There are a number of strategies for the measurement of IPPs with different strengths and weaknesses. Most applied strategies for general public were quantitative surveys recruiting more than 1000 participants using a face-to-face structured interview, and then qualitative studies on less than 150 health care providers, with focus group discussion. This review provides a comprehensive picture of current informal patients' payments measurement tools, which helps researchers in future investigations.

Introduction Out-of-pocket (OOP) is among the payment methods in Iran’s health system. The present study aimed to examine the OOP treatment costs for patients with COVID-19 in Iran. Methods A descriptive-analytical, cross-sectional study was conducted in 2021. In this study, the cost records of 550 patients with COVID-19 hospitalized in a referral center of COVID-19 were selected using the stratified random sampling method. The required data were collected using a researcher-made questionnaire. Data were analyzed by t-test, ANOVA, and Pearson’s correlation coefficient in SPSS software version 23 at p = 0.05. Results The total direct costs were 1,037,992.15 US $. Moreover, the shares of patients (OOP), basic insurance, government subsidy, supplementary insurance, discounts, and out-of-government subsidy in the total direct costs were US $ 92,231.21, 746,932.99 US $, 155,127.08 US $, 39,690.25 US $ and 4010.61 US $, respectively. In addition, the results confirmed that there was a positive and significant relationship between the patients’ OOP payments and the length of stay. It also found that the patients’ OOP payments are subject to the type of insurance program and discharge method. Conclusion According to the results, 8.89% of the total direct costs were directly paid out of the patients’ pockets. The research findings confirm the urgent need to make decisions and implement effective interventions for COVID-19 disease by controlling risk factors and exploiting other countries’ successful experiences and international organizations’ recommendations to decrease the prevalence of the infected and consequently reduce the financial pressure of the disease on patients by approving the expansion of the insurance organizations’ role.

Background and objectives: One of the main goals of the health system is the fair contribution of people to healthcare financing. Therefore, the current study not only evaluated the status of fair financial contribution, but also investigated the impacts of the health reform plan on the financial pillars of the Iranian healthcare system. Method: To conduct this retrospective descriptive study, the data of Income and Expenditure Survey (2011-2015) commissioned by Statistical Center of Iran were used. To measure fairness of financing, four indices were used. Data were analyzed using the Excel and SPSS software. Findings: The results show that although the health reform plan has increased insurance coverage of both rural and urban households, out of pocket, and even its proportion to household capacity to pay continues to rise. Prevalence of catastrophic health expenditures in the baseline year in rural and urban areas was 2.19% and 1.04%, reaching 3.69% and 2.39% at the end of the study, respectively. Accordingly, fair financial contribution in rural and urban areas was obtained 0.830% and 0.850% in the baseline year, reaching 0.823% and 0.850% in the last year of the study, respectively. Conclusion: Although indices of fair financial contribution during the 5-year period varied, they ultimately showed a worse situation compared to the baseline year. Thus, it is assumed that the health reform plan has not yet been successful in meeting the goal of improving fair financial contribution to the health system.

Aim: According to the negative impact of informal payment on the efficiency and equity of the health care system and considering the catastrophic expenditures made for poor and vulnerable groups, this study was conducted to investigate informal payments and the associated factors in the educational hospitals affiliated with Shiraz University of Medical Sciences. Methods:The statistical population of the present descriptive-analytical study was all patients who were discharged from the teaching hospitals of Shiraz University of Medical Sciences (10 hospitals) in a specific month of the year 2018 (June). The sampling method was stratified random and 336 people were selected. Data collection tools were a questionnaire and a telephone interview with the patient or the patient's family. The questionnaire consisted of 40 questions in 6 sections. , Data were analyzed by using SPSS software version 23,the T-test, ANOVA, and Pearson correlation coefficient.. Results:The present findings show that the most informal payments were payed to the physicians and then the nurses. Among the physicians, general surgeons (1241+236.12) orthopedic specialists (1041+193.64), and urologists (561+89.59) have received the highest amount, respectively. Other findings indicate that the variables of household income level, place of residence and physician's specialty significantly affected the amount of informal payment (P<0.05). Conclusion:According to the results of the present study and in order to manage informal payments, health managers and policymakers should plan for identifying the causes of informal payment and designing effective interventions.