Policy-makers of almost all of the CE/EECCA countries are confronted
with informal payments for health care. The phenomenon is the legacy of
the pre-transition health system, in which it was well-known that patients
made payments to doctors for health services that should have officially been
exempt from user charges (Ádám 1985; Feeley, Sheiman and Shishkin 1999;
Wlodarczyk and Zajac 2002). With a few notable exceptions, such as the GDR
and possibly Slovenia, there is evidence that informal payments to medical
personnel were widespread during the communist period (Ádám 1989a;
Masopust 1989; Marrée and Groenewegen 1997; Gaál, Evetovits and McKee
2006). Nonetheless, the issue only attracted significant international interest
after the end of the communist era, when in many countries informal payments
became more pervasive and took forms other than cash payments to health
workers (Delcheva, Balabanova and McKee 1997; Ensor and Savelyeva 1998;
Thompson and Witter 2000; Ensor and Witter 2001; Lewis 2002; Ensor 2004;
Falkingham 2004). It is perhaps for this reason that informal payments are
often regarded as a special phenomenon of the transition period (Lewis 2000),
although the evidence suggests that they are not exclusively the product of the
political, social and economic changes of the region