تعیین توزیع عوامل موثربر پرداختهای مستقیم (رسمی وغیررسمی) در بیماران قلبی بستری در مرکز آموزشی درمانی شهید مدنی تبریز و اثرات جانبی آن از دیدگاه بیمار یا همراه وی - سال 1389

Background: The different effective factors on out of pocket payment (OOP)have been introduced as follows: low salary of the employee's, low governmental tariff, chronic disease, gifts to personnel, physician and other cadre's requests, fear of bad or no services. In addition OOP has negative effects on the accessibility of services .This article studies the distribution of effective factors on OOP (formal and informal) through cardiac patients and its side effects. Materials & Methods: This is a descriptive-exploratory study. The data were collected byinterviews and questionnaires reliability of which was approved by specialists and their validity were approved by simulation-in Shahid Madani hospital in Tabriz in the winter of 2010. Results: all the persons studied had an experience of OOP. Formal payments included the free cost of the services with no insurance cover and the margin between the tariff and the rate that the physician or the hospital declares (83% of OOP). In addition 10% of persons encountered informal payments 80% of which was due to the physician's request and 20%as a gift. The results describes the OOP`s side effects so that 52% of patients faced a postpone in getting services because of the OOP and 72% pointed that OOP has had an enormous effect on providing the necessary needs of the families. Conclusion: The high rate of OOP and the weak performance of insurance system will result in injustice and intensifies the unfavorable effects of OOP on the health system and society.