Habibi Nodeh Farhad, Jafari Pooyan Ibrahim, Harirchi Iraj, Arab Mohammad
Department of Health Management and Economics, Public Health School, Tehran University of Medical Sciences, Tehran, Iran.
Deputy of Minister, Ministry of Health, Treatment and Medical Education, Tehran, Iran, & Medical School, Tehran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2017 Dec 28;31:139. doi: 10.14196/mjiri.31.139. eCollection 2017.
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. Initially, solutions to reduce informal payments were extracted by reviewing resources and searching Persian and Englishlanguage 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. 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). 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.
非正规支付可能导致获得医疗服务的机会延迟，迫使人们为支付治疗费用而出售房产；结果，他们对医疗系统失去信任。鉴于这个问题的重要性，2016年开展了这项研究，以确定减少和消除伊朗医疗系统中非正规支付的解决方案。最初，通过查阅资料并搜索波斯语和英语数据库（包括科学Direct、PubMed、Scopus、Medline、ISC、Magiran、SID），使用以下关键词提取减少非正规支付的解决方案：非正规支付、私下支付、贿赂、感恩支付以及非正规支付/费用。然后，通过对19名了解该问题的个人进行半结构化访谈，获得了针对伊朗具体情况的解决方案。接下来，使用德尔菲技术并在50名专家的参与下对确定的策略进行了确认。确定并确认了各种减少或消除伊朗医疗系统中非正规支付的解决方案，这些方案可分为不同的经济领域，例如基于绩效向提供者支付费用、宗教领袖的法特瓦（社会文化方面）、公布违法者姓名（法律政治方面）以及采用家庭医生制度（结构方面）。所提出的解决方案可供卫生部门的政策制定者和管理人员用于管理非正规支付。仔细识别医疗服务提供者和接受者的动机和需求，对于认识和消除这一现象可能会有成效。
