Journal Article

Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran

Ghiasipour, Maryam, Gordeev, Vladimir Sergeevich, Doshmangir, Leila, Sajadi, Haniye Sadat, Aboutorabi, Ali

2020

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Academic achievement / Adult / Analysis / Behavior modification / Biostatistics / Cross-Sectional Studies / Data collection / Education / Elimination / Environmental Health / Epidemiology / Ethical standards / Ethics / Expenditures / Female / Financing, Personal / Generalized linear models / Governance / Health care / Health care costs / Health care industry / Health care policy / Health care reform / Health expenditures / Health Expenditures - statistics & numerical data / Health insurance / Health policies / Health policy / Health policy and systems research / Health services / Hospitalization - economics / Hospitals / Household size / Households / Humans / Informal economy / Informal payments / Inpatient care / Inpatients / Interviews as Topic / Iran / Male / Medical treatment / Medicine / Medicine & Public Health / Middle Aged / Monitoring / Patient education / Patient satisfaction / Patients / Payments / Physicians / Practitioner patient relationship / Private hospitals / Public Health / Qualitative analysis / Qualitative research / Questionnaires / Reduction / Reforms / Regression analysis / Research Article / Respondents / Response rates / Sample size / Stakeholders / Statistical analysis / Surveys / Surveys and Questionnaires / systems and management in low and middle-income countries / Tariffs / Teaching / Teaching hospitals / Telemedicine / Telephone hotlines / Telephone surveys / Transformation / Vaccine