علل پرداخت‌های غیررسمی در بخش سلامت از دیدگاه پزشکان، سیاست‌گذاران و بیماران: مطالعه‌ی کیفی

In recent years, the financial relationship between the physician and the patient and some issues such as informal payments for health care have arisen as an unethical but common problem in many countries, including the Islamic Republic of Iran. Such issues are a threat to the professional reputation of physicians, and can have their own causes in different parts of the world. This study attempts to assess the causes of informal payments and the manners in which they are done in the hospitals of the Kerman Province in Iran in 2012. This study was carried out using qualitative research methods, and semi-structured interviews. Structured interviews were conducted on a purposeful sample of 45 participants including patients, providers and policy makers in the Kerman province in Iran in 2012. This study was authorized by the ethics committee of Kerman University of Medical Sciences, and the consent form was completed by all participants. In this study the participants were asked questions regarding reasons for informal payments, and data were analyzed using content analysis. There are several reasons for making informal payments, which include cultural, legal and quality factors. A number of reasons for asking informal payments by providers were discovered, including those related to tariffs, structural factors and ethical factors as well as to demonstrate the skill and competence of service providers. Most of the reasons discovered for informal payments in Iran are similar to other countries in the world. They showed that inadequate funding of the health systems and inadequate formal payments to providers are the most important supply-side factors leading to informal payments. Given that qualitative studies usually cover potential reasons only, further studies are needed to investigate the matter more extensively.