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

Q3 Medicine

Ethics, Medicine and Public Health Pub Date : 2025-01-01 DOI:10.1016/j.jemep.2025.101080

Q.-H. Vuong , V.-P. La , G. Hoang , T.-T. Vuong , M.-H. Nguyen

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引用次数: 0

Abstract

Background

Bribing doctors for preferential treatment is rampant in the Vietnamese healthcare system, which is commonly deemed an “envelope culture.” This study employed the mindsponge theory for reasoning the mental processes of both patients and doctors for why they embrace the “envelope culture”.

Methods

The Bayesian Mindsponge Framework (BMF) analytics was employed on a dataset of 1042 Vietnamese patients to validate our reasoning.

Results

The study discovered that bribing doctors can help patients reduce the destitution risk induced by treatment. Such effect of doctor bribery remains consistent among patients who 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.

Conclusion

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, as vulnerable individuals are exposed to a greater threat of poverty.

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医疗保健系统中的信封文化：弱势群体的快乐毒药

贿赂医生以获得优惠待遇在越南的医疗体系中十分猖獗，这通常被认为是一种“信封文化”。这项研究采用了思维海绵理论来推理病人和医生的心理过程，为什么他们拥抱“信封文化”。方法采用贝叶斯海绵思维框架（BMF）分析1042名越南患者的数据集来验证我们的推理。结果研究发现，贿赂医生可以帮助患者减少因治疗而导致的贫困风险。医生贿赂的这种影响在支付高额日常费用（如住宿费和生活费）的患者中保持一致，无论其就业状况如何。然而，对于没有工作或工作不稳定的患者来说，如果他们要支付更多的感谢费，他们陷入贫困的风险就会增加。结论医生贿赂是患者在医疗供给不能满足实际需求的环境下的一种适应性策略。此外，由于弱势群体面临更大的贫困威胁，医疗保健公平性大大加剧。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ethics, Medicine and Public Health Medicine-Health Policy

CiteScore

2.20

自引率

0.00%

发文量

107

审稿时长

42 days

期刊介绍： This review aims to compare approaches to medical ethics and bioethics in two forms, Anglo-Saxon (Ethics, Medicine and Public Health) and French (Ethique, Médecine et Politiques Publiques). Thus, in their native languages, the authors will present research on the legitimacy of the practice and appreciation of the consequences of acts towards patients as compared to the limits acceptable by the community, as illustrated by the democratic debate.