Table 2.

Types of informal patient payments for publicly financed health care

Forms of informal patient payments	Description
Under-the-table (cash or in-kind) payments to health care professionals	These payments are unofficial in their nature. They might be paid before or after the provision of services. The former are often considered a bribe to obtain better care, while the latter might be seen as an expression of gratitude, especially if they are in kind and of small value.
Goods and materials bought and brought to health care facility	These are goods (e.g., medicines) that are brought to health care facilities, often hospitals, by patients or their families, although they should be supplied by the health care facilities.
Cash payments to cover non-medical costs during health care utilization	These are usually official payments imposed by health care facilities (e.g., hospitals) for electricity, disinfectant liquid, etc., although these costs should be covered by the health care facilities.
Payments for “non-standard” health care services	These are official payments determined by providers, usually hospitals (e.g., for family childbirth, anaesthesia on request, individual nursing/midwife care) for (supposedly) better or extra services than the guaranteed ones, when in fact these services should be provided free of charge, or extra billing/balance billing for services/costs not covered is not allowed in the publicly financed system.
Donations by patients or their families	These are brick payments or donations to foundations established by health care facilities. Even if they are operating within a legal framework, they are considered informal payments if they can be linked to a particular episode of care. Also, they are not always fully voluntary as they might be hinted or requested by health care providers.
Overpayments on top of formal fees	These payments are often made unknowingly by patients, either because they do not know the exact amount of formal fees or are unaware of exemptions from formal payments. It is also possible that patients are aware that they pay more than is required, e.g., they do not ask for the change.
Payments for publicly financed health care when a patient mistakenly believes that the services are provided in the private sector	These payments might occur when health care facilities provide both public and private services, and the boundaries between the two are blurred. Health care providers may charge both the patient (privately) and the public payer (e.g., health insurance) for the same service.
Payments in private practices for faster access to/better quality of public health care	These payments might appear in countries where dual physician practice is allowed, and the private sector is used as a gate to (faster) access publicly financed health care and obtain better quality care in the public system. Hence, they are considered informal payments even if they are official and reported to the tax authorities.