Аңдатпа
Background It is believed that informal payments for medical services contribute to health worker motivation and retention. Our study aims to assess whether informal payments are associated with patient’s satisfaction with hospital care. Methods We conducted a cross-sectional study among adult population in Almaty region, Kazakhstan Face-to-face interviews were used to collect data. 680 respondents who received hospital care in past 12 months were asked about informal payment, buying medicines for hospital treatment, physician’s attitude to patients, quality of his/her work and general satisfaction with hospital care. Results Around 23% of respondents made informal payments to health workers during the last hospital stay. Informal payments were less prevalent among rural respondents than urban ones (18.4% and 28.9% respectively, р=0,001); and among persons aged 40-59 years as compared to other respondents (p < 0.05). Gender, education and socio-economic status were not associated with informal payments The patients who gave informal payment to health workers during a hospital stay were less likely to report that health workers treated them friendly (68.1% vs 83.3%, p < 0.001), respected their personal interests (45.3% vs 64.3%, p < 0.001), provided recommendations on health behavior and disease prevention (61.2% vs 83.7%, p < 0.001) The patients who gave informal payments were less satisfied with the received hospital care (69.8% vs 92.5%, p < 0.001) in general The only aspect of hospital care that was assessed better by informal payers was provision of medicines: 41.2% of those who gave and 23.6% of those who didn’t give informal payments didn't buy medicine in hospitals (р=0.015). Conclusions The patients making informal payments estimated almost all aspects of the hospital care worse than other patients. Key message: To improve the patient satisfaction with medical care it is necessary to use patient-oriented approach: respecting people’s values and taking into account people’s preferences and expressed needs