A growing pattern within the ECA (East Europe and Central Asia) region is informal payments to doctors, hospital administrators, nurses and others connected with health service delivery. These payments have implications for governance of health systems and for equity and access, as well as for incentives for both health providers and managers. According to the research findings, informal payments are widespread in the Polish health sector. They include both cash and in-kind contributions. The study reinforces the existing anecdotal evidence as well as evidence from studies in other countries of the ECA Region and shows that the phenomenon has, if anything, become more widespread over the last few years. Informal payments are both paid voluntarily and coerced by providers in one way or another. As this paper shows, the main reasons for paying for medical services are to ensure quality care, to buy future care, and to jump queues. Providers are also paid to show gratitude and appreciation. In addition, users contribute in-kind for ancillary services. For instance, they bring their own sheets, food, or even medicines to the hospital because the hospital is not providing them. Building on the existing literature, this research is aimed at: (1) identifying the nature, extent, and economic dynamics (mechanisms of collection and revenue distribution among different actors) of informal payments
(2) understanding the leading causes of informal payments
(3) identifying the consequences of informal payments on accessibility and quality of care, and (4) articulating policy options to reduce the size and negative impact of such payments.