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Burnout among healthcare workers is a challenge for the availability and quality of healthcare services in many countries. Overall, burnout has far-reaching implications on doctors, patients, and the healthcare system. For example, emotionally and physically exhausted workers become less attentive and make mistakes more often. Moreover, contextual features of the healthcare system and the organizational culture of healthcare institutions can contribute to burnout prevention and vice versa. Burnout among healthcare workers also increases the risk of alcohol misuse, sleep disorders, fast food consumption, and the occurrence of obesity.Considering the shortage of standardized tools to measure burnout among medical workers, we aimed to adapt to the Ukrainian context one of the research tools: Maslach Burnout Inventory for Medical Personnel (MBI-HSS (MP)). The MBI-HSS (MP) addresses three scales: emotional exhaustion (EE) measures feelings of being emotionally overextended and exhausted by one’s work; depersonalization (DP) measures an unfeeling and impersonal response toward patients; personal accomplishment (PA) measures feelings of competence and achievement in one’s work.From November 2020 – April 2021 we conducted semi-structured interviews and questionnaires among HIV care providers (N = 117). The result revealed that 83.7 % of respondents had high emotional exhaustion, and 58.5 % had high depersonalization. But the dimension of personal achievement level was not indicative of burnout in this component: 45.5 % had a high level of personal achievement. Pre-test and piloting of the Ukrainian version of the Maslach Burnout Inventory for Medical Personnel (MBI-HSS (MP)) show the validity of this instrument. In addition, it was found that relationships with colleagues and the management of the healthcare institution were associated with higher rates of burnout among healthcare workers., Вигорання медичних працівників є викликом для доступності та якості медичних послуг в усіх країнах. Емоційно і фізично виснажені працівники стають менш уважними, частіше припускаються помилок. Контекстуальні особливості системи охорони здоров’я, організаційна культура закладів охорони здоров’я можуть як сприяти запобіганню вигоранню, так і навпаки. З огляду на брак стандартизованих інструментів для вимірювання вигорання серед медичних працівників ми мали на меті адаптувати до українського контексту і доповнити один із дослідницьких інструментів, який надалі можуть використовувати дослідники. З листопада 2020 р. по квітень 2021 р. було проведено напівструктуровані інтерв’ю та анкетування надавачів медичної допомоги людям, які живуть з ВІЛ (ЛЖВ). Виявлено високі середні показники двох вимірів вигорання: емоційного виснаження медичних працівників і деперсоналізації, проте показники рівня особистих досягнень не засвідчують вигорання в цьому компоненті. Претест і пілотування шкали вигорання Human Services Survey for Medical Personnel (MBI-HSS (MP)) вказують на валідність цього інструменту, який може бути використаний у подальших дослідженнях в Україні.

In the post-communist countries, limited access to treatment, lack of financial protection mechanisms, lack of information and low quality of health care frequently imposes an enormous burden on family’s well-being when cancer is diagnosed. While many studies have explored barriers to cancer treatment, little attention is paid to the question how patients and their caregivers cope with cancer. In this paper, we systematically review the evidence on patients’ coping strategies with cancer in post-communist countries. We performed a literature search in PubMed, JSTOR, Web of Science and EBSCO (CINAHL) to identify papers that describe patients’ coping strategies because of organizational and financial barriers to cancer treatment. Papers published between January 1991 and January 2020 were included if they described individual experiences of patients at any stage of cancer treatment. We applied the Preferred Reporting Items for Systematic Literature Review as a guide for our review. In total, 28 publications from post-communist countries were included in this review. They presented evidence on coping strategies and barriers faced by patients when coping with poor access to cancer treatment, lack of finances, lack of information and low quality of health care services. Most sought coping strategies included using personal finances to pay for medical services, medicines and supplies, charitable contributions to the hospital and informal payments; visiting a private medical doctor; using personal connections and looking for additional information. We conclude that coping strategies are similar across post-communist countries and can be seen as an indicator of the shortcomings in cancer treatment. This evidence can be used to study and/or improve access to cancer treatment and improve health care policies. Research on the prevalence and quantification of coping strategies is needed to provide evidence-informed policies for countries that face gaps in cancer treatment.

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.

In den vergangenen Jahrzehnten hat die Ukraine im Gesundheitssektor keine gute Regierungsführung gezeigt. Die Covid-19-Pandemie hat zwar keine neuen Schwachstellen geschaffen, sondern verschärfte eher die bestehenden. Die Regierung hat es nicht vermocht, ein effektives System zum Testen und Rückverfolgen von Kontakten einzurichten; auch wurde eine nur recht schleppende Impfkampagne gestartet, während die dritte Welle der Pandemie langsam, aber sicher anrollt. Die Reform der Gesundheitsfinanzierung im Jahr 2018 hat jedoch einige Instrumente für mehr Transparenz und Verantwortlichkeit geschaffen. Das trug bereits erste Früchte und half dabei, eine bessere Antwort auf die Pandemie zu finden. Auch die wachsendeZivilgesellschaft in der Ukraine trug in den schwierigsten Phasen der Epidemie massiv zur Stützung des Gesundheitssystems bei.

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.

Purpose The aim of this paper is to systematize the evidence on the validity and reliability of subjective measurements of satisfaction with healthcare. Data sources In this qualitative systematic literature review, we searched for relevant publications in PubMed and JSTOR databases. Study selection The key inclusion criteria included (i) original research articles in peer-reviewed journals, (ii) year of publication from 2008 onward and (iii) English language publications. Data extraction We applied directed qualitative content analysis to the publications included in the review. Results of data synthesis Overall, 1167 publications are found and screened. Of these, 39 publications that focus on the psychometric properties of the measurement of patient satisfaction are included. The majority of the studies validate the already existing instruments adapted to different contexts; the rest describe psychometric properties of self-developed tools. Psychometric properties are assessed by means of reliability and validity assessment. Reliability assessment is performed via Cronbach alpha and test–retest reliability. Overall, 94.9% of studies find that the satisfaction measures are reliable. Validation is performed by a variety of different methods, among which the most applicable are face validity and factor analysis. Overall, 71.8% of studies find that the satisfaction measures are valid. Conclusion Because of the complexity of the studies, we cannot make strong recommendations on the application of self-reported satisfaction measures. We recommend the following key strategies: (i) developing of a unified standard toward satisfaction measurement and (ii) identifying a combination of tools to routinely measure satisfaction. We also suggest to further research the issue of subjectivity reduction.

In post-socialist spaces, informal payments in educational institutions have often been at the centre of anti-corruption campaigns. A direct consequence, so far, has been that reforms in the public sector have largely been based on attempts to eradicate, or at least minimize, the phenomenon of informal payments. Ukraine is no exception. According to several independent surveys, educational institutions are second only to health care providers for the number of informal transactions recorded. While more than two in three of Ukrainians claim to have engaged with informal exchanges in the past 12 months, almost half of them has made an informal payment in an educational institution, be this a university or a school. The goal of this paper is two-fold. First, we explore the nature and relevance of the phenomenon of informal payments in the educational sector. We rely for this on quantitative studies showing how widespread informal payments are. Second, we provide an alternative explanation on informal payments by suggesting that they have an ambiguous function: while often regarded as a legacy of the socialist period, they can also be seen as a way to cope with an ineffective system that is mostly based on informal rules. By doing this we will provide some recommendations on how anti-corruption policies, and in general reforms aimed at decreasing the amount of informal payments in the country, could be improved.

Die Nach-Maidan-Ukraine erlebt die Reform verschiedener gesellschaftlicher Bereiche, darunter auch die des Gesundheitswesens, die auf den Druck der Zivilgesellschaft und internationaler Organisationen auf die Regierung zurückzugehen scheint. Dieser Artikel schildert ihren Entstehungskontext und analysiert ihre Inhalte. Der Schwerpunkt der Gesundheitsreform bezieht sich auf Veränderungen der Finanzierung zum Schutz vor finanziellen Risiken in Form von Mehrausgaben. Dazu werden Dienstleistungen im Gesund- heitsbereich nicht mehr direkt aus dem Staatshaushalt finanziert, sondern zu pauschalen Preisen an kon- krete Dienstleister vergeben. Die Vergabe wird durch die Nationale Gesundheitsagentur erfolgen, die 2018 geschaffen werden soll. Für eine effizientere Nutzung der begrenzten vorhandenen Ressourcen sind außerdem die Einführung elektronischer Gesundheitsvorsorge und eine Verbesserung der medizinischen Grundversor- gung nötig. Die Haupterrungenschaften des Jahres 2017 sind zwei verabschiedete Gesetzentwürfe – einer zur Reform der Finanzierung des Gesundheitswesens und das im Frühjahr 2017 eingeführte Vergütungs- programm »Bezahlbare Arzneimittel«.

Der Artikel untersucht einige der neuesten Tendenzen im Bereich informeller Zahlungen im ukrainischen Gesundheitswesen. Wir betrachten die quantitativen und qualitativen Aspekte von Informalität, um zu zeigen, wie weit verbreitet das Phänomen ist, was die möglichen Ursachen sind und in welchen Situationen die informellen Zahlungen am häufigsten vorkommen. Wir nutzen das Phänomen Informalität als Ausgangspunkt, um einige der wichtigsten Mängel im ukrainischen Gesundheitswesen zu untersuchen.

In the light of the serious health problems in Ukraine and uncertainties of post-communist transformations and healthcare system reforms, this chapter considers how Ukrainian health care facilities are actually governed. The chapter draws on about 150 face-to-face interviews with physicians, nurses and administrators of both healthcare facilities and regional healthcare departments. The analysis focuses on the actual governance of priorities, human resources, professional performance, and medical technology. It shows that in the context of stagnation of national policy reforms and lack of funding, health facilities are run in Soviet style by powerful chief doctors, while simultaneously informal practices develop to keep the facility operations. The informal governance mechanisms that proved to be barely penetrable to formal regulation allowed healthcare organisations to survive through societal turmoil and disorientation. But through relying on extraction of profits for those on top of the healthcare organisations these mechanisms threaten accessibility and responsiveness of healthcare provision.

Background Although the literature offers various theoretical explanations for the existence of informal patient payments, empirical research has mostly focused on socio-demographic features as determinants of these payments. The role of health-care users’ perceptions on informal payments are rarely taken into account especially in multicountry surveys. Objective Our aim is to examine the association between informal payments for health-care services and perceptions of health-care consumers about paying informally as well as socio-demographic characteristics. Design We use data from a multicountry quantitative empirical research conducted in 2010. Setting and participants A national representative sample is drawn in six Central and Eastern European countries – Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine. In each country, about 1000 respondents are interviewed. Main variables studied Data related to informal payments for health-care services consumed during the preceding 12 months are analysed in addition to data on respondents’ perceptions about paying informally and socio-demographic data. Results Health-care users in Bulgaria and Poland are less inclined to make informal payments, while health-care users in Romania and Ukraine most often report such payments. The informal payment rates for Hungary and Lithuania fall between these two groups. In all six countries, individuals who feel uncomfortable when leaving the physician's office without a gratuity and who feel unable to refuse the request of medical staff to pay informally, more often make informal payments. Conclusions Such consumers’ perceptions can undermine policy efforts to eradicate these payments; therefore, health policy measures should reinforce social resistance to informal payments.

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.

Korruption wird in der Ukraine genauso wie in den meisten ehemaligen Sowjetrepubliken als großes Problem angesehen. Häufig sind informelle Zahlungen eher die Regel als die Ausnahme. Der vorliegende Beitrag illustriert diese Situation am Beispiel des Studiums und diskutiert die gesellschaftlichen Folgen.

Maternity care in Ukraine is a government priority. However, it has not undergone substantial changes since the collapse of the Soviet Union. Similar to the entire health care sector in Ukraine, maternity care suffers from inefficient funding, which results in low quality and poor access to services. The objective of this paper is to explore the practice of informal payments for maternity care in Ukraine, specifically in cases of childbirth in Kiev maternity hospitals. The paper provides an ethnographic study on the consumers' and providers' experiences with informal payments. The results suggest that informal payments for childbirth are an established practice in Kiev maternity hospitals. The bargaining process between the pregnant woman (incl. her partner) and the obstetrician is an important part of the predelivery arrangement, including the informal payment. To deal with informal payments in Kiev maternity hospitals, there is a need for the following: (i) regulation of the "quasi-official" patient payments at the health care facility level; and (ii) improvement of professional ethics through staff training. These strategies should be coupled with improved governance of the health care sector in general, and maternity care in particular in order to attain international quality standards and adequate access to facilities.

The lack of systematic research on the assessment of patient payment policies emphasizes the need to evaluate the mechanisms of official patient charges. This paper aims to contribute to this research area by outlining a comprehensive framework for the assessment of patient payment policies, and by validating it on data for six CEE countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine). Three broad groups of assessment criteria are included in the framework: policy context, policy content and policy effects. Within each of these groups, several sub-groups of criteria are defined. Our application of the assessment framework to the six CEE countries shows its relevance for the comparison of patient payment policy across countries, and for outlining common policy options. At the same time, it also reveals the need of collecting data on other relevant indicators that are not included in this paper, as well as for updating indicators already included. Research on patient payments will be essential for a continuous monitoring of patient payment policies (e.g. those in CEE) and their prompt adjustment.

The healthcare systems of many European post-communist and post-Soviet countries have been considerably affected by informal patient payments (also known as ‘under-the-table’ or ‘envelope’ payments) (Chawla et al., 1998; Gaal et al., 2006; Stepurko et al., 2010). The definition of informal patient payments usually includes a cash or in-kind supplement to the official payment for healthcare services (Belli, 2002; Gaal et al., 2010) as well as payments for commodities, such as pharmaceuticals (Lewis, 2000). Additionally, informal payments take place outside the official payment channels (Lewis, 2007), and payers may not even know that they are making an informal payment if they are not well informed about official fees (Thompson and Witter, 2000). Still, informal patient payments are not always perceived as illegal (Ensor, 2004; Gaal et al., 2006; Lewis, 2000) especially when the legislation and codes of ethics (even the moral codes) in the country fail to prescribe proper conduct and behaviour. As a result, informal patient payments are typically not prosecuted. Besides, the healthcare sector is not unique in such behaviour. Informal payments are also seen in other areas, for example in education, police, court and customs offices (Miller et al., 1998; Polese, 2008). Thus, general moral dispositions in society such as ‘everything that is not forbidden is allowed’ may well predispose to the existence of informal payments in the healthcare sector.

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.

Informal payments for health care are a well-known phenomenon in many health care systems around the world. While informal payments could be an important source of health care financing, they have an adverse impact on efficiency and access to care, and are a major impediment to ongoing health care reforms. This paper aims to study the scale and patterns of informal patient payments for out-patient and in-patient services in three former-socialist countries: Bulgaria, Hungary and Ukraine. The data are collected in 2010 and 2011 based on national representative samples and are analysed in pooled models to explain variations in payments. The results of the cross-country comparison suggest a relatively higher prevalence of informal patient payments in Ukraine and Hungary than in Bulgaria, where patients also have to pay formal user charges in the public sector. Nevertheless, informal payments for hospitalization in Bulgaria are quite extensive. We observe some differences in informal payments across the years. Variations in payment size are mainly explained by the nature, type and need for services, fee awareness and, on some occasions, by household income. Interpreted within the context of structural differences (e.g. reform paths, regulations, funding, user fees, anti-corruption policies), the findings of our study have implications on how to address informal payments for health care.

Maternity care in Ukraine is a government priority. However, it has not undergone substantial changes since the collapse of the Soviet Union. Similar to the entire health care sector in Ukraine, maternity care suffers from inefficient funding, which results in low quality and poor access to services. The objective of this paper is to explore the practice of informal payments for maternity care in Ukraine, specifically in cases of childbirth in Kiev maternity hospitals. The paper provides an ethnographic study on the consumers' and providers' experiences with informal payments. The results suggest that informal payments for childbirth are an established practice in Kiev maternity hospitals. The bargaining process between the pregnant woman (incl. her partner) and the obstetrician is an important part of the predelivery arrangement, including the informal payment. To deal with informal payments in Kiev maternity hospitals, there is a need for the following: (i) regulation of the "quasi-official" patient payments at the health care facility level; and (ii) improvement of professional ethics through staff training. These strategies should be coupled with improved governance of the health care sector in general, and maternity care in particular in order to attain international quality standards and adequate access to facilities.

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.