Is it acceptable for a physician to request informal payments for treatment? Lay people’s and health professionals’ views in Togo

Abstract

The people’s views regarding informal payments for healthcare is essential if we are able to develop publicly supported interventions to address this phenomenon. We recruited a convenience sample of 300 lay people and health practitioners in Togo, a developing country experiencing this practice, and asked them how acceptable it would be for a physician to request informal payments for treatment in 36 scenarios. The scenarios were all combinations of three levels of the physician’s income (relatively well-paid, average, or underpaid); two levels of the patient’s wealth (wealthy vs. poor); two levels of the frequency of the practice in the area (common vs. rare); and three levels of the amount of payment requested ($50, $30, or $10). Two contrasting positions were found. A substantial minority of participants rejected the practice of informal payments, irrespective of circumstances. In contrast, a majority of them were of the opinion that when patients were wealthy and physicians were underpaid, this practice was acceptable. Health practitioners more frequently adhered to the ethical position than lay people. Implications for health policy are discussed.

Keywords:

• healthcare
• informal payments
• attitudes
• empirical study
• Togo