Predictors of Informal Health Payments: The Example from Turkey

Özgen, Hacer; Şahin, Bayram; Belli, Paolo; Tatar, Mehtap; Berman, Peter

doi:10.1007/s10916-008-9251-8

Cited by 35 publications

(61 citation statements)

References 21 publications

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“…Some studies have reported a meaningful relationship between informal payment behavior with gender, age, educational level, place of residence, health insurance coverage and household economic status (6,13,22,(38)(39)(40)(41)(42). This discrepancy in the results can be attributed to the study setting (hospi- tal or household), the type of surveyed patients, country of study, and the data analysis methods.…”

Section: Discussionmentioning

confidence: 99%

Informal Payments for Inpatient Services and Related Factors: A Cross-Sectional Study in Tehran, Iran

et al. 2018

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Background: Informal payments, as one of the components of out-of-pocket (OOP) payments, are often a form of corruption and outside the official bill. The purpose of the present study was to investigate the frequency of informal payments for inpatient services and its related factors in Tehran, Iran. Methods: In this cross-sectional study, the samples included 450 patients who were admitted to hospital's clinics affiliated to Shahid Beheshti University of Medical Sciences in Tehran, to receive follow-up and post-surgical care. After obtaining patient consent, data were collected via a 28-item questionnaire included two parts of patient's demographic characteristics and informal payments experience that it's validity and reliability were confirmed. Data were analyzed using descriptive statistics and regression analyses in SPSS 16 software. Results: The findings showed 21.1% of the patients had informal payments, paid voluntarily, mostly in cash, for service's staff, in public hospitals, after discharge and, due to the employees' proper behavior and attention. The average informal payments per patient were 5,304,630 IRR (175.4 USD). There was no significant relationship between the informal payment behavior and the patient demographics characteristics (P > 0.05). Conclusions: Despite the efforts made in the HTP to eliminate informal payments in inpatient services, the goal has not been fully realized. A part of the payments was paid at the provider's request and before the patient's admission that these compulsory informal payments are illegal and unethical and therefore, must be controlled and eradicated. Policymakers can take steps to reduce informal payments by improving the healthcare quality, supervision, setting salary and benefits, enforcing laws, and increasing staff incentives.

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Section: Discussionmentioning

confidence: 99%

Informal Payments for Inpatient Services and Related Factors: A Cross-Sectional Study in Tehran, Iran

et al. 2018

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“…Informal payment is a part of out of pocket payments and it is a distinctive feature of health systems in many countries around the world [5]. Such a payment is a source of inequity and inefficiency in a health system [6].…”

Section: Introductionmentioning

confidence: 99%

At first glance, informal payments experience on track: why accept or refuse? Patients’ perceive in cardiac surgery department of public hospitals, northeast of Iran 2013

Najar

Ebrahimipour

Pourtaleb

et al. 2017

BMC Health Serv Res

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BackgroundPatient’s Informal payments is among the main source of health care financing in some countries. This paper aimed at determining the patient informal payments and relative factors in Cardiac Surgery Departments (CSD) in hospitals affiliated to Mashhad University of Medical Sciences (MUMS) in 2013.MethodsIn this cross-sectional study, 316 discharged patients were selected using multi-stage sampling. Data gathering tool was a questionnaire which was filled by structured telephone interviews. We used quantitative content analysis for open-ended questions besides descriptive statistics and nonparametric tests by SPSS 16 at 0.05 Sig level.ResultsSixteen (5.93%) patients made voluntary informal payments. The purpose of payment was: “gratitude” (43.75%), satisfaction with health services provided” (31.25%) and (18.75%) for better quality of services. About 75% of the payments were occurred during receiving health care services. The main causes were “no request for informal payments” (98.14%), “not affording to pay for informal payments” (73.33%) and “paying the hospital expenses by taking out a loan” (55.91%). Responders said they would pay informally in demand situation (51.85%) just for patient’s health priority, 40.71% would also “search for other alternative solutions” and 27.33% “accepted the demand as a kind of gratitude culture”. Twenty four patients (8.9%) had experienced mandatory informal payments during the last 6 months. The minimum amount of payment was 62.5$ and the maximum was 3125$. There was a significant relationship between the way of referring to medical centers and informal patient's payment (P ≤0.05).ConclusionDespite the widespread prevalent belief about informal payments in public hospitals —particularly to the well-known physicians — such judgment cannot be generalized. The main reasons for the low informal payments in the current study were the personality characteristics of the physicians and hospital staff, their moral conscience and commitment to professional ethics, cultural factors and social-economic status of the patients. Health care system should notify people about their rights specially the payments calculation mechanism and methods. Better communication with the public and especially the media can help to correct attitude toward these payments.

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“…Although the importance of data on informal patient payments is universally recognized, there have been few attempts to study this phenomenon, especially in the context of Iran (1,18). This might be due to the challenges involved in data collection, given the informal and potentially sensitive nature of the topic (3,19,20). To fill this knowledge gap, this paper aimed to identify the motivations behind informal payments in Iran, how informal payments are perceived and why they are made in the health system of Iran from the perspectives of patients, health care providers and officials.…”

Section: Introductionmentioning

confidence: 99%

Informal Payments in Healthcare: A Case Study of Kerman Province in Iran

Nekoei‐Moghadam

Esfandiari

Ramezani

et al. 2013

Int J Health Policy Manag

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Background: Informal payments for health care, which are common in many countries, can have negative effects on health care access, equity and health status as they lead people to forgo or delay seeking care, or to sell assets to pay for care. Many countries are putting reforms in place with the aim of reducing informal payments. In order to be successful, such policies should be informed by the underlying causes of such payments. This study attempts to explore why, how, and in what ways informal payments occur. Methods: We conducted face-to-face interviews with a purposeful sample of 45 participants, including patients, healthcare providers and officials, in Kerman province in Iran, in 2010. The research participants were asked about the nature of informal payments, the reasons behind both asking and making those payments. We analysed the data using content analysis. Results: We found that people make informal payments for several reasons, namely cultural, qualityrelated and legal. Providers ask for informal payments because of tariffs, structural and moral reasons, and to demonstrate their competence. Informal payments were found to be more prevalent for complex procedures and are usually asked for directly. Conclusion:Informal payments are present in Iran's health system as in other countries. What makes Iran's condition slightly different from other countries is the peculiarity of reasons behind asking informal payments and the disadvantages associated with these kinds of payments. Iran could overcome this dilemma by precise investigation of the reasons to inform appropriate policy formulation. Some policies such as raising salaries, justifying the tariffs and cost-sharing, defining a benefits package of services, and improving accountability and transparency in the health system could be taken by the government to alleviate the problem.

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Predictors of Informal Health Payments: The Example from Turkey

Cited by 35 publications

References 21 publications

Informal Payments for Inpatient Services and Related Factors: A Cross-Sectional Study in Tehran, Iran

Informal Payments for Inpatient Services and Related Factors: A Cross-Sectional Study in Tehran, Iran

At first glance, informal payments experience on track: why accept or refuse? Patients’ perceive in cardiac surgery department of public hospitals, northeast of Iran 2013

Informal Payments in Healthcare: A Case Study of Kerman Province in Iran

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