Under the Table in Health Care System: A Case Report in Iran

Under the table or informal payments in several middle and low income countries is a serious impediment to health care reform. These payments are effectively a form of systemic corruption. This report shows the efforts of a patient who seek health care for his ankle while being requested to pay under the table in hospital and private clinic. The data were collected by interview and surveying patient documents. Informal payments have adverse impact on access and utilization of health services, efficiency, quality and equity. Informal payments lead to false information about the real costs of disease and the patient share of these costs and consequently wrong government policies. Appropriate deterrent sanctions should be imposed on providers that request for under the table payments, especially in the public sector where the government tries to subsidize healthcare to ensure it is accessible to all, especially the poor.