The inequity of informal payments for health care: The case of Hungary

As in most countries of Central and Eastern Europe, informal payments have been a characteristic feature of the Hungarian health care system both during and since the demise of Soviet type socialist rule. Although informal payments continue to be so characteristic in the region, little empirical evidence exists on their scope or working. As far as equity is concerned, it has sometimes been suggested that physicians play a ‘Robin Hood’ role and subsidise the poor at the expense of the rich. With the aid of an interview survey of a representative sample of the Hungarian population, we examine the distribution of the burden of informal payments across income groups. Results indicate that informal payments are a highly regressive way of funding health care, with Kakwani progressivity indices of −0.38, −0.39, −0.35 and −0.36 for GP, outpatient specialist, hospital, and total care, respectively. The finding that people with lower income pay proportionally more for public health care through informal payments underlines the emptiness of the ‘Robin Hood’ claims and the need for reform.