Informal payments in government health facilities in Albania: results of a qualitative study.

As governments seek to expand access to quality health care services, policy makers in many countries are confronting the problem of informal payments to medical personnel. The aim of this study was to help health planners in Albania understand informal payments occurring in government health facilities. Researchers used in-depth interviews and focus groups with 131 general public and provider informants in three districts. The results suggest that factors promoting informal payments in Albania include perceived low salaries of health staff; a belief that good health is worth any price; the desire to get better service; the fear of being denied treatment; and the tradition of giving a gift to express gratitude. Members of the general public also believe informal payments create uncertainties and anxiety during the care-seeking process, while providers perceive that informal payments harm their professional reputation, induce unnecessary medical interventions, and create discontinuity of care. The study showed that focusing on the most harmful effects and targeting the most vulnerable populations may be one way to gain consensus for policy reform. Understanding citizens' and caregivers' viewpoints is an important step in designing regulatory and bureaucratic interventions.