The FGD questions explained that the government was concerned about high OOP payments, and asked questions about motivation for payments people make for care; advantages and disadvantages of the payments for the providers and patients; and ideas for reform.
Because reinsurance deals can be malleable and opaque, companies have been under scrutiny for using them to mask the real motivation for payments.
In a recent systematic literature review, Stepurko et al. (2010) [ 8] identify only six studies examining consumers or patients' attitude towards informal payments in different countries (see [ 4, 28- 32])These studies are rather divided regarding their conclusions, namely the attitudes reported in these studies vary from strongly negative to tolerant, depending on the motivation of the payment.
It was unclear how the receipts would form a defense strategy for Kim, or what the ultimate motivation of the payments were.
Hungarian health care consumers often use the term gratitude to explain the motivation behind informal payments, even though in most of the cases they pay informally in order to receive a better quality care, quicker access or more attention.
For this reason and given the context of a global health workers crisis [ 20], the specific relationship between informal payments, motivation and retention of health workers needs to be urgently investigated.
Consequently, the authors explore the linkages between motivation, retention and informal payments by means of a case study from Tanzania.
This section discusses the main findings to obtain better insights in the consumers' motivation to make informal payments for health care services.
The analysis of the perceived relationship between informal payments, and motivation and retention in the public health sector has yielded controversial and discordant results.
In fact, the highly complicated web of relationships and interactions between factors, many of which are hard to measure (e.g. informal payments, staff motivation and community cooperation) makes even exploration of heterogeneity difficult.
