Irena Gryga

The attitudes of health care system stakeholders towards official patient charges have not been studied in Ukraine although both the central and local governments have several times considered to introduce such charges. Instead, informal patient payments are widespread and wellestablished. Ukrainian patients pay either unofficially or quasi-officially (i.e. charitable contributions) to health care institutions. The reasonable solution for dealing with these types of payments would be the introduction of official patient charges. However, the legal base for such reform in Ukraine is ambiguous. The Constitution declares that health care provision is free-of-charge. Nevertheless, in our study,  representatives of stakeholders groups appear keen not only on discussing official charges but are also favor their introduction. The expectations regarding the possible objectives of these charges expressed by different  stakeholders are the focus of this paper.

The topic of informal patient payments is rather new in policy discussions although the phenomenon has existed for decades. These payments are a threat to public health since they jeopardise efficiency, equity and quality of health care provision. Most importantly, those who  cannot afford to pay might not seek or delay seeking treatment. Before attempting to deal with informal patient payments, it is necessary to understand the reasons for their existence and their role in health care provision. This could indicate the mechanisms through which these payments can be influenced by policy, as well as relevant strategies for dealing with these payments. This paper outlines a mixture of strategies as a plausible solution to informal patient payments. The successful implementation of these strategies depends on the particular setting and the overall conditions in the country (e.g. prevalence of corruption, and attitudes of health system stakeholders towards informal payments).