Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran
Abstract 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 t...
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| Format: | Article |
| Language: | English |
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BMC
2020-04-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-020-8432-3 |
| _version_ | 1811196627532120064 |
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| author | Leila Doshmangir Haniye Sadat Sajadi Maryam Ghiasipour Ali Aboutorabi Vladimir Sergeevich Gordeev |
| author_facet | Leila Doshmangir Haniye Sadat Sajadi Maryam Ghiasipour Ali Aboutorabi Vladimir Sergeevich Gordeev |
| author_sort | Leila Doshmangir |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-12T01:02:03Z |
| format | Article |
| id | doaj.art-3bf213731ad241e29db42efcfb9d2545 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-04-12T01:02:03Z |
| publishDate | 2020-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-3bf213731ad241e29db42efcfb9d25452022-12-22T03:54:25ZengBMCBMC Public Health1471-24582020-04-0120111410.1186/s12889-020-8432-3Informal payments for inpatient health care in post-health transformation plan period: evidence from IranLeila Doshmangir0Haniye Sadat Sajadi1Maryam Ghiasipour2Ali Aboutorabi3Vladimir Sergeevich Gordeev4Social Determinants of Health Research Center, Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical SciencesKnowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical SciencesDepartment of Health Management and Economics, School of Public Health, Tehran University of Medical SciencesSchool of Management and Medical Informatics, Iran University of Medical SciencesDepartment of Infectious Disease Epidemiology, The London School of Hygiene & Tropical MedicineAbstract 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.http://link.springer.com/article/10.1186/s12889-020-8432-3Health expendituresInformal paymentsIranHealth care reformHealth policyHealth policy and systems research |
| spellingShingle | Leila Doshmangir Haniye Sadat Sajadi Maryam Ghiasipour Ali Aboutorabi Vladimir Sergeevich Gordeev Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran BMC Public Health Health expenditures Informal payments Iran Health care reform Health policy Health policy and systems research |
| title | Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran |
| title_full | Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran |
| title_fullStr | Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran |
| title_full_unstemmed | Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran |
| title_short | Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran |
| title_sort | informal payments for inpatient health care in post health transformation plan period evidence from iran |
| topic | Health expenditures Informal payments Iran Health care reform Health policy Health policy and systems research |
| url | http://link.springer.com/article/10.1186/s12889-020-8432-3 |
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