According to a recent POF poll, most Russians (77%) visit their local medical centers on a fairly regular basis: 13% see their local doctors one a month and more often, 10% go two or three times a month, groups of 18% each go once every six or twelve months, and 19% visit their clinic even less often. One-fifth of Russians (21%) never go to their local clinic. Slightly less than one-half (44%) say that their health is average, one-third (31%) say they are in good health, and one-quarter (23%) believe they are in poor health. Naturally, the worse one’s health is, the more often they are likely to see the doctor.

One-fifth of those who visit outpatient clinics or medical centers (16% of the total sample) reported having had to pay medical staff directly - off the record. This experience is mostly reported by university graduates (24%) and Muscovites (23%). Half of those who have made unofficial payments to doctors and nurses (7%) noted that the amount was quite significant for their family budget, while the other half said the amounts were not significant. The services they received in return included jumping the line to see the doctor (3%) and undergoing medical tests (3%), injections and/or other medical procedures (1%). Some respondents said they had paid unofficially for surgeries (2%) and treatment in the hospital (1%). One percent admitted having paid dentists off the record (1%), while 2% say they paid for various references (2%), such as sick leave documentation, referrals to medical commissions, and disability certificates.

Not all Russians have had the experience of making unofficial payments to medical staff, but the overwhelming majority are familiar with this practice. Half of the respondents (52%) believe that unofficial payments are widespread in all (30%) or most Russian medical centers (22%); one-sixth (15%) suggest that this practice is accepted only in a few clinics (7%), or not accepted at all (8%); another third (33%) have no opinion on the issue.

When asked to suggest the possible reasons why unofficial payments are given to medical staff, respondents were most likely to say that such incentives ensure “better medical service” (19%) or more attentive care (14%).

Some respondents mentioned situations in which they were forced to pay money to get to the doctor (9%) or obtain various references, such as an urgent sick leave slip (2%). Other cases included unofficial payments for home injections, treatment at dental clinics, obtaining a disability certificate or undergoing medical examination and securing an appointment with a doctor without producing a medical insurance policy (1% each). Some people say that low salaries among Russian medical staff could be one possible reason for the unofficial payment “system” (10%), while others suggest that the “doctors themselves force their patients to pay” (4%). Another group says this practice is an accepted tradition (4%). Three percent of respondents assume that patients pay the doctors “to thank them.”

One-third of those interviewed (36%) always regard unofficial payments to doctors as a form of bribery, 19% think it is sometimes a bribe, 13% don’t consider them a bribe at all, and one-fourth of respondents (23%) had difficulty answering the question.

Russians who do not consider unofficial payments in medical centers a form of bribery were asked to provide specific examples. According to these respondents, unofficial payments to medical staff are not considered bribery when patients themselves want to thank the doctors (6%), when they want to pay for “good treatment” (2%), “for urgency” (2%) or medical aid provided after working hours (1% each). Additionally, 2% of those interviewed note that bribery always involves money, while “a chocolate bar cannot be viewed as a bribe.”

There is no consensus who takes the initiative in suggesting the exchange of payments off the record. Equal percentages of respondents say patients take the initiative (32%) or that doctors are the ones to suggest it (32%), while 28% have no opinion on the matter.

Marina Ivanova

Would you rate your health as good, average, or poor?

How often do you visit your local health clinic? (One response is possible per card.)

Our next question is about unofficial payments to doctors and medical staff at your local health clinic. By unofficial payment we mean payments for medical services that are made off accounting records. Did you ever have to give doctors or medical staff at your local health clinics an unofficial payment? (Asked of those saying they visit their local medical centers, 79% of the total sample).

Was the money you paid unofficially at your local clinic a significant or insignificant part of your family budget? (Asked of those stating they had to make unofficial payments at clinics, 16% of the total sample).

In your view, how widespread is the practice of making unofficial payments to doctors and nurses at local Russian medical centers? (One response is possible per card.)

What is your personal opinion on offering money to medical staff at health clinics? Do you see it as a always a bribe, sometimes as a bribe, or never as a bribe? (Asked of respondents excluding those stating that unofficial payments are not practiced in Russian clinics, 92% of the total sample)

Some people believe that partients primarily take the initiative in offering money to medical staff at clinics, while others suggest that doctors and medical staff themselves suggest that patients offer money unofficially. Which of these two views comes closest to your own? (Asked of respondents excluding those stating that unofficial payments are not practiced in Russian clinics, 92% of the total sample)

Would you rate your health as good, average, or poor?

Categories of respondents, %	100	65	23	8	47	53	36	37	27	14	35	33	18	21	28	25	8	12	17	38	25	20
good	31	31	29	35	40	24	54	23	10	17	35	30	37	20	25	38	37	42	34	29	24	52
average	44	44	49	39	41	46	41	57	32	28	45	48	47	47	41	49	48	37	42	46	45	42
poor	23	24	19	25	17	29	4	18	58	54	18	21	13	33	33	12	12	21	22	23	30	3
hard to answer	1	1	2	0	2	1	2	2	1	2	1	1	2	1	1	0	2	0	2	2	1	2

How often do you visit your local health clinic? (One response is possible per card.)

Categories of respondents, %	100	65	23	8	47	53	36	37	27	14	35	33	18	21	28	25	8	12	17	38	25	20
at least once a week	1	2	1	1	0	2	1	1	3	3	1	1	1	3	2	1	1	2	1	1	1	0
several times a month	5	5	5	3	4	6	2	3	11	9	5	5	2	5	7	3	5	2	6	4	7	1
once a month	7	7	7	4	5	9	5	5	13	12	8	4	6	8	10	4	5	5	5	7	9	4
once two or three months	10	10	8	13	7	12	6	10	16	17	8	9	10	11	13	7	3	9	12	10	11	4
once in six month	18	18	18	14	11	23	18	19	15	15	16	20	18	22	15	17	15	17	15	18	20	18
once a year	18	18	19	17	20	16	19	21	13	14	19	19	17	18	21	19	12	11	18	21	19	18
less than twice a year	19	19	22	14	22	16	21	19	15	15	18	19	22	15	13	24	20	25	21	17	16	24
never	21	20	20	31	28	15	27	21	14	12	24	21	24	16	18	25	40	26	21	21	14	30
hard to answer	1	2	0	1	2	1	1	2	2	2	2	1	1	2	2	0	0	3	2	1	2	1

Our next question is about unofficial payments to doctors and medical staff at your local health clinic. By unofficial payment we mean payments for medical services that are made off accounting records. Did you ever have to give doctors or medical staff at your local health clinics an unofficial payment? (Asked of those saying they visit their local medical centers, 79% of the total sample).

Categories of respondents, %	100	65	23	8	47	53	36	37	27	14	35	33	18	21	28	25	8	12	17	38	25	20
yes	16	16	18	16	13	20	18	19	9	6	15	18	24	16	16	18	23	15	17	16	15	23
no	61	62	61	53	58	64	53	59	76	81	60	59	51	67	65	57	36	59	61	62	69	46
hard to answer	1	2	1	1	1	1	2	1	1	0	1	2	1	1	1	1	1	0	1	2	2	1

Was the money you paid unofficially at your local clinic a significant or insignificant part of your family budget? (Asked of those stating they had to make unofficial payments at clinics, 16% of the total sample).

Categories of respondents, %	100	65	23	8	47	53	36	37	27	14	35	33	18	21	28	25	8	12	17	38	25	20
significant	7	7	9	9	5	9	7	9	5	5	6	8	10	8	7	8	10	5	7	7	8	8
insignificant	8	9	8	7	7	9	10	8	4	0	8	8	12	6	8	9	12	10	9	7	6	15
hard to answer	1	1	1	0	1	1	1	2	1	1	1	1	2	1	2	0	1	0	1	2	0	1

In your view, how widespread is the practice of making unofficial payments to doctors and nurses at local Russian medical centers? (One response is possible per card.)

Categories of respondents, %	100	65	23	8	47	53	36	37	27	14	35	33	18	21	28	25	8	12	17	38	25	20
unofficial payments is a practice accepted at all outpatient clinics	30	29	29	41	26	33	33	32	21	18	29	32	35	32	28	34	40	18	34	29	30	35
unofficial payments is a practice accepted at most outpatient clinics	22	23	21	20	23	22	26	23	16	12	22	23	28	25	18	23	21	26	24	22	20	29
unofficial payments is a practice accepted at some outpatient clinics	7	7	10	6	7	7	8	8	5	5	8	7	8	4	7	9	3	12	7	8	5	9
unofficial payments is a practice that is not accepted anywhere	8	9	7	7	8	9	8	8	11	13	7	8	8	9	9	8	4	12	7	8	10	5
hard to answer	33	31	32	27	36	29	26	30	46	52	33	30	21	30	38	26	31	33	28	33	35	21

What is your personal opinion on offering money to medical staff at health clinics? Do you see it as a always a bribe, sometimes as a bribe, or never as a bribe? (Asked of respondents excluding those stating that unofficial payments are not practiced in Russian clinics, 92% of the total sample)

Categories of respondents, %	100	65	23	8	47	53	36	37	27	14	35	33	18	21	28	25	8	12	17	38	25	20
always	36	35	36	49	36	36	36	37	35	35	38	37	32	38	36	37	26	30	39	40	35	33
sometimes	19	20	21	14	18	20	22	20	15	8	20	23	20	18	21	21	23	25	17	20	17	24
never	13	13	15	10	13	13	14	16	7	6	12	13	21	11	9	17	25	13	15	12	9	23
hard to answer	23	22	21	20	25	21	21	19	32	38	23	20	19	24	24	18	22	20	23	21	28	15

Some people believe that partients primarily take the initiative in offering money to medical staff at clinics, while others suggest that doctors and medical staff themselves suggest that patients offer money unofficially. Which of these two views comes closest to your own? (Asked of respondents excluding those stating that unofficial payments are not practiced in Russian clinics, 92% of the total sample)

Categories of respondents, %	100	65	23	8	47	53	36	37	27	14	35	33	18	21	28	25	8	12	17	38	25	20
first	32	33	32	28	32	31	34	32	28	20	36	29	36	29	32	33	40	33	38	30	27	36
second	32	32	34	38	31	34	33	36	27	23	32	36	33	35	28	35	30	30	31	35	31	33
hard to answer	28	26	27	27	30	26	26	24	35	44	25	26	23	27	30	24	25	26	23	27	32	26

POF database > Dominants. Opinion Field > Dominants 33 August 16, 2007 > Unofficial Payments at Clinics > Unofficial Payments at Clinics