Consumption and expenditures on out‐patient services
Q.1	During the preceding 12 months, how many times did YOU PERSONALLY visit a physician or a physician visited you personally at your home, including any physician in both the public and private system? (Homeopaths and traditional healers who are not physicians, and also dentists are excluded.)
Q.2	Considering all types of official and informal cash payments, and in‐kind gifts, how much IN TOTAL did you spend (out‐of‐pocket) on these visits EXCLUDING payments for travelling, transportation by ambulance and pharmaceuticals?
Q.3	How much of this amount approximately was for INFORMAL cash payments and in‐kind gifts?
	Consumption and expenditures on in‐patient services
Q.4	During the preceding 12 months, how many times were YOU hospitalized (placed in a hospital), including day surgeries or day treatments? (Re‐hospitalization, i.e. repeated hospitalization for the same health problem, should be counted separately as a different hospitalization.)
Q.5	Considering all types of official and informal cash payments, and in‐kind gifts, how much IN TOTAL did you spend (out‐of‐pocket) on these hospitalizations EXCLUDING payments for travelling, transportation by ambulance and pharmaceuticals?
Q.6	How much of this amount approximately was for INFORMAL cash payments and in‐kind gifts?
	Experience of ever giving informal patient payments in cash or in‐kind gifts
Q.7	Have you ever personally paid INFORMALLY IN CASH to physicians, medical staff or other personnel in health care facilities?
Q.8	Have you ever personally given any GIFT IN KIND to physicians, medical staff or other personnel in health care facilities?
	Perceived behavioural statements related to informal patient payments
	Do the following statements apply to YOU PERSONALLY?
Q.9	I will feel UNCOMFORTABLE if I leave the physician's office without a gratitude cash payment or gift in kind.
Q.10	I would RECOGNISE the hint of physicians or medical staff for an informal cash payment or a gift in kind.
Q.11	I will REFUSE to pay if a physician or medical staff ask me to pay informally for a medical service.
Q.12	I will PREFER to use private medical services if I have to pay informally for public medical services.
Q.13	If I have SERIOUS PROBLEMS with my health, I will be ready to pay as much as I have in order to get better medical services.