Informal Payments for Inpatient Services and Related Factors: A Cross-Sectional Study in Tehran, Iran

Abstract

Background: Informal payments, as one of the components of out-of-pocket (OOP) payments, are often a form of corruption and outside the official bill. The purpose of the present study was to investigate the frequency of informal payments for inpatient services and its related factors in Tehran, Iran. Methods: In this cross-sectional study, the samples included 450 patients who were admitted to hospital's clinics affiliated to Shahid Beheshti University of Medical Sciences in Tehran, to receive follow-up and post-surgical care. After obtaining patient consent, data were collected via a 28-item questionnaire included two parts of patient's demographic characteristics and informal payments experience that it's validity and reliability were confirmed. Data were analyzed using descriptive statistics and regression analyses in SPSS 16 software. Results: The findings showed 21.1% of the patients had informal payments, paid voluntarily, mostly in cash, for service's staff, in public hospitals, after discharge and, due to the employees' proper behavior and attention. The average informal payments per patient were 5,304,630 IRR (175.4 USD). There was no significant relationship between the informal payment behavior and the patient demographics characteristics (P > 0.05). Conclusions: Despite the efforts made in the HTP to eliminate informal payments in inpatient services, the goal has not been fully realized. A part of the payments was paid at the provider's request and before the patient's admission that these compulsory informal payments are illegal and unethical and therefore, must be controlled and eradicated. Policymakers can take steps to reduce informal payments by improving the healthcare quality, supervision, setting salary and benefits, enforcing laws, and increasing staff incentives.

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

“…We think that parents are perhaps more willing to pay for their children, and when paying for themselves, they may have more time in circumventing the providers who may demand informal payments, and may use services in which informal payments are less common. The evidence on the effect of age on IPs is mixed [25,27,34,35]. For example, Meskarpour-Amiri et al reported that the elderly are at increased risk of paying informally for health care, while Zarei et al found no significant relationship between the IPs behaviour and the patient's age.…”

“…Some of them reported that living in the rural areas increased the likelihood of paying IPs [7], while others stated that living in an urban area and large cities increased the probability of paying IPs [37]. In addition, there is some evidence showing no significant relationship between IPs and the place of the patient's residence [28,30,35,38]. Our study provided evidence to confirm that those living in large cities are at increased risk of paying informally for inpatient health care services.…”

Setting health care services tariffs in Iran: half a century quest for a window of opportunity

“…However, the improper adaptation of the tariffs, manipulating and involving some intentional changes in the relative values of healthcare services, caused moving tariff values away from the actual fiscal values of the health services. During the last years, irrational medical tariffs have caused some health professionals to request informal patients payments or attempt to get high revenues [47,48]. The dissatisfaction of some stakeholders with tariffs has also produced different viewpoints about continuation or discontinuation of California book values as a reference point for tariff setting.…”

Setting Health Care Services Tariffs in Iran: Half a Century Quest for a Window of Opportunity

“…However, the improper adaptation of the tariffs, manipulating and involving some intentional changes in the relative values of healthcare services, caused moving tariff values away from the actual scal values of the health services. During the last years, irrational medical tariffs have caused some health professionals to request informal patients payments or attempt to get high revenues [48,49]. The dissatisfaction of some stakeholders with tariffs has also produced different viewpoints about continuation or discontinuation of California book values as a reference point for tariff setting.…”