News Release

From Health Affairs: Trends in informal patient-to-provider payments in European Union countries

Peer-Reviewed Publication

Health Affairs

Corruption is a major challenge in health care systems across the European Union (EU), where it manifests most visibly as informal payments from patients to providers. In what is believed to be the first study to examine trends in informal payments across the twenty-eight EU states between 2013 and 2019 in relation to changes in public health care expenditure, Giulia Dallera and coauthors from Imperial College London analyzed representative data from Eurobarometer surveys, which included survey responses from more than 80,000 EU citizens. They found that the prevalence of informal payments in EU health care systems increased during those years, but perception of corruption decreased, with significant differences between countries. They also found that higher public health care expenditure was associated with fewer informal payments; however, this relationship became less clear throughout the study period. The authors conclude that their findings can inform further research to investigate drivers of informal payments at the health systems level and to understand the directionality of the relationship between informal payments and public health care expenditure. Their findings also point toward the need to couple public health care investments across EU member states with measures to strengthen health systems to effectively confront corruption.


Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.orgHealth Affairs Today, and Health Affairs Sunday Update.

Health Affairs podcasts go beyond the journal’s pages to bring you insightful discussions on the latest news and research affecting health policy. On our flagship podcast, A Health Podyssey, Editor-In-Chief Alan Weil interviews the leading researchers and influencers shaping the field’s big ideas. Join Health Affairs editors on Health Affairs This Week as they discuss the week’s most pressing health policy news. All in 15 minutes or less.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.

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