Khodamoradi Abdolvahed, Rashidian Arash, Daryabeygi-Khotbehsara Reza, Aghlmand Siamak
Researcher, Department of Health Economics, Social Security Research Institute, Tehran, Iran.
Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
J Med Ethics Hist Med. 2018 Jul 11;11:7. eCollection 2018.
Informal payments refer to sums that patients may pay to individual or organizational health care providers outside of the official payment channels or approved fee schedules. The aim of the current research was to investigate informal payments and related influential factors in Urmia city hospitals. The present study was a cross-sectional survey conducted among post-discharged patients from all Urmia city hospitals during one Iranian calendar month (January 21 to March 19, 2013). Simple random sampling was used to recruit 265 patients to undergo assessment via phone call interviews and complete a questionnaire. Data analysis was performed using SPSS software for descriptive reports, and EViews software for determination of factors affecting informal payments. Eleven percent of the patients had made informal payments to physicians (mean amount: 503,000 Tomans, equivalent of $412), 5% to nurses (mean amount: 20,000 Tomans, equivalent of $16), and 17% to other employees (mean amount: 16,000 Tomans, equivalent of $13). Hospital ownership, patients' place of residence, education and income significantly influenced the payments. Most substantially, patients receiving surgical care were 100 times more likely to make informal payments compared to those who had received non-surgical inpatient care. The present study showed that although informal payment is illegal in Iran, it is a common practice among hospitalized patients, and has now become a challenge for the health system. Considering the high prevalence of informal payments and their severe impacts on equity and justice, policymakers have focused on this phenomenon to reduce and eliminate it.
非正规支付是指患者在官方支付渠道或批准的收费标准之外，可能向个体或机构医疗服务提供者支付的款项。当前研究的目的是调查乌尔米耶市医院的非正规支付情况及相关影响因素。本研究是一项横断面调查，在伊朗历一个月（2013年1月21日至3月19日）期间，对乌尔米耶市所有医院的出院患者进行。采用简单随机抽样法招募265名患者，通过电话访谈进行评估并完成一份问卷。使用SPSS软件进行描述性报告的数据分析，使用EViews软件确定影响非正规支付的因素。11%的患者向医生进行了非正规支付（平均金额：503,000托曼，相当于412美元），5%向护士进行了支付（平均金额：20,000托曼，相当于16美元），17%向其他员工进行了支付（平均金额：16,000托曼，相当于13美元）。医院所有制、患者居住地、教育程度和收入对支付有显著影响。最重要的是，接受手术治疗的患者进行非正规支付的可能性是接受非手术住院治疗患者的100倍。本研究表明，尽管在伊朗非正规支付是非法的，但在住院患者中却是一种普遍现象，现已成为卫生系统面临的一个挑战。鉴于非正规支付的高发生率及其对公平和正义的严重影响，政策制定者已将重点放在这一现象上，以减少和消除它。
