What is it about?

The aim of this paper is to explain the prevalence of informal payments in the health services sector in Southern Europe using the lens of institutional theory. To evaluate whether informal payments prevail due to formal institutional failures which lead to an asymmetry between the laws and regulations (formal institutions) and the unwritten rules (informal institutions), an analysis is undertaken of 2013 Eurobarometer survey data on the propensity to make informal payments by patients in Southern Europe.

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Why is it important?

A strong association is found between the extent to which formal and informal institutions are unaligned, and the prevalence of informal payments, and such payments are found to be more likely when there is a lack of modernisation of governance coupled with a low range and reach of health services provision, lower health outcomes and systems focus on curative rather than preventative health services. The theoretical and policy implications are then explored.


This paper reveals whether patients make informal payments for health services and identifies the determinants of its prevalence

Professor Colin C Williams
University of Sheffield

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This page is a summary of: Informal payments by patients for health services: prevalence and determinants, Service Industries Journal, March 2018, Taylor & Francis, DOI: 10.1080/02642069.2018.1450870.
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