Informal Payment in Health Settings: A Survey of Teaching Hospitals

Document Type : Research Paper


1 Health Human Resources Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran

2 Shiraz University of Medical Sciences, Shiraz, Iran

3 Student Research Committee, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran


Background and Objectives: Informal payment in the health settings is a significant challenge facing the health system, with consequences such as inequity in access to healthcare services, distrust to health care system, and dissatisfied customers. Detailed identification of the nature of the problem is perquisite to developing relevant overcoming strategies. Given that, this study aimed at providing information on the frequency of informal payment in teaching hospitals and exploring the factors influencing this phenomenon.   Methods: A sample of 201 patients was selected from Surgical, Internal, and Emergency departments and ICU and CCU of teaching hospitals of Shiraz University of Medical Sciences to participate in the study. A researcher-designed questionnaire was used as the study tool. Chi-square test was applied for examining the significance of the differences.   Findings: Of the total patients surveyed, 41 (20%) experienced informal payment. Cash offering was the most frequent form of payment (39%). More than half of the payments have been done in Emergency department (51.2 %) followed by Internal (17.1 %) and Surgery (12.2 %) departments. The informal payment was found to be significantly more prevalent among the primarily insured patients (P < 0.05). No significant relationship between demographic variables and informal payment frequency was identified.   Conclusions: This study identified the Emergency department as the area of focus for controlling informal patient in health care system. The finding that insured patients are more exposed to informal payment request encourages further studies to identify the causative factors.