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A five-year (2017–2021) time series evaluation of patient-reported informal healthcare payments in Romania - P4H Network

A five-year (2017–2021) time series evaluation of patient-reported informal healthcare payments in Romania

A Journal of Medicine and Life research article on the causes of out of pocket payments towards health services in Romania and its impact on universal health coverage.


Low wages of health professionals are widely recognized as one of the drivers of informal payments in Romania’s healthcare system. In January 2018, the government increased wages by an average of 70% to 172% in the public healthcare sector. This study examined the trends in patient-reported informal healthcare payments, discussing the effect of a one-time wage increase in 2018 and the impact of the COVID-19 pandemic in 2020 and 2021. It draws on monthly survey data of patient-reported informal payments collected between January 2017 and December 2021.
We analyzed three periods: before the wage rise (“low pay”), between the wage rise and the COVID-19 pandemic (“high pay”), and during the COVID-19 pandemic. We found that patient-reported informal payments decreased between the “low pay” and “high pay” period but with a sharper decline during the COVID-19 pandemic. The share of respondents willing to report informal payments increased during the “high pay” period, indicating a stronger willingness to voice dissatisfaction with health services and informal payments, but slowed down during the first lockdown in 2020. Informal payments were more frequently reported in larger hospitals and the poorest geographical areas.
While the 2018 wage increase may have contributed to less prevalent informal payments, survey coverage and design must be improved to draw robust, system-level conclusions to inform tailored policy actions.
KEYWORDS: Romania, patient-reported informal payments, universal health coverage, out-of-pocket payments,
Patient Feedback System.