Informal Payments in Health Care

Informal payments in health care exist in many countries around the world. However, the prevalence of informal payments varies between countries. A distinction between illegal or unethical informal payments like bribes and corruption, and legal and ethical forms of informal payment like giving gifts is not always easy to make. Illegal and unethical practices include, for example, buying medical certificates, bid rigging during procurements, or selecting service-providers for a hospital based on personal connections. A conceptual global definition of informal payments in health care is not feasible because informality depends on local regulations, values, and traditions. In this chapter, we provide an up-todate understanding of informal payments in health care (including corruption, fraud etc.) by distinguishing micro, meso, and macro levels of informal payments. We argue that informal payments that occur at these levels cannot be unified under one umbrella of corruption because the various forms of informal payments in health care differ in nature, scope, and damaging effects.