A systematic review of empirical studies on methodology and burden of informal patient payments in health systems

Khodamoradi, Abdolvahed; Ghaffari, Mohammad Payam; Daryabeygi-Khotbehsara, Reza; Sajadi, Haniye Sadat; Majdzadeh, Reza

doi:10.1002/hpm.2464

Cited by 20 publications

(35 citation statements)

References 48 publications

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“…This is important, as our study confirmed that the prevalence of IPs for inpatient health care services, even after the revision of the medical tariff schedule, is still 14%. These findings correspond to a previously reported range of IPs in the Iranian health care sector of 7-10% in a hospital department to 20-48% in the whole hospital [17], as well as an overall level of IPs in other countries, varying from 2 to 80% [26]. We believe that this relatively low reported prevalence of IPs could be reasonable, given the adjustment of the medical tariffs and the introduction of the new hotline, which allows for real-time feedback by patients who paid IPs and subsequent actions to investigate all cases.…”

Section: Discussionsupporting

confidence: 91%

“…For future healthcare reforms assessment, we recommend conducting well-planned and timely evaluations, using before and after design, applying similar evaluation methodology, as well as setting up a cohort follow-up, if possible. We found that the prevalence of IPs was higher in private hospitals, like previous studies conducted in Iran and other countries [17,22,26,29,30], confirming that the type of hospital ownership is one of the factors contributing to IPs prevalence. We recommend paying more attention when designing future policy interventions to control IPs in the private sector as well.…”

Section: Actors and Stakeholderssupporting

confidence: 87%

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

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Actors and Stakeholderssupporting

confidence: 87%

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

et al. 2020

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“…Based on the available scientific evidence, one of the most suitable methods for collecting data about the informal payments is the use of a researcher-made questionnaire designed according to the specific features of each country, and completed by face-to-face interviews with the healthcare recipients. 31,32 However, the researchers did not find any standard questionnaire on the factors affecting informal payments in Iran upon literature review. Therefore, a structured questionnaire was prepared and standardized by using the factors extracted from the systematic review of factors that affect informal payments, and by holding a focus group discussion with a panel of 15 related experts who reviewed and examined the questions.…”

Section: Methodsmentioning

confidence: 99%

“…Greater information asymmetry, getting more urgent and critical services in the hospital wards, and higher patient stress for receiving such services can cause patients who use these services to opt for informal payments much more than others. 21,31,46 Also, the results showed that the odds of paying informal payments in services such as dental and emergency services is higher, so that the use of dental and emergency services increased the probability of paying informal payments three and two times, respectively (ORs = 3.02, 2.09; P < 0.001). The higher probability of paying informal payments for dental services can be due to higher patients' out-ofpocket share in dental costs and less insurance coverage for these services in Iran.…”

Section: Factors Affecting Informal Paymentsmentioning

confidence: 98%

Health informal payments and their main determinants: The case of Iran

Amiri

Teymourzadeh

Ravangard

et al. 2019

Proceedings of Singapore Healthcare

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Introduction: Informal payments are a serious obstacle to equitable access and universal health coverage in developing countries. This study aimed to identify the most important factors affecting health informal payments in Iran. Methodology: The cross-sectional and descriptive-analytical study was carried out on a study population of all Iranians who, at least once over the past year (i.e. 2017), had received healthcare services and were exposed to paying health informal payments. A sample of 1477 households was selected using a multi-stage stratified-cluster sampling method. The required data were collected using a researcher-made questionnaire and completed by face-to-face interviews with the heads of households. The main factors affecting the odds of making informal payments were identified using the Ordered Logistic Regression model. Results: Having basic health insurance coverage, awareness of health insurance entitlements, education, perceived behavioral control, and the pattern of health service utilization had, respectively, the highest effects on the odds of making informal payments for healthcare. The odds of making informal payments for patients with no awareness of the health insurance entitlements were 3.5, 3.6, and 6.7 times more than those with low, medium, and high awareness, respectively (Odds Ratio = 3.58, 3.69, 6.74; P < 0.001). Conclusion: The health policymakers, in addition to improving service financing, should plan to increase patients' awareness, correct their false beliefs, change their attitudes, and improve social participation regarding health informal payments in order to reduce such transactions.

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“…To our knowledge, an extensive literature is available on IPs prevalence in inpatient services, due to the well-known methodology of measuring IPs and the feasibility of data gathering in inpatient services (19). Based on this evidence, high prevalence of IPs, ranging from 7-10% in a hospital department to 20-48% in the whole hospital is still a major challenge in the Iranian healthcare system for many years (20).…”

Section: Introductionmentioning

confidence: 99%

More than 70 Percent of Insured Patients are Paying Informally During Outpatient Visits? Country Wide Evidence from Iran

Sajadi

Yaghoubi³

et al. 2020

Preprint

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Background: Reliance heavily on out-of-pocket (OOP) payments, including informal payments (IPs), to finance total health expenditure has undesired effects on financial risk protection and access to care. While a significant share of total health expenditure is spending on outpatient services, there is scant evidence of the amount paid informally by patient in outpatient services. Such evidence is available for inpatient services, showing high prevalence of informal payments, ranging from 7-10% in a hospital department to 20-48% in the whole hospital. This study aimed to investigate the extent of IPs for outpatient services in Iran.Methods: Data used were drawn from the 2015 IR. Iran’s Utilization of Health-care Services Survey, with a focus on all individuals with basic health insurance who were visited at least once by a physician in two private and public health care centers. The percentage of OOP and the frequency of IP were determined and the relationships between them and demographic variables were investigated.Results: The share that insured patients in Iran pay for a general practitioner (GP) visit was 38% in the public versus 61% in the private sector, while for a specialist practitioner visit the figures were 80% and 96%, respectively, which is higher that defined copayment (=30%). This share was significantly more in female, urban area, high educated people, private service providers, and specialist visits. The frequency of IPs also was 73% for a GP in the public versus 86% in the private sector, while for a specialist practitioner visit these were 90% and 93%, respectively. Conclusion: It seems that informal patient payments for outpatient services is more prevalent for outpatient service. Hence, more interventions are required to eliminate or control the IPs in outpatient services, particularly in private sector. In this regard, making a well-regulated market, reinforcing the referral system and developing an equity-oriented essential health services package would be fundamental.Trial registration: NA

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A systematic review of empirical studies on methodology and burden of informal patient payments in health systems

Cited by 20 publications

References 48 publications

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

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

Health informal payments and their main determinants: The case of Iran

More than 70 Percent of Insured Patients are Paying Informally During Outpatient Visits? Country Wide Evidence from Iran

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