The data collection took a form of household survey carried out in July 2010 in six CEE countries - Bulgaria, Lithuania, Hungary, Poland, Romania and Ukraine. The data collection was sub-contracted to Gallup International. The subcontractor used the survey questionnaire developed by the research team. The questionnaire and its translations were adjusted based on recommendations by the sub-contractor. The sub-contractor was responsible for the preparation of the data collection, the data-collection and the creation of the database.
The objective of the survey was to provide quantitative data on past payments for health care services, data on preferences and willingness to pay for health care improvements. The objective also was to provide data comparable across the countries. For this purpose, the questionnaire for all countries was identical, and the data collection process took place simultaneously in all six countries in a compact period of time – 20 calendar days. In all countries, the surveys were conducted based on face-to-face individual interviews. The respondents were identified using the same sampling methodology for all countries. The aim was to have 1000 effective interviews per country that present samples representativeness of the countries.
The sampling methodology was developed by the sub-contractor. It was based on a multi- staged random probability method:
Stage 1: Distribution of sampling points.
The sampling points in each country were distributed proportionally to regional, urban/rural and ethnic characteristics of the population. Within each region, the cities and towns belonging to the same group were put in an alphabetical order. The cities and towns included in the survey, were selected at random from that list. The number of sampling points in the
11 The survey represented the first wave of data collection held within the framework of the International Project
ASSPRO CEE 2007 (Assessment of patient payment policies and projection of their efficiency, equity and quality effects: The case of Central and Eastern Europe). The Project was financed by the European Commission under FP7 Theme 8 Socio-economic Sciences and Humanities, Grant Agreement no. 217431. For details see:
rural areas was calculated based on the ratio urban/rural population in a country. In total, there were ca. 150 sampling points per country.
Stage 2: Selection of addresses/ households.
The objective was to identify, 8-10 respondents per sampling point. To select addresses/households of potential respondents, the random route method was used. For each sampling point, a starting point and direction were determined. The household selected for the survey was every forth address on the left-hand side of the street in urban areas, turning left at intersections and, after reaching a dead end, going back to the last crossing and further proceeding at random. In a block-of-flats of up to four floors, every fifth apartment household was selected, counting from the first apartment on the left of the ground floor. In cases of unsuitable household, the interviewers approached the apartment next-door and continued doing this until reaching a suitable household. At that point, the interviews resume the standard step of every fifth apartment. In a block-of-flats of 5 floors and more, the selection is every tenth apartment. In rural areas, every fourth inhabitable house on both sides of the interviewer’s route was selected. In compounds of several houses behind a common fence, the interviewer had to select the fourth one from the left (counting from the gate), or if there were less than four houses behind a common fence, then the interviewer went out of the common yard, counting the houses as if they were along the street.
Stage 3: Selection of the respondent within the household selected.
The selection of the respondent within the selected household was done by using the “last birthday” principle. In this procedure, the interviewer asked to speak to the adult member of the household who had the last birthday. The last-birthday method is based on the assumption that the assignment of birthdates is a random process and also every household member has an equal chance of being selected. Only one individual per household was interviewed.
Stage 4: Replacement of the respondent/household.
If the respondent determined on stage 3 refused or was unavailable to take part in an interview after two call backs recorded in the fieldwork report, a replacing respondent was identified following stage 2-3. The sampling procedure described above, is known as an efficient method for selecting a sample representative for the population for a particular country. It is proven by practice that the sample produced by this method does not differ significantly from the official statistical data on age, gender and other demographic parameters. The sub- contractor organised and managed the interviewers’ training to clarify the fieldwork standards
and the specificities of the questionnaire. A high number of interviewers were involved in the survey to avoid the interviewer bias that might occur when one interviewer carries out many interviews.
The final number of effective interviews in the dataset, number of interviewers per country, and median duration of interview are presented in Table B.1. The duration of the interviews was as expected – on average 30 min per interview. Number of effective interviews is no less than 1000 in each country.About 10% of all interviews per country were verified (re- contacted) either by telephone or in person by the sub-contractor. The verifications of the interviews confirmed that that the interviews were carried out in reality. The sub-contractor entered the data collected according to the preliminary data entry mask consulted and agreed with the research team.
Table B.1 Short summary of the results of data collection
Bulgaria Hungary Lithuania Poland Romania Ukraine
Number of effective interviews (respondents) 1003 1037 1012 1000 1000 1000 Total number of interviewers 108 130 84 70 100 111 Median duration of interviews (minutes) 35.00 35.00 33.00 27.00 30.00 32.00
The sub-contractor also performed the standard data cleanup and logical checks procedures. The research team checked the representativeness of the sample and the overall quality of the dataset. The sample characteristics related to age, gender place of residence and household income are overall comparable to the countries’ national statistics. The descriptive statistics of the samples are presented in Table B.2.
Table B.2 Descriptive characteristics of the study samples
Bulgaria Hungary Lithuania Poland Romania Ukraine
Total number of the respondents 1003 1037 1012 1000 1000 1000
Categorical characteristics Sex male 46.86% 46.38% 43.18% 47.00% 41.70% 41.50% female 53.14% 53.62% 56.82% 53.00% 58.30% 58.50% Place of residence village 29.81% 29.22% 33.60% 37.00% 43.80% 31.50% town 44.37% 50.92% 39.13% 40.00% 33.70% 32.80% city 25.82% 19.86% 27.27% 23.00% 22.50% 35.70%
Table B.2 (continued) Descriptive characteristics of the study samples
Bulgaria Hungary Lithuania Poland Romania Ukraine Categorical characteristics Education level ≤ lower/secondary 22.93% 51.01% 12.65% 25.05% 23.10% 7.30% upper secondary 53.84% 32.50% 42.89% 61.22% 50.70% 62.40% ≥ post-secondary 23.23% 16.49% 44.47% 13.73% 26.20% 30.30% Self-reported health status
very bad or bad 13.81% 11.86% 9.29% 12.20% 15.90% 24.00% Fair 27.33% 27.39% 37.55% 25.90% 29.80% 49.20% Good 33.13% 34.23% 33.20% 32.50% 38.40% 19.00% very good/perfect 25.73% 26.52% 19.96% 29.40% 15.90% 7.80% Chronic disease any 47.36% 45.13% 47.33% 35.50% 42.60% 46.00% diabetes 8.20% 10.51% 4.94% 6.50% 7.00% 3.50% cardio-vascular 33.60% 31.63% 27.96% 19.50% 28.50% 27.10% kidney,liver,lung 10.10% 5.59% 10.67% 4.50% 12.70% 14.50% other problems 23.94% 20.93% 29.15% 21.50% 21.40% 28.50% Perceived level of income not sufficient 36.09% 24.61% 23.06% 15.50% 38.24% 29.11% meets expenses 55.02% 48.25% 47.32% 48.97% 43.09% 55.67% allows saving 8.89% 27.14% 29.62% 35.52% 18.67% 15.22% Willingness to pay Willing 75.96% 66.54% 80.90% 72.96% 81.43% 73.47% (s.e.) 1.36% 1.47% 1.24% 1.41% 1.24% 1.40% Not willing 24.04% 33.46% 19.10% 27.04% 18.57% 26.53% (s.e.) 1.36% 1.47% 1.24% 1.41% 1.24% 1.40% Continuous characteristics
Age, years mean 50.49 46.34 46.38 44.12 48.49 48.56
(s.e.) 0.54 0.55 0.53 0.52 0.54 0.56
Monthly household income, €
mean 358.01 587.10 531.40 733.16 357.34 252.66
(s.e.) 8.77 10.29 13.93 14.31 10.61 5.32
Size of the household, members mean 2.90 2.66 2.61 3.10 2.63 2.83 (s.e.) 0.04 0.04 0.04 0.05 0.04 0.04 Monthly income per person, € mean 135.87 252.15 225.73 273.81 157.82 101.02 (s.e.) 3.14 4.33 5.54 5.45 5.70 2.43
Number of children mean 0.44 0.47 0.56 0.61 0.50 0.56
(s.e.) 0.02 0.03 0.03 0.03 0.03 0.03
Number of members with chronic disease
mean 0.80 0.61 0.63 0.59 0.57 0.77
(s.e.) 0.81 0.76 0.76 0.77 0.73 0.81
Payment experience in the past year for outpatient physian services
Number of visits mean 4.48 5.26 3.67 3.78 3.24 1.98
(s.e.) 0.22 0.19 0.16 0.15 0.14 0.12
All types of payments, €
mean 16.81 16.85 26.98 14.35 48.92 19.91
(s.e.) 2.46 1.90 3.09 1.56 8.76 2.43
Informal payments, € mean 3.40 9.99 11.77 3.48 14.68 6.81
(s.e.) 1.37 1.20 2.14 0.76 2.94 1.01
Official payments, € mean 13.18 6.96 15.19 10.79 33.90 13.03
(s.e.) 2.00 1.05 1.88 1.20 6.62 1.85
Willingness and ability to pay for the services of medical specialists
All zeros included, € mean 6.63 9.05 9.63 10.97 8.94 4.92
(s.e.) 0.23 0.58 0.43 0.45 0.42 0.23
median 7.50 5.26 7.43 9.76 6.98 4.12 Only positive, € mean 8.79 13.91 11.95 15.11 11.16 6.77
(s.e.) 0.25 0.83 0.50 0.54 0.50 0.29