The Analysis of Informal Payments Among Hospitals Covered Under Tehran University of Medical Sciences(TUMS)2009.

Informal health payment in several middle and low income countries is a serious impediment to health care reform. This payment is effectively a form of systemic corruption. Informal health payments have adverse impact on access and utilization of health services, efficiency, quality and equity. Informal payments lead to false information about the real costs of disease and the patient share of these costs and consequently wrong government policies. The objective of this paper is analyses of informal payments among hospitals covered under Tehran University of medical sciences (TUMS) 2009. In this cross- sectional study, we used random sampling and selected finally 3 hospitals. Then in a simple random sampling, we recruited 300 discharged patients from general,surgery, emergency, ICU & CCU wards. All of the data are collected by interview and questionnaire.We analyzed data with Chi- Square, T-test, Annova, Bonferroni. According to the findings, Of the total 300 respondents in the study sample, about 3.7% had requested informal payment. 21% of respondents reported at least one informal payment. Cash payments constituted the bulk of total informal payment (88.8%). In the majority of the cases, the Patient paid for appreciation (55.6%). All of the people who had paid informal payment, it has been paid to the servant and maid, Only in one case, in addition to the servant and maid, the Guardian has also been paid. None of the socio-economic characteristics of the family, Insurance status, type of referral, payment form (voluntary or solicited) were related to the size of informal payments. And there is a relationship between length of stay and size of informal payment (p-value=0.015). There isnt relationship between these factors- except marital status(p-value=0.042) - and frequency of informal payments. It seems that training about informal payments properly, increasing health sector resources, increasing official income levels, improving quantity and quality of health services and Trying to change the opinions which believes informal payments are necessary (changing culture) can be effective in controlling informal payments.