 9.34 | 14.66 | ||||||||
Prob. > F | 0.000 | 0.000 |
Logistic Regression | Probit Regression with Sample Selection | |||||
---|---|---|---|---|---|---|
With Weighting Scheme | Without Weighting Scheme | Without Weighting Scheme | Imputed Missing Data | With Weighting Scheme | Without Weighting Scheme | |
Socio-demographic control variables | Yes | Yes | Yes | Yes | Yes | Yes |
Tested Hypotheses | ||||||
Acceptability Index 1 | −0.323 *** (0.093) | −0.451 *** (0.068) | −0.451 *** (0.059) | −0.319 *** (0.093) | −0.177 *** (0.050) | −0.250 *** (0.038) |
Trust Index 2 | −1.027 *** (0.196) | −1.143 *** (0.140) | −1.143 *** (0.105) | −1.034 *** (0.187) | −0.557 *** (0.105) | −0.622 *** (0.076) |
Transparency Index (COVID-19) 3 | −0.419 *** (0.106) | −0.192 *** (0.073) | −0.192 ** (0.080) | −0.392 *** (0.102) | −0.219 *** (0.056) | −0.103 *** (0.039) |
Health System Performance | ||||||
Access and Quality Index 4 | −1.437 *** (0.195) | −1.555 *** (0.162) | −1.555 *** (0.499) | −1.390 *** (0.191) | −0.789 *** (0.108) | −0.855 *** (0.089) |
COVID-19 Mortality Index 5 | −1.823 *** (0.211) | −1.551 *** (0.158) | −1.551 ** (0.619) | −1.736 *** (0.201) | −0.997 *** (0.113) | −0.868 *** (0.087) |
Clustered by country (11) | Yes | |||||
Selection equation 6 | Yes | Yes | ||||
Observations | 9794 | 9794 | 9794 | 10,859 | 16,866 | 16,866 |
Censored | 7072 | |||||
Uncensored | 9794 | |||||
Imputations (multivariate) | Yes | |||||
Prob. > F/chi2 | 0.000 | 0.000 | 0.000 | 0.000 | 0.000 | 0.000 |
Hypothesis | Result |
---|---|
H1: During a pandemic, informal payments are more likely to occur with higher acceptability of corruption. | Confirmed |
H2: During a pandemic, informal payments are more likely to occur when patients display low trust in authorities. | Confirmed |
H3: During a pandemic, informal payments are more likely to occur when the transparency of how the pandemic is handled is perceived as low by the patients | Confirmed |
H4: During a pandemic, informal payments are more likely to occur when the health system performance is poor. | |
H4a: Informal payments are more likely to occur when the access and quality of public healthcare services are poorer. | Confirmed |
H4b: Informal payments are more likely to occur when the pandemic mortality rate is higher. | Confirmed |
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Horodnic, A.V.; Williams, C.C.; Drugă, R.I.; Incaltarau, C. Informal Payments by Patients in Central and Eastern Europe during the COVID-19 Pandemic: An Institutional Perspective. Int. J. Environ. Res. Public Health 2021, 18, 10914. https://doi.org/10.3390/ijerph182010914
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. https://doi.org/10.3390/ijerph182010914
Chicago/Turabian StyleHorodnic, Adrian V., Colin C. Williams, Răzvan Ionuț Drugă, and Cristian Incaltarau. 2021. "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 18, no. 20: 10914. https://doi.org/10.3390/ijerph182010914
APA StyleHorodnic, A. V., Williams, C. C., Drugă, R. I., & Incaltarau, C. (2021). 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, 18(20), 10914. https://doi.org/10.3390/ijerph182010914