Open Access Open Badges Research article

Exploring consumers’ attitudes towards informal patient payments using the combined method of cluster and multinomial regression analysis - the case of Hungary

Petra Baji123*, Milena Pavlova3, László Gulácsi12 and Wim Groot34

Author Affiliations

1 Health Economics and Health Technology Assessment Research Centre, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary

2 Center for Public Affairs Studies Foundation, Budapest, Hungary

3 Department of Health Services Research; CAPHRI; Maastricht University Medical Center; Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT Maastricht., P.O. Box 616, Maastricht, MD, 6200, The Netherlands

4 Topinstitute Evidence-Based Education Research (TIER), MaastrichtUniversity, Maastricht, The Netherlands

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BMC Health Services Research 2013, 13:62  doi:10.1186/1472-6963-13-62

Published: 15 February 2013



Previous studies on informal patient payments have mostly focused on the magnitude and determinants of these payments while the attitudes of health care actors towards these payments are less well known. This study aims to reveal the attitudes of Hungarian health care consumers towards informal payments to provide a better understanding of this phenomenon.


For the analysis, we use data from a survey carried out in 2010 in Hungary involving a representative sample of 1037 respondents. We use cluster analysis to identify the main attitude groups related to informal payments based on the respondents’ perception of and behavior related to informal payments. Multinomial logistic regression is applied to examine the differences between these groups in terms of socio-demographic characteristics, as well as past utilization and informal payments paid for health care services.


We identified three main different attitudes towards informal payments: accepting informal payments, doubting about informal payments and opposing informal payments. Those who accept informal payments (mostly young or elderly people, living in the capital) consider these payments as an expression of gratitude and perceive them as inevitable due to the low funding of the health care system. Those who doubt about informal payments (mostly respondents outside the capital, with higher education and higher household income) are not certain whether these payments are inevitable, perceive them as similar to corruption rather than gratitude, and would rather use private services to avoid these payments. We find that the opposition to informal payments (mostly among men from small households and low income households) can be explained by their lower ability and willingness to pay.


A large share of Hungarian health care consumers has a rather positive attitude towards informal payments, perceiving them as “inevitable due to the low funding of the health care system”. From a policy point-of-view, the change of this consumer attitude will be essential to deal with these payments in addition to other policy strategies.

Informal payments; Hungary; Consumer perceptions