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Background: Ukraine has been improving the quality of health care by reforming the health care system. Evidence on healthcare users' perceptions of quality is important for future system changes. This paper aims to analyze the aspects of quality that outpatient care users find most important.Methods: Data from a longitudinal household survey 'Health Index. Ukraine' in 2016-2019 were used. The survey had a sample size of over 10,000 participants per wave. Data were analyzed using descriptive statistics as well as binary regression analysis.Results: Our results showed the importance of quality attributes as 'effectiveness of treatment' and 'qualification of medical personnel' as well as changes in the perception of quality attributes connected with payment policies and general management of the facility (like working hours, setting and hygiene ensuring by medical personnel).Conclusions: Our study provides new insights into the importance of healthcare quality attributes for outpatient healthcare users in Ukraine, showing the need to develop in future a national policy on quality and a national quality strategy for health care that incorporates quality aspects important to patients to make the healthcare system more responsive to the needs and expectations of healthcare users.

This case study explores the coping strategies of oncology patients and their family members in Ukraine. These coping strategies are seen as an individual-level response to the organizational and financial failures of the Ukrainian health care system. Based on semistructured interviews with medical doctors, patients, representatives of charitable foundations, and policy makers, we identify a variety of coping strategies, including personal connections and informal payments. Unequal access to diagnostic and treatment services is observed: coping strategies are developed by patients and their families taking into account the available financial and social capital. Importantly, we could not identify a typical path for cancer patients as cancer patients act in an environment of great uncertainty-in terms of their prognosis and in terms of the cost of treatment. With a weak state and financial uncertainty, patients and physicians perceive coping strategies rather positively as it may contribute to the chance of life.

In this study we aim to compare the public perceptions towards informal patient payments in six Central and Eastern European countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine). Overall, around 35–60% of the general public in each country has ever made informal payments, though informal cash payments are perceived negatively, mostly as corruption. In-kind gifts are often seen as a token of gratitude. However, significant differences among countries are observed. Despite the public support for the eradication of informal payments, there are population groups who favor their existence and this should be taken into account in policy-making.

Background The measurement of consumer satisfaction is an essential part of the assessment of health care services in terms of service quality and health care system responsiveness. Studies across Europe have described various strategies health care users employ to secure services with good quality and quick access. In Central and Eastern European countries, such strategies also include informal payments to health care providers. This paper analyzes the satisfaction of health care users with the quality of and access to health care services. The study focuses on six Central and Eastern European countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine). Methods We use data on past experience with health care use collected in 2010 through uniform national surveys in these countries. Based on these data, we carry out a multi-country analysis to investigate factors associated with the satisfaction of health care users in the six countries. Results The results indicate that about 10-14 % of the service users are not satisfied with the quality of, or access to health care services they used in the preceding year. However, significant differences across countries and services are observed, e.g. the highest level of dissatisfaction with access to outpatient services (16.4 %) is observed among patients in Lithuania, while in Poland, the level of dissatisfaction with quality of outpatient and inpatient services are much lower than dissatisfaction with access. The study also analyses the association of users’ satisfaction with factors such as making informal payments, inability to pay and relative importance of service attributes stated by the service users. Conclusions These multi-country findings provide evidence for health policy making in the Central and Eastern European countries. Although the average rates of satisfactions per country are relatively high, the results suggest that there is ample room for improvements. Specifically, many service-users still report dissatisfaction especially those who pay informally and those unable to pay. The high shares of informal payments and inability of users to deal with the health expenditures lead to doubts about the fairness of the health care provision in Central and Eastern Europe. There is an urgent need for policy makers in the region to not only acknowledge but also to effectively address this key problem. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1585-1) contains supplementary material, which is available to authorized users.

Informal payments for health care services are a well-known phenomenon in many health care systems around the world. Deeply ingrained informal practices accepted by both providers and consumers, and neglected by the government, seem to be a major impediment to ongoing health care reforms. The examination of level, scope and consumer’s perceptions of informal patient payments in Central and Eastern European (CEE) countries is the aim of the thesis. Based on national representative samples, the most empirical data are collected in 2010 in six CEE countries and in 2011 in three CEE countries. The results of the cross-country comparison suggest a relatively higher prevalence of informal patient payments in Romania and Ukraine, then in Hungary and Lithuania and much lower than in Poland and in Bulgaria. In the latter one, patients also meet formal service charges in the public sector. The patterns of informal patient payment confirm more incidents and higher expenditures for hospitalizations than for ambulatory care. Although users resort to informal patient pursuing better quality, quicker access and better attention, public opinions towards informal patient are quire negative and associated with corruption suggesting users’ willingness to elimination of this practice. Hereby, governments should meet public expectations and implement a strategy for dealing with informal patient payments.

Background Empirical evidence demonstrates that informal patient payments are an important feature of many health care systems. However, the study of these payments is a challenging task because of their potentially illegal and sensitive nature. The aim of this paper is to provide a systematic review and analysis of key methodological difficulties in measuring informal patient payments. Methods The systematic review was based on the following eligibility criteria: English language publications that reported on empirical studies measuring informal patient payments. There were no limitations with regard to the year of publication. The content of the publications was analysed qualitatively and the results were organised in the form of tables. Data sources were Econlit, Econpapers, Medline, PubMed, ScienceDirect, SocINDEX. Results Informal payments for health care services are most often investigated in studies involving patients or the general public, but providers and officials are also sample units in some studies. The majority of the studies apply a single mode of data collection that involves either face-to-face interviews or group discussions. One of the main methodological difficulties reported in the publication concerns the inability of some respondents to distinguish between official and unofficial payments. Another complication is associated with the refusal of some respondents to answer questions on informal patient payments. We do not exclude the possibility that we have missed studies that reported in non-English language journals as well as very recent studies that are not yet published. Conclusions Given the recent evidence from research on survey methods, a self-administrated questionnaire during a face-to-face interview could be a suitable mode of collecting sensitive data, such as data on informal patient payments.