Evaluating the prevalence of informal payments for health services in Southeast Europe: an institutional approach

The aim of this paper is to explain the prevalence of informal payments for health services in Southeast Europe through the lens of institutional theory as resulting from formal institutional failures which lead to an asymmetry between the laws and regulations (formal institutions) and the unwritten rules (informal institutions), making informal payments acceptable. Reporting on a 2013 Eurobarometer survey of the propensity to make informal payments for health services in Southeast Europe, a strong association is found between the degree to which formal and informal institutions are unaligned and the prevalence of informal payments. The relationship between informal payments and formal institutional imperfections is then explored to identify the structural conditions which lead to this institutional asymmetry, and thus the propensity to make informal payments. The paper concludes by exploring the theoretical and policy implications.