Table . Summary of the Findings .

No/Ref	Country	Sample Size	Focus and Aim	Setting	Type	Qual.Score	Main Findings	Described Effects	Perceptions on Interventions
(1) Arsenijevic et al, 2015	SER	17 375	Evidence on bought and brought goods, formal and informal patient payments in the public healthcare	General pop. single country	Quant	++	Only about 5% of healthcare users report informal patient payments, whereas around 60% report paying bought and brought goods.	Payments for bought and brought goods present the highest share in the annual household consumption per household member. The burden is minor for informal patient payments. Rural residents, poorer and non-married report more payments for bought and brought goods. Young and more educated report more informal patient payments.
(2) Arsenijevic et al, 2014a	SER	45 127	OOP payments for in- and outpatient care by exempted groups	General pop. single country	Quant	+	All population groups report informal patient payments in 2002, 2003, and 2007. OOP payments (formal, informal and bought and brought goods) in exempt groups (elderly, children, unemployed, disabled, poor) are less frequently reported for outpatient care than for inpatient services, except for the year 2007.	Elderly and patients with low income pay more for pharmaceuticals, disposable materials and orthopedic devices brought by patients to the hospital than other population group.
(3) Arsenijevic et al, 2014b	SER	657	Quality and access indicators and patient payments for maternity care in Serbia	Maternity patients, District/municipality	Mix	+ Quant ++ Qual	21% paid informal patient payments for maternity services. Quasi-formal payments (payments organized by the facilities in the absence of government regulations) are charged for standard services that should be provided for free. Recipients of informal patient payments are obstetricians, anesthesiologists, midwives or nurses. Informal patient payments are given to secure obstetricians’ presence during childbirth, better quality of care, and the timely application of epidural analgesia. The highest amount of reported informal patient payment is 500 Euro.	Almost 90% of bribers continue to experience inconveniences during stay in hospital. Some did not report bribes but indicated having special connections to ensure better treatment and care. Women with connections report fewer inconveniences than those who have paid informally.
(4) Avdyli, 2010	KOS	39	Perception of how informal patient payments affect the quality of and access to healthcare	Patient and providers, District/municip.	Qual	+	Informal patient payments are accepted due to poor healthcare system governance. They are necessary to receive care or better quality care or are given in gratitude or to maintain a positive relationship. Some providers do not receive informal patient payments for fear of getting caught, for ethical reasons or because they choose to work in public and private clinics to earn more money.	Informal patient payments are used to support further education of doctors, increase living standards, increase professional growth, maintain a professional level of care, act as counter-favors between doctor and patient, and increase happiness among the staff.	Providers suggest a performance-based system of payments or legalization of informal patient payments
(5) Bredenkamp, 2011	ALB BH KOS MON SER	49 848	The effects of health-related expenditures on household welfare	General pop. multiple country	Quant	+	Informal patient payments are substantial in all countries, but particularly high in Albania. They represent a large share of total health expenditure, often among the poor. In Albania, the poorest households pay higher health expenditures in informal patient payments than the richer quintiles. In Serbia, the rich pay a slightly greater share of health expenditure in informal patient payments than poorer. In Kosovo, expenditure shares are almost the same across quintiles.
(6) Budak and Rajh, 2012	CRO	3005	Underreporting of corruption	General pop. single country	Quant	+	92% of the 14% within the study population with corruption experiences claimed gifts to providers, mostly voluntary. Few reported corruption experiences formally as they gained benefits from the bribe, believed nothing useful would come from reporting, or had given a gratitude gift. People reporting corruption was perceived as likely to regret it.
(7) Vian and Burak, 2006	ALB	222	Intentions, past behaviours, attitudes and beliefs about informal patient payments in government health facilities	General pop. Cities/towns	Quant	++	No significant demographic difference was found among people intending to make informal patient payment vs. those that did not. Intenders were more positive in attitude and consequences of informal patient payments than non-intenders. The practice was believed unethical and illegal but did not influence people’s intention. Informal patient payments were beneficial and were necessary to obtain quicker and better care or medical attention. Intenders are more likely to believe they will get faster and better quality care than non-intenders, but they also believe that they must pay to receive any care at all.	People not intending to pay informally more often report having connections with medical personnel.
(8) Vian et al, 2006	ALB	131	Help health planners to understand informal patient payments in government health facilities	General pop. and providers, Districts/municipalities	Qual	+	Factors promoting informal patient payments are perceived low salaries of health staff, a belief that good health is worth any price, to obtain care or better service, security or fear of being denied treatment, lack of social connections, and the custom of gratitude gifts. For one person, payments for healthcare are reported up to 50 000 Albanian LEK (approx. 380 Euro) per transaction.	Informal patient payments create uncertainties and anxiety during the care-seeking process, harm providers’ professional reputation, induce unnecessary medical interventions, and create discontinuity of care or better patient-provider relationships.
(9) Colombini et al, 2012	ALB MAC	58	Access of Romani in S-E Europe to sexual and reproductive health services	Roma people, Cities/towns	Qual	++	Romani’s report paying up to 11 000 FYR Macedonian MKD (approx. 177 Euro) per transaction for one person, while also paying for care despite having health insurance.
(10) Tomini and Maarse, 2011	ALB	17 302	How patients’ characteristics influence informal patient payments for in- and outpatient care	General pop. single country	Quant	+	Informal patient payments for healthcare services are widespread in in- and outpatient care and are dependent on certain characteristics of patients, including age, area of residence, education, health status, and health insurance. These payments are less dependent on income. Payments are higher in inpatient care than in outpatient care. Patients paid either voluntarily or because they were requested to.	Patients with chronic illnesses, the lower educated, or rural residents were more likely requested to pay informally to medical staff.
(11) EBRD, 2011	ALB BH CRO KOS MAC MON SER	Not clear	How transition is affecting the lives of people in CEE, SEE, the Baltics, CIS and Mongolia	General pop. multiple country	Quant	++	Informal patient payments to public health officials were made mostly because they were asked to or it was necessary. To a lesser extent, gratitude gifts to doctors were given. The highest reported incidents of informal patient payments were reported in Albania with 39% of respondents reporting making such payments.	Lacking drugs in healthcare reduces the satisfaction in services. The likelihood that patients are asked to or voluntarily bring pharmaceuticals increases.
(12) UNDOC, 2011	ALB BH, CRO KOS MAC MON SER	28 066 people	Gain knowledge about and learn from people’s experiences with corruption in the Western Balkans	General pop. multiple country	Quant	++	On average, one in six citizens of the region experiences bribery with a public official annually, and 12% of citizens pay at least one bribe. Corruption in the general public sector is mostly in rural areas and cash payments account for two-thirds of all bribes. The average bribe across the region is 257 EUR and as high as 1000 Euro. Bribes are paid in response to a direct or indirect request, offered voluntarily, or to receive better treatment at the doctor.	The average number of bribes paid is higher among lower income groups than wealthier citizens. No social group is exempt from bribery.
(13) Grødeland, 2013	SER KOS MAC	1900	Public perception of corruption, types of corruption, institutions responsible for anti-corruption reform and anti-corruption efforts	General pop. multiple country	Mix	+ Quan ++ Qual	Small gifts or amounts of cash are reported. Payments were perceived as corruption, due to socialism or transition, to be necessary or a custom (gratitude), to get access or quicker access to healthcare services, for physical comfort, or to supplement salary of providers. Respondents were asked or volunteered to bring or buy goods for healthcare services supposed to be provided for free. Informal patient payments were max. 50 EUR but bought and brought goods were more than 1000 EUR per transaction for one person.	Informal patient payments were avoided in informal networks (People who are able and willing to help each other, providing information access to other people or assistance) between doctors and patients and payments were typically in vulnerable groups.	Study participants suggest to change mentality; use organized religion to indicate morality and reduce informal patient payments; prosecuting and sentencing corrupt politicians, government officials and others engaging in corruption; strengthen powers of institutions fighting corruption; and introducing new anti-corruption legislation. Measures would be successful with political will, stricter laws and law enforcement, higher living standards or use of force.
(14) Hotchkiss et al, 2005	ALB	2000 HH	Understand the magnitude and distribution of OOP payments and identify factors why and how much people pay	General pop. Cities/towns and districts/municipalities	Quant	++	45% of those requiring hospitalization reported extra fees for provider services and 61% report making gift payments. 44% of those using outpatient services for acute health problems reported paying (unofficial) consultation fees and 25% providing gifts. Gifts were mostly voluntary.	Cost of services was a reason for not using healthcare. Of patients with acute health problems, the poor were more likely to pay for consultations, but were less likely to make gift payments than better off clients. Clients of polyclinics and hospitals paid OOP payments more frequently than clients of PHCs and ambulances. Rural residents paid more frequently for consultations. Socio-economic status did not affect paying informally.
(15) Janevic et al, 2011	MAC SER	90	Develop a conceptual framework showing how levels of racism affects access to maternal healthcare in Romani women	Roma women, gynecologists, NGOs and state institutions, cities	Qual	++	Informal patient payments were cited in all focus groups and social connections were believed to give access to better quality service. The ability to make informal patient payments or contribute gifts influenced the quality of service and level of negligent behavior toward Romani women.	The perceived or actual need to pay bribes reduced the likelihood of seeking maternal healthcare.
(16) Krupic et al, 2015	BH	21	How immigrants and refugees experience different institutions and the health system	Refugees, cities/ towns	Qual	++	Informal patient payments were given to receive access to care or to receive better care.
(17) Uka, 2013	KOS	29	Perceptions of informal patient payments	Patients and providers	Qual	+	IP are a result of culture and custom rather than socio-economic conditions. Payments vary by level of healthcare, department, urgency of treatment, and patients’ attitude towards informal patient payments. Seventy percent of patients had offered informal patient payments for themselves or for a family member. Most doctors denied receiving IP. IP was most prevalent in surgery, gynecology and obstetrics. Patients pay to receive better care and subsidized drugs, to skip the queue, for a preferable doctor, and/or to express gratitude.
(18) Radin, 2013	CRO	2300	Assess the relationship between corruption and trust in public healthcare	General pop. single country	Quant	++		Corruption has negative effects on trust in public healthcare in the 2007 survey but not in the 2009 survey. Perceptions of and experience with corruption is negatively correlated with choice of public healthcare facilities, suggesting lower trust in public care providers. Patients are more willing to provide drugs to healthcare when there are shortages of medicine.
(19) RCC, 2015	ALB, BH, CRO, KOS, MAC, MON, SER	7000	Examine public opinion on various topics covered in the five pillars of the SEE 2020 Strategy	General pop. multiple country	Quant	++	Respondents believe that giving or taking bribes is widespread in people working in the public health sector in Croatia (17%), Serbia (38%), Bosnia and Herzegovina (28%), FYROM (23%), Kosovo (13%), Albania (24%) and Montenegro (30%).
(20) Tomini et al, 2013	ALB	10 840 people	Analyse how much OOP health spending impoverishes households	General pop. single country	Quant	+	There is lack of clarity between formal and informal patient payments in Albania. The amount of informal patient payments per capita has increased substantially over the years, from 220 (1,6 Euro) ALL in 2002 to 384 (2,8 Euro) ALL in 2008 on average per transaction for one person.	The amount paid informally by the lowest quintile increased almost five times over the years, while there was a more moderate increase in the higher quintiles over the same period. On average, the poorest households had relatively less budget than the rich but faced higher OOP payments.
(21) Tomini, 2007	ALB	7973 People and 1782 HH	Identify determinants of informal patient payments in healthcare	General pop. single country	Quant	++	There are differences between the determinants of informal patient payments in inpatient and outpatient care. For example there are reasons to believe that if services of inpatient sector are purchased by health insurance we may observe less informal patient payments.	If services of the inpatient sector are purchased by health insurance there may be less informal patient payments (at least for some categories). Other determinants were higher level of incomes, positive health rating, lower level of education, and services offered by public providers.
(22) Tomini et al, 2012a	ALB	7238 HH	Intra-household differences in spending on informal patient payments	General pop. single country	Quant	++	There are no significant differences between household members’ incidence of informal patient payments, but there are more differences in the amount paid informally. Thus, households strategically favor individuals with higher earning potential (human capital).
(23) Tomini et al, 2012b	ALB	7238 HH	Measure the amounts of informal patient payments	General pop. single country	Quant	+	Medical staff has less information on patients’ maximum willingness to pay informally than patients have on medical staff’s minimum expected amount.	Informal patient payments are characterized by rural residents paying lower amounts; household size is negatively related to the amount paid; older individuals pay smaller amounts in inpatient care; patients are either asked or expected to pay informally; higher educated or patients married or living together pay higher amounts informally; and health insurance decreases the amount paid informally.
(24) Tomini and Groot, 2013	ALB	10 839 HH	Explore the demand side of informal patient payments in in- and outpatient care	General pop. single country	Quant	++		Incidents of informal patient payments are highest among rural residents; lower educated patients; those with difficulties paying for healthcare; patients with less information on the amount required, patients with fewer social connections. Having national health insurance lowers the probability of paying informally both for outpatient and inpatient care.

Abbreviations: HH, households; OOP, out-of-pocket; PHC, primary healthcare; NGOs, non-governmental organizations.