Exploring the changes of physicians' behaviour toward informal payment based on Health Transformation Plan in Iran: A qualitative study

Sakha, Minoo Alipouri; Moghadam, Telma Zahirian; Ghobadi, Hassan; Zandian, Hamed

doi:10.1002/hpm.3020

Cited by 3 publications

(1 citation statement)

References 41 publications

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“…Improper tariff valuation of health services was one of the main reasons for the prevalence of informal payments [15,17]. In studies conducted in Iran [18] Turkey [19], Tanzania [4,20], Hungary [21], and Central and Eastern European Countries [22], health care providers cited low incomes and wages as the main reasons for receiving informal payments. Another reason given by doctors was the existence of injustice in tariffs of various medical groups.…”

Section: Discussionmentioning

confidence: 99%

Reasons for informal payments from the perspective of health care providers and recipients: a qualitative study in Iran

Arab

Khosravi

Safari

et al. 2022

glob health res policy

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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 environment included the Ministry of Health, physicians' offices, medical universities, and hospitals and health centers. The study population included health care providers (physicians and hospital staff, managers, supervisors, and nurses) and health care recipients (patients or patients who had a history of dealing with informal payments). Data were collected using open-ended questions and semi-structured interviews. Snowball sampling method was used to select managers, chief executive officers (CEOs) and nurses. Convenience sampling was used to select physicians due to their lack of participation and cooperation. Content analysis method was used to analyze the data. Results Reasons for informal payments were divided into 4 themes including: Economic factors (improper tariff valuation of services; failure to increase tariffs proportionate to inflation; lack of comprehensive participation of stakeholders in determining tariffs; tariff inconsistency in the public, private and charity sectors; etc.); socio-cultural factors (decreased social capital of the medical community among the people; improving the quality of life; incorrect comparison of providers' income levels with the income of doctors in other countries; existence of a culture of gratitude and appreciation; health as a priority for society; pride of service recipients; pride of service providers; etc.); service delivery challenges (high professional skills of the doctor; use of modern medical equipment; the monopoly of some doctors, etc.) and legal-political factors (inadequate monitoring by upstream organizations; lack of strict rules; difficulty of proving informal payments; presence of stakeholders in management and policy making processes). Conclusions Knowing the causes of informal payments can help reduce or eliminate it. The results of this study identified the causes of informal payments in the Iranian health system. Accurate knowledge of the needs and motivations of both health care providers and recipients can be effective in accurately identifying and eliminating this phenomenon.

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Section: Discussionmentioning

confidence: 99%

Reasons for informal payments from the perspective of health care providers and recipients: a qualitative study in Iran

Arab

Khosravi

Safari

et al. 2022

glob health res policy

View full text Add to dashboard Cite

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Fragmentation of payment systems: an in-depth qualitative study of stakeholders’ experiences with the neonatal intensive care payment system in Iran

Ostad-Ahmadi,

Nkangu,

Nekoei-Moghadam

et al. 2024

Health Econ Rev

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Background Iran’s fee-for-service (FFS) payment model in neonatal intensive care units (NICUs) is contentious due to the involvement of multiple stakeholders with differing interests, leading to increased costs, fragmentation, and reduced quality of care. This study explores the experiences and challenges of stakeholders with the NICU payment system and considers alternative payment methods. Method A qualitative research approach was used, involving key informant interviews with stakeholders at various levels of the health system. Data were collected between March 2022 to September 2023 using a purposive sampling method with a snowball strategy. The transcribed data were analyzed using an inductive thematic approach in MAXQDA, with themes and sub-themes emerged and assessed by two independent coders. Four trustworthiness criteria were applied to ensure the quality of the results. Results The study involved 23 participants with diverse NICU payment backgrounds, identifying issues related to service accessibility, rising costs, neonatologists’ income, and service quality. Stakeholders held differing views on the best payment model: health insurance executives favored a prospective payment method, faculty members favored supported modified FFS or per diem, and neonatal specialists expressed concerns about low tariffs and delayed payments. Conclusion Iran’s NICU payment system is unsatisfactory and requires urgent reform. Although stakeholders disagree on the best approach, reforms must be evidence-based and collaborative, addressing structural and cultural issues within the health system. The identification of an optimal payment system is essential for supporting neonatal care, benefiting newborns, families, society, and the broader health system. Supplementary Information The online version contains supplementary material available at 10.1186/s13561-024-00564-w.

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The Gap Between the Actual Cost and Tariffs of Global Surgical Procedures: A Retrospective Cross-sectional Study in Qazvin Province, Iran

Zarei,

Hashemi,

Farrokhi

2024

Arch Iran Med

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Background: Iran’s healthcare system has a significant discrepancy between the national tariff and the cost of global surgical procedures (GSPs). This study aimed to compare the actual costs of GSPs with national tariffs in Iran’s public hospitals. Methods: This retrospective cross-sectional study was conducted in 2017. Using the census method, 6126 GSPs performed in three public hospitals were investigated in this study. Additionally, national tariffs from the Supreme Council of Health Insurance were obtained. The tariff-cost gap was the discrepancy between a GSP’s actual costs and tariff. Multiple linear regression analysis determined factors affecting the tariff-cost gap. Results: The average actual cost of GSPs was 637 USD, while the average tariff was 495 USD. The reimbursement covered only 78% of the costs. The gap was higher in older (B=1.05, 95% CI: 0.76-1.35, P<0.001), females (B=26.7, 95% CI: 15.5-37.9, P<0.001), patients with a longer stay (B=81.2, 95% CI: 77.5-84.8, P<0.001), and procedures performed by full-time surgeons (B=67.3, 95% CI: 56.9-77.5, P<0.001). Furthermore, neurosurgery had the highest effect on forecasting the gap between actual costs and tariffs among surgical specialties (B=346.9, 95% CI: 214.3-479.5, P<0.001). Conclusion: Public hospitals suffer from large financial losses due to the national tariff for many GSPs not covering their actual costs. It is suggested that tariffs be increased for certain customer segments that can bear higher costs and global tariffs be adjusted to match actual service delivery costs.

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Exploring the changes of physicians' behaviour toward informal payment based on Health Transformation Plan in Iran: A qualitative study

Cited by 3 publications

References 41 publications

Reasons for informal payments from the perspective of health care providers and recipients: a qualitative study in Iran

Reasons for informal payments from the perspective of health care providers and recipients: a qualitative study in Iran

Fragmentation of payment systems: an in-depth qualitative study of stakeholders’ experiences with the neonatal intensive care payment system in Iran

The Gap Between the Actual Cost and Tariffs of Global Surgical Procedures: A Retrospective Cross-sectional Study in Qazvin Province, Iran

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