Changing Perceptions of Informal Payments under Privatization of Health Care: The Case of Kazakhstan

Previous studies on informal exchanges in the health care sector in post-socialist states have extensively discussed their complex and diverse nature, in particular the difficulty in distinguishing between gratuities and bribes given to health care providers. In examining this in Kazakhstan, I argue that the ongoing privatization of health care has blurred the boundary between official user fees and informal payments given as a reward for quality care. This has, in turn, sharpened the contrast between informal payments given in the expectation of proper treatment and money extorted by health practitioners. This paper also demonstrates that ordinary people often circumvent formal procedures by using money to obtain services to which they are not officially entitled or to gain access to public medical funding.