Background: Nowadays, a growing literature reveals how patients use informal payments to seek either better treatment or additional services, but little systematic review has been accomplished for synthesizing the main factors. The purpose of this study was to analyze the content of literatures to demonstrate the factors for informal patient payments. Methods: In this systematic review study, PubMed, Web of Science, Wiley Online Library, Science Direct, Ovid, Scopus, and Iranian databases were investigated without time limitation for eligible English and Persian studies. Achieved data were analyzed using content analysis approach and MAXQDA 10 software. Results: Themes related to informal payments in external context of health system were demographic features of health service consumers, patient's personality features and social & cultural backgrounds of the community. Health system challenges' themes were about stewardship weakness, and sustainable financing and social protection weakness. These were followed by human resources' organizational behavior challenges, drugs, medical products, and services delivery provision process challenges and finally change management weakness for reducing and dealing with IPs. Conclusion: It appears that improving the quality of health care services and accurate monitoring of delivery processes, along with performing some strategies for regulating payroll and medical tariffs, strict rules and regulations and improving health staff motivation, would be effective ways against informal payments. Improving the health insurance contribution, promoting transparency & accountability in health system especially in financing, identify precise control mechanism, using empower patient/public related approach, modifying community perception, reinforcing social resistance to unofficial payments and rebuilt lost social capital in health care are some of the other recommendations in this field. To practice these strategies, a comprehensive and systemic vision and approach is needed, however, the key point is that before applying any strategy the impact of this strategy on access, efficiency, equity, and other health systems' goals and policies should be investigated due to the consideration.

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Objective: This study aims to identify the challenges for public participation in health legislation in Iran. Materials & Methods: This is an exploratory and qualitative study. The study data were collected by using semi-structured interviews. The participants were experts in the field of health law with at least ten years of work experience. They had both experience and enough knowledge about the country’s health system. All interviews were transcribed verbatim after recording and then analyzed using thematic analysis. Results: We identified five main categories (themes) and 26 subcategories related to challenges. The main themes included legal barriers, infrastructure barriers, sociocultural barriers, people’s barriers, and legislators’ barriers. The legal barriers had three subcategories of parliament’s structure, legal requirements for participation, and facilitating laws. The infrastructure barriers had seven subcategories of the existence of mass media and communication networks, informing, ability to access to/meet the legislators, ability to categorize opinions, the possibility of electronic participation, financial resources, and structural facilities. The sociocultural barriers had three subcategories of people’s desire to participate, belief in teamwork, and social capital. Barriers related to people included eight subcategories of access to information, access to legislators, getting answers or feedback from legislators, feeling safe after participation, people’s awareness of their rights, education, ability to exchange views, and the existence of a highly-skilled expert team. Barriers related to legislators had nine subcategories of the desire to use others’ opinions, capacity to accept different opinions, party-related factors, regional factors, administrative health, education, opportunity, priorities, and motivational factors. Conclusion: Iranian citizens have several challenges to participate in health legislation. Regarding legal challenges, it is necessary to determine the participation right of citizens in the legal system. Besides, members of parliament should be educated to use the capacity of public participation. On the other hand, people should speak freely with the legislators and gain health knowledge as well.

Background: Many factors affect physicians' dispersion across various locations in Iran. Identifying these factors can be effective in planning for a fair distribution of physicians throughout geographical areas.