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• W2244369749 abstract "Background: Informal payments for health services are common in many transition and developing countries. Informal payments are often claimed to reduce the access to health services, but the impact on the quality of care is more ambiguous. Objective: The objective of the study is to investigate the nature of informal payments in the health sector in Tanzania and to generate hypotheses on the mechanisms through which these payments are affecting the quality of care. Method: We held eight focus groups with health workers both in rural and urban settings and from different levels of care. Focus groups were set up in order to facilitate learning about the interactions among health workers and how informal payments may affect their pattern of behaviour. The empirical evidence is used to motivate a theoretical model where the level of quality of care emerges as an equilibrium in a game between patients and health providers. Results: We found that patients are making informal payments in order to buy higher quality services, including shorter waiting times. At the same time, health workers are involved in rent seeking activities, such as creating artificial shortages, in order to extract extra payments from the patients. Gifts of appreciation are also common, but the distinction between gifts and bribes is often blurred as apparent gifts may be intended to buy better services in the future. Health workers may share the payments received, but only partially, and more rarely within cadre than across cadres. Many health workers think that the distribution of received payments is grossly unfair. Discussion: Limited sharing of payments may contribute to higher quality of care as it creates competition among health workers about being the ones who receive the payments. On the other hand, due to elements of joint production, the lower cadre workers may reduce the quality of care towards patients that they think have paid to the doctor, because they want to bargain a higher share of what the doctor has received. Moreover, the unfair allocation of payments may create frustrations that eventually lead to low quality care. Interestingly, the presence of corruption may induce even non-corrupt workers to reduce their quality of care, because high quality care works as a signal that informal bribes have been made." @default.
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• W2244369749 date "2007-06-01" @default.
• W2244369749 modified "2023-09-26" @default.
• W2244369749 title "Informal Payments and the Quality of Health Care in Tanzania: Results from Qualitative Research" @default.
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