The impact of informal payments on quality and equality in the Chinese health care system: A study from the perspective of doctors

Abstract

Informal payments are prevalent in the health care systems in the post-communist economies. Some scholars attribute the emergence of the phenomenon to the tension between patients’ rising expectations for quality and the shortages due to government failure, and accuse it of exacerbating inequality in health care. However, existing literature does not identify which part of medical services is affected by poor quality. Drawing on evidence from interviews with Chinese doctors, this research shows that the informal payment system has only limited impact on the technical core of medical procedures but can considerably improve the quality of the peripheral components of medical practice. It further argues that the influence of informal payments on inequality is also limited because evidence indicates that Chinese doctors maintain their professionalism.

Keywords:

• red packet
• informal payment
• quality
• inequality
• ‘inxit’
• China