Gaal Peter, Belli Paolo Carlo, McKee Martin, Szócska Miklós
Semmelweis University.
J Health Polit Policy Law. 2006 Apr;31(2):251-93. doi: 10.1215/03616878-31-2-251.
There is increasing interest in the issue of informal payments for health care in low- and middle-income countries. Emerging evidence suggests that the phenomenon is both diverse, including many variants from cash payments to in-kind contributions and from gift giving to informal charging, and widespread, reported from countries in at least three continents. However, cross-national research is hampered by the lack of consensus among researchers on the definition of informal payments, and the definitions that have been proposed are unable to incorporate all forms of the phenomenon that have been described so far. This article aims to overcome this limitation by proposing a new definition based on the concept of entitlement for services. First, the various forms of informal payment observed in practice are reviewed briefly. Then, some of the proposed definitions are discussed, pointing out that none of the distinctive characteristics implied by these definitions, including illegality, informality, and corruption, is adequate to capture all varieties of the phenomenon. Next, an alternative definition is formulated, which identifies the distinctive feature common to all forms of informal payments as something that is contributed in addition to the terms of entitlement. Then, the boundaries implied by this definition are explored and, finally, the implications for research and policy making are discussed with reference to the lessons developed countries can learn from the experiences of transitional countries.
低收入和中等收入国家医疗保健领域的非正规付费问题日益受到关注。新出现的证据表明，这一现象既多样（包括从现金支付到实物捐赠、从送礼到非正规收费等多种形式），又广泛存在，至少在三大洲的国家都有相关报道。然而，跨国研究受到阻碍，因为研究人员对非正规付费的定义缺乏共识，而且已提出的定义无法涵盖迄今所描述的该现象的所有形式。本文旨在通过基于服务应享权利概念提出一个新定义来克服这一局限。首先，简要回顾在实践中观察到的各种非正规付费形式。然后，讨论一些已提出的定义，指出这些定义所隐含的独特特征（包括非法性、非正规性和腐败）都不足以涵盖该现象的所有变体。接下来，制定一个替代定义，将所有形式的非正规付费的共同独特特征确定为应享权利条款之外所提供的东西。然后，探讨这一定义所隐含的界限，最后，参照发达国家可以从转型国家的经验中学到的教训，讨论对研究和政策制定的影响。
