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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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.