Health Economics, Policy and Law


Informal payments for health care – the phenomenon and its context

Nissim Cohena1 c1

a1 Department of Management and Economics, The Open University of Israel, Raanana 43107, Israel


This paper reviews current research and literature on the issue of informal payments for health care and its context and suggests a new perspective for a better understanding of this phenomenon. This perspective, based on political culture and behavior and on wider social processes, is already used to explain various phenomena from different fields of public policy. The paper explains the impact of a specific type of political culture, called ‘alternative politics’ (AP) in the Israeli literature, on healthcare policy and institutional healthcare settings. AP is based on a ‘do-it-yourself’ approach adopted by citizens to address their dissatisfaction with governmental services. When such a mode of political culture is diffused to all sectors and levels of society, all players, including bureaucrats and politicians, are guided by short-term considerations and apply unilateral strategies that bypass formal rules either through illegal activity or by marginalizing formal rules. Explaining informal payments by analyzing social processes and political culture and behavior has some disadvantages, but it provides us with a better understanding of the phenomenon while covering most of its characteristics and configurations.

(Online publication May 05 2011)


c1 Correspondence to: Nissim Cohen, Department of Management and Economics, The Open University of Israel, P.O.B. 808, Raanana 43107, Israel. Email: