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Envelope culture in the healthcare system: happy poison for the vulnerable

Author

Listed:
  • Vuong, Quan-Hoang
  • La, Viet-Phuong
  • Le, Tam-Tri
  • Hoang, Giang
  • Jin, Ruining
  • Quang-Loc, Nguyen
  • Vuong, Thu-Trang
  • Nguyen, Minh-Hoang

Abstract

Bribing doctors for preferential treatment is rampant in the healthcare system of developing countries like Vietnam. Although bribery raises the out-of-pocket expenditures of patients, it is so common to be deemed an “envelope culture.” Given the little understanding of the underlying mechanism of the culture, this study employed the mindsponge theory for reasoning the mental processes of both patients and doctors for why they embrace the “envelope culture” and used the Bayesian Mindsponge Framework (BMF) analytics to validate our reasoning. Analyzing responses from 1042 Vietnamese patients, we discovered that bribing doctors can help patients reduce the destitution risk induced by treatment. Such effect of doctor bribery remains consistent among patients that have to pay high daily costs (e.g., accommodation and subsistence fees) regardless of their employment status. Nevertheless, for patients with no or unstable jobs, their risks of destitution increase if they have to pay more thank-you money. These findings suggest that doctor bribery is an adaptive strategy for patients in an environment where the healthcare supply cannot meet the actual demand. Moreover, healthcare equity is greatly exacerbated due to the envelope culture, as vulnerable individuals are exposed to a greater threat of poverty. At the same time, those with good economic conditions get preferential treatment by paying a higher amount of thank-you money. Healthcare workers’ ethics must be the top priority for an equitable and proper healthcare system.

Suggested Citation

  • Vuong, Quan-Hoang & La, Viet-Phuong & Le, Tam-Tri & Hoang, Giang & Jin, Ruining & Quang-Loc, Nguyen & Vuong, Thu-Trang & Nguyen, Minh-Hoang, 2023. "Envelope culture in the healthcare system: happy poison for the vulnerable," OSF Preprints 4fwj9, Center for Open Science.
  • Handle: RePEc:osf:osfxxx:4fwj9
    DOI: 10.31219/osf.io/4fwj9
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    References listed on IDEAS

    as
    1. Midori Matsushima & Hiroyuki Yamada, 2016. "Impacts of Bribery in Healthcare in Vietnam," Journal of Development Studies, Taylor & Francis Journals, vol. 52(10), pages 1479-1498, October.
    2. Manh-Toan Ho & Viet-Phuong La & Minh-Hoang Nguyen & Thu-Trang Vuong & Kien-Cuong P. Nghiem & Trung Tran & Hong-Kong T. Nguyen & Quan-Hoang Vuong, 2019. "Health Care, Medical Insurance, and Economic Destitution: A Dataset of 1042 Stories," Data, MDPI, vol. 4(2), pages 1-14, April.
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    5. Minh-Hoang Nguyen & Tam-Tri Le & Hong-Kong To Nguyen & Manh-Toan Ho & Huyen T. Thanh Nguyen & Quan-Hoang Vuong, 2021. "Alice in Suicideland: Exploring the Suicidal Ideation Mechanism through the Sense of Connectedness and Help-Seeking Behaviors," IJERPH, MDPI, vol. 18(7), pages 1-24, April.
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