Global Fight Against Informal Payments for Health Services

In a public health system, informal payments represent amounts paid by patients to doctors or other medical staff in exchange for services that should be free by the public nature of the system. These are sometimes expected, suggested more or less explicitly or required by a physician or medical personnel, and in other cases offered by the patient without any request or expectation do so by the physician.The objective is to assess the problem of informal payments in the public health system, to formulate a vision and to offer recommendations to improve the situation of the system in order to reduce the level of informal payments.The reasons are diverse, ranging from economic factors (low salaries of medical staff, which lead them to accept payments from patients) to the social and cultural factors (high number of patients for one doctor and the willingness to take precedence, the mentality and the habits), ethical and legal factors (lack of effective tools for prevention and sanction). Some patients feel compelled to make informal payments, while others say that they do this in gratitude to medical staff