Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran
Volume
20
Publisher
DOI
10.1186/s12889-020-8432-3
Journal
BMC Public Health
Issue
Metadata
Show full item recordAbstract
Background: In 2014, a revision of the national medical tariffs for inpatient health care services took place in Iran,
and a new hotline was set up to report informal payments. It was expected that such measures would eliminate or
decrease informal payments prevalence. This study estimates the prevalence of informal payments for inpatient
health care services in the post-reform period, explores factors associated with informal payments and examines
patients’ and healthcare providers’ views regarding the causes of informal payments and possible practical solutions
for their reduction.
Methods: We surveyed by phone patients who used inpatient health care services in seven Iranian hospitals in
2016. Descriptive and regression analyses were used to estimate the prevalence and determine factors associated
with informal payments. We conducted a qualitative analysis through thematic analyses based on focus group
discussions and in-depth interviews.
Results: Of 2696 respondents, 14% reported paying informally for inpatient services. Informal payments were reported
more frequently among private hospital users, given more frequently to physicians in public teaching hospitals and
‘other staff’ in private hospitals, in the form of cash and voluntary. Being an adult, hospital or treatment type, being
insured, and household head’s education influenced the probability of paying informally. The amount paid informally
was associated with being insured, the educational status of the household’s head, household size, service, and
hospital types. Based on qualitative findings, the leading causes of informal payments reported by patients and
healthcare providers can be categorized into four groups - financing challenges; governance challenges; service
delivery challenges; and actors and stakeholders. Modifying, adjusting and applying policy interventions; supervision,
monitoring and evaluation; and actors and stakeholders were identified as possible solutions for tackling informal
payment in the inpatient health care services.
Conclusion: The prevalence of informal patient payments for inpatient services in the post-reform period seems to
have reduced; however, they remain to be common. Regular monitoring, reviewing of payment policies to the
physicians, informing patients, changing the behaviour of healthcare providers and patients, and developing ethical
guidelines to prevent informal payments were suggested for reduction and elimination of informal payments in the
Iranian healthcare sector.
Keywords: Health expenditures, Informal payments, Iran, Health care reform, Health policy, Health policy and systems
research