Informal payments analysis and its influential variables: a case study of the health system in Iran

Informal payments are defined as amounts paid by patients to healthcare providers outside of routine methods or approved fee plans. This study thus aimed to investigate informal payments and their determinants, as well as the effect of the Health System Reform Plan on reducing the rate of informal payments in Iran. This was a cross-sectional study performed in public hospitals affiliated with the Ministry of Health of Chahar-Mahal-va-Bakhtiary Province, carried out from June 22 to October 22, 2018. The population was discharged patients. Stratified sampling was used. Data was obtained through interviews. Both SPSS and EVIEWS were used for descriptive and analytical analysis, respectively. In the analytical section, the Logit model was used to define the determinants of informal payments. Out of 325 patients, 147 cases were chosen from teaching hospitals, while 178 cases were chosen from non-teaching hospitals. Overall, 15.7% of patients had made informal payments, of which 2.8% had paid physicians, 6% nurses, and 8% other employees. Patients hospitalized in teaching hospitals also paid higher amounts of money than those in non-teaching hospitals. The determinants of informal payments were hospital type, treatment type, and gender. The results of this study show that there is an issue related to the informal payments in the hospitalization department, which is considered one of the important challenges of financing the health system in Iran. The health transformation plan that has also been made to aim to reduce direct payments from people's pockets and informal ones has not been able to solve this big social problem.