Rethinking informal payments by patients in Europe: An institutional approach

- In East-Central Europe 9% of patients make informal payments to healthcare professionals.
- Formal institutional imperfections result in higher levels of informal payments by patients.
- The greater the institutional asymmetry, the more prevalent are informal payments.
- Tackling informal payments requires changes in both the formal and informal institutions.

The aim of this paper is to explain informal payments by patients to healthcare professionals for the first time through the lens of institutional theory as arising when there are formal institutional imperfections and asymmetry between norms, values and practices and the codified formal laws and regulations. Reporting a 2013 Eurobarometer survey of the prevalence of informal payments by patients in 28 European countries, a strong association is revealed between the degree to which formal and informal institutions are unaligned and the propensity to make informal payments. The association between informal payments and formal institutional imperfections is then explored to evaluate which structural conditions might reduce this institutional asymmetry, and thus the propensity to make informal payments. The paper concludes by exploring the implications for tackling such informal practices.