Informal Payments and Health System Governance in Serbia: A Pilot Study

Abstract

Few studies address Serbian providers’ perceptions of informal payments and the association between these perceptions and health system governance. The aim was to investigate civil servants’ perceptions on informal payments of the health care system in Serbia and to link these results with available evidence on informal payments in other Western Balkan countries. A literature review on informal payments in Western Balkan and in-depth interviews of civil servants working with Serbian health care were conducted. Informal payments were mostly taking place in inpatient care and were based on low salaries of doctors, poor resources, a desire to receive better or faster service, fear of being denied treatment, and an expression of gratitude through gifts. Policy measures had limited effect and vulnerable groups were more likely to pay informally. There is a need for further research to highlight how health system governance and prevailing policies affect informal payments in Western Balkan.