Informal Payments in Health Systems: Purpose and Occurrences in Turkey

Tengilimoglu D., GÜZEL A., Toygar A., Akinci F., Dziegielewski S. F.

JOURNAL OF SOCIAL SERVICE RESEARCH, vol.41, no.5, pp.684-696, 2015 (SSCI) identifier identifier


Informal payments constitute a significant portion of out-of-pocket payments in health systems, especially in developing countries. This study examined the current status of informal payments in Turkey and the opinions, attitudes, and behavior of individuals toward informal payments. To examine this concept, 1,033 residents in Ankara, the capital city of Turkey, were surveyed. The 28-item questionnaire used in data collection was developed based on previous research and expert opinions. The data analysis revealed that approximately 29% of the study participants made informal payments in return for the medical service they received. Three out of 4 people who made informal payments were from a low-income group. Informal payments were made in the form of cash prior to medical procedures and also as gifts following the procedures. Future recommendations for health policymakers include designing a new patient copay mechanism where informal payments can be effectively incorporated into the formal payment system, assistance to low-income individuals, and improvement in current medical staff salaries that would discourage taking such payments.