How Culture Affects Street-Level Bureaucrats’ Bending the Rules in the Context of Informal Payments for Health Care: The Israeli Case

Abstract

What is the role of culture in street-level bureaucrats’ bending the rules and accepting informal payments for health care? The literature on street-level bureaucrats stresses the importance of both individual and organizational factors in understanding how they use their discretion but usually neglects the importance of the culture in determining how far they are willing to go in exercising this discretion. Using data from 102 in-depth interviews with doctors and nurses in Israel, and by linking the literature about street-level bureaucrats to that of the research on informal payments for health care, we demonstrate that the culture plays a key role in decisions about accepting such payments. According to our findings, such payments are a phenomenon rooted in the culture and range from the extreme case of bribery to the fuzzier area of making exceptions for favored and sympathetic clients.