Characterizing the role of informal payments in the delivery of pathology and clinical laboratory services

Abstract

OBJECTIVES: Stronger pathology and laboratory medicine (PALM) services are needed in low- and lower-middle income countries (LMICs), though the impact of informal payments (IPs) on PALM remains unclear. IPs are a common, but regressive method of financing health care in LMICs. This study aims to characterize the prevalence and impact of IPs on PALM services. METHODS: PALM staff were surveyed about the frequency, determinants, and impacts of IPs in their workplace from September 2021 - September 2022. RESULTS: In total, 268 responses were received with 46.6% (n = 125) reporting experience with IPs. These 125 participants were more likely to work in the public sector and in LMICs. Approximately 65% reported accepting IPs to perform tests or release results. Obtaining faster results was the most commonly perceived reason for patients offering IPs. Overall, participants reported this activity had more negative than positive impacts on their workplace. CONCLUSIONS: This represents a first step in characterizing IPs within PALM and how this practice may impact access to these services in LMICs. Specifically, the fact that faster turn-around time was the most frequently perceived reason for offering IPs uncovers a potential barrier to improving PALM capacity in these regions.