Table 4 Drivers of formal and informal payments

Medicine is not covered by insurance

Desire for faster care

The hospital gives some medicines, but [a patient] might need an expensive one the hospital doesn’t have. – Patient FGD 2013

I said ‘I can pay.’ The physician is happy and I am happy. And I did not stay in line. –IDI 2012, insured male

If you want your child to be healthy and get well, you need to pay a lot for medicines. – Patient FGD 2013

I leave some money on the table. If you go downstairs to the payment office, when you come back the doctor is already busy and you have to wait. It is easier to pay him/her directly. –IDI 2012, uninsured male

Sense that inexpensive medicines in public sector must not be good quality, and that “better” medicines are offered in private sector

Fear of poor quality:

How can a drug be good if it costs 10 times less than another medicine? – Provider FGD 2013

When I was hospitalized, there were some people telling us we shouldn’t pay since we had health insurance…But I was paying anyway to assure myself that everything would be fine. I was very worried and I just wanted to know that everything would be OK. –IDI 2012, insured female

If you don’t want the hospital’s drugs, but you want your own drugs, then you have to purchase them. – Patient FGD 2013

The relatives pay the staff to tend their patient since there aren’t enough staff and the staff can’t take care of all the patients. The staff aren’t asking for these payments, but the relatives are paying. – Patient FGD 2013

Service not covered by insurance

The acupuncture treatment …is expensive and not covered by insurance. – Patient FGD 2013

Unless you put some cash in their pockets, they won’t even look at you…they don’t even come close to you and don’t even check on you…I noticed an immediate change after we paid. They looked after [my wife] and came regularly to check on her. The workers from there expected to be paid. –IDI 2012, insured male

Uninsured or not referred

Wish to thank providers

[People prefer] to pay for a hospitalization and medicines rather than purchasing insurance. – Patient FGD 2013

For the birth of my two children, I gave money. Nobody forced me. I gave 5000 or 6000 lei (317–380 euro) with all my heart. – IDI 2012, insured male

If I wanted to see the specialist right away, I would have had to pay. – Patient FGD 2013

I think it is normal, not forced. – Patient FGD 2013

About informal payments, I think it is something about individuals giving flowers and candies. No one is imposing this. – Patient FGD 2013