Evaluating the prevalence of informal payments for health services in Southeast Europe: an institutional approach

ABSTRACT

The aim of this paper is to explain the prevalence of informal payments for health services in Southeast Europe through the lens of institutional theory as resulting from formal institutional failures which lead to an asymmetry between the laws and regulations (formal institutions) and the unwritten rules (informal institutions), making informal payments acceptable. Reporting on a 2013 Eurobarometer survey of the propensity to make informal payments for health services in Southeast Europe, a strong association is found between the degree to which formal and informal institutions are unaligned and the prevalence of informal payments. The relationship between informal payments and formal institutional imperfections is then explored to identify the structural conditions which lead to this institutional asymmetry, and thus the propensity to make informal payments. The paper concludes by exploring the theoretical and policy implications.

KEYWORDS:

• Informal payments
• Southeast Europe
• health services
• institutional theory
• institutional asymmetry

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Colin C. Williams

Colin C. Williams is Professor of Public Policy in the Management School at the University of Sheffield in the United Kingdom. His research interests are in labour practices, the informal economy and economic development, subjects on which he has published some 20 books and 350 journal articles over the past 25 years.

Adrian V. Horodnic

Dr. Adrian V. Horodnic is an Assistant Professor of Ethics and Health Economics at “Grigore T. Popa” University of Medicine and Pharmacy in Romania. His current research interests include issues related to informal economy and informal payments.