Corruption vs Gratitude: Informal Payments in Healthcare in Romania

Public tolerance for corruption in Central and Eastern Europe often reflects the erosion of trust in public institutions and the persistence of informal norms. While research show that corruption and lack of good governance in healthcare system linked with low financial support determine poor health results, little is known about how individuals in Romania perceive informal payments to medical professionals. Using a vignette survey methodology, this study examines what drives individuals to asses certain scenarios as corrupt and how their evaluations shift depending on the timing of payments—before or after receiving medical services. Specifically, the study employs hypothetical scenarios to investigate how variables such as the severity of the illness, the amount of money offered, patient vulnerability, the perceived necessity of the transaction, and the moment of payments influence the framing of informal payment as corruption or gratitude. The study integrates qualitative analysis, responses to vignettes are analysed o identify patterns in corruption perceptions, while follow-up interviews provide deeper understanding of the reasoning behind patients evaluation. By focusing on Romania, the study not only contributes to the literature on medical corruption in Central and Eastern Europe, but also offers policymakers data to address the normalization of certain corrupt practices and enhance public trust in healthcare system.