The Reasons for Informal Payments from the Perspective of Health Care Providers and Recipients: A Qualitative Study in Iran
Abstract Background: Informal payments are one of the major obstacles to health system reform in many developing countries, and its elimination is on the agenda of health system policymakers in many countries, including Iran. This study was conducted to identify the causes of informal payments in the Iranian health system.Methods: This was a qualitative and exploratory study. The study population included health care providers and health care recipients. Data were collected using open-ended questions and semi-structured interviews. Convenience and snowball sampling methods were used to select the providers. Content analysis method was used to analyze the data.Results: In the present study, 6 participants were physicians, 4 were hospital managers or CEOs, 4 were treatment or technical managers, 2 were nurses and 12 were patients or their companions. Reasons for informal payments divided in 4 themes include Economic factors, Socio-cultural factors, Service delivery challenges and Legal-political factors.Conclusions: In the Iranian health system, there is a great effort in order to reduce and eliminate the informal payments phenomenon, especially with the implementation of the health system transformation plan. Knowing the causes of this phenomenon can help reduce or eliminate it.