Reduction and elimination solutions of informal payment in Iran’s health system

Authors

  • Farhad Habibi Nodeh Department of Health Management and Economics, Public Health School, Tehran University of Medical Sciences, Tehran, Iran.
  • Ibrahim Jafari Pooyan Department of Health Management and Economics, Public Health School, Tehran University of Medical Sciences, Tehran, Iran.
  • Iraj Harirchi Deputy of Minister, Ministry of Health, Treatment and Medical Education, Tehran, Iran, & Medical School, Tehran University of Medical Sciences, Tehran, Iran.
  • Mohamad Arab Department of Health Management and Economics, Public Health School, Tehran University of Medical Sciences, Tehran, Iran.
Abstract:

Background: Informal payments can cause delayed access to health care services, forcing people to sell their properties for cost of treatment; and as a result, they lose trust in the health system. Considering the importance of this issue, this study was conducted in 2016 to identify solutions to reduce and eliminate informal payments in Iran’s health system.    Methods: Initially, solutions to reduce informal payments were extracted by reviewing resources and searching Persian and English-language databases including Science direct, PubMed, Scopus, Medline, ISC, Magiran, SID using the following keywords: informal payments, under the table payment, bribes, gratitude payment, and informal payments/fees. Then, Iranian context specific solutions were obtained by performing semi-structured interviews with 19 individuals, who were aware of the problem. Next, the identified strategies were confirmed using Delphi technique and with the participation of 50 experts.    Results: Various solutions were identified and confirmed to reduce or eliminate informal payments in Iran’s health system, which are divisible in different economical fields, such as payments to providers based on performance, religious leaders’ fatwa (sociocultural), disclosing the offenders’ names (legal-political), and using family doctor system (structural).    Conclusion: The proposed solutions can be used by policymakers and managers in the health sector to manage informal payments. Careful identification of health care providers and recipients’ motivations and needs can be effective in recognizing and eliminating this phenomenon.  

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Journal title

volume 31  issue 1

pages  915- 922

publication date 2017-01

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