Researchers: Nissim Cohen¹, Dani Filc²

Objectives: This study aims to evaluate, characterize, and explain the phenomenon of informal payments (“black medicine”) within the Israeli healthcare system. It examines how experiences related to the process of receiving medical care and its outcomes may either encourage or discourage the use of such practices.

Method: Based on a national survey

Findings: We found that the more individuals perceive procedural justice in the delivery of medical care and view the healthcare system as equitable, the lower the likelihood of their engagement in informal payments. Conversely, the more individuals feel that the healthcare system discriminates against people like them, the more likely they are to justify the use of informal payments.

Conclusions: The findings reveal that informal payments have become normative, and private healthcare services are increasingly perceived as legitimate. In some cases, patients proactively initiate informal payments even without being prompted, while in others, medical staff guide patients toward receiving treatment through private healthcare channels.

Recommendations: This study thus contributes to the existing knowledge on informal payments and offers practical policy recommendations.

Research end date: 07/2025