More than 70 Percent of Insured Patients are Paying Informally During Outpatient Visits? Country Wide Evidence from Iran

Abstract

Background: Reliance heavily on out-of-pocket (OOP) payments, including informal payments (IPs), to finance total health expenditure has undesired effects on financial risk protection and access to care. While a significant share of total health expenditure is spending on outpatient services, there is scant evidence of the amount paid informally by patient in outpatient services. Such evidence is available for inpatient services, showing high prevalence of informal payments, ranging from 7-10% in a hospital department to 20-48% in the whole hospital. This study aimed to investigate the extent of IPs for outpatient services in Iran.Methods: Data used were drawn from the 2015 IR. Iran’s Utilization of Health-care Services Survey, with a focus on all individuals with basic health insurance who were visited at least once by a physician in two private and public health care centers. The percentage of OOP and the frequency of IP were determined and the relationships between them and demographic variables were investigated.Results: The share that insured patients in Iran pay for a general practitioner (GP) visit was 38% in the public versus 61% in the private sector, while for a specialist practitioner visit the figures were 80% and 96%, respectively, which is higher that defined copayment (=30%). This share was significantly more in female, urban area, high educated people, private service providers, and specialist visits. The frequency of IPs also was 73% for a GP in the public versus 86% in the private sector, while for a specialist practitioner visit these were 90% and 93%, respectively. Conclusion: It seems that informal patient payments for outpatient services is more prevalent for outpatient service. Hence, more interventions are required to eliminate or control the IPs in outpatient services, particularly in private sector. In this regard, making a well-regulated market, reinforcing the referral system and developing an equity-oriented essential health services package would be fundamental.Trial registration: NA