Riklikiene Olga, Jarasiunaite Gabija, Starkiene Liudvika
Department of Nursing and Care, Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania
Department of Theoretical Psychology, Faculty of Social Sciences, Vytautas Magnus University, Kaunas, Lithuania.
Scand J Public Health. 2014 Aug;42(6):488-96. doi: 10.1177/1403494814538125. Epub 2014 Jun 6.
Since the late 1990s Lithuania has had a mixed, solidary based healthcare system, predominantly funded from the National Health Insurance Fund through a compulsory health insurance scheme. The cultural tradition of informal payments in healthcare in Lithuania was inherited from the Soviet past and is still alive.
This study reveals the extent and nature of informal patient payments, and identifies the motivation behind those payments occurring in publicly financed healthcare facilities in Lithuania.
The quantitative household survey design was chosen for this study. The randomly selected sample was comprised of inhabitants aged 18 years and older, representing the entire population of Lithuania by county, place of residence (urban and rural), age and sex. The study sample consisted of 1067 participants interviewed in 2009 and 2010, and 1068 in 2011 (response rate ranged from 66.6% to 68.2%).
Users of healthcare services usually made informal payments for the visit to, and consultation with, a general practitioner or physician specialist and for diagnostic services. Females and older citizens, the disabled, public/private sector employees, retirees, those with higher education and those in the highest household monthly income group were more prone to pay informally for health services. The majority of respondents were against formalization of informal patient payment.
National health insurance payments for healthcare services from the formal public fund for healthcare are further augmented by informal payments from service consumers, used routinely for better access to and higher quality of healthcare service.
自20世纪90年代末以来，立陶宛拥有一个混合的、基于团结的医疗保健系统，主要通过强制性医疗保险计划由国家健康保险基金提供资金。立陶宛医疗保健领域非正式支付的文化传统继承自苏联时期，至今仍然存在。
本研究揭示了非正式患者支付的程度和性质，并确定了立陶宛公共资助医疗设施中此类支付背后的动机。
本研究选择了定量家庭调查设计。随机抽取的样本由18岁及以上的居民组成，按县、居住地点（城市和农村）、年龄和性别代表立陶宛的全体人口。研究样本包括2009年和2010年接受访谈的1067名参与者，以及2011年的1068名参与者（回复率在66.6%至68.2%之间）。
医疗服务使用者通常会为看全科医生或专科医生以及进行诊断服务进行非正式支付。女性、老年公民、残疾人、公共/私营部门雇员、退休人员、受过高等教育的人和家庭月收入最高的群体更倾向于为医疗服务进行非正式支付。大多数受访者反对将非正式患者支付正规化。
医疗服务消费者的非正式支付进一步增加了从正式的公共医疗基金中支付的国家医疗保险费用，这些支付通常用于更好地获得医疗服务和提高医疗服务质量。
