The Reasons for Informal Payments in Hospitals: A Qualitative Study in Iraq

The responsibility of health systems has evolved to encompass not only the improvement of individuals' health but also the protection of their financial well-being against the costs of illness. However, many healthcare systems worldwide have experienced the issue of informal payments, which is considered a significant challenge to the credibility of medical professionals. The reasons for these payments vary across different regions. To tackle this issue, the current research was carried out in 2021 to examine the factors contributing to unofficial payments within healthcare facilities situated in Erbil, Iraq.

The present study utilized a qualitative, applied research approach, employing semi-structured interviews as the primary data collection method. The sample consisted of 60 patients, doctors, and policymakers from Erbil, Iraq, who were selected based on targeted criteria. Informed consent was obtained from all participants, and the study was conducted with the approval of the Medical Ethics Council of Hawler Medical University. During the interviews, participants were asked about their reasons for engaging in informal payments, and the collected data were analyzed using content analysis techniques.

Patients' perspectives on informal payments suggest that legal, cultural, and quality-related factors are influential in their decision to make such payments. On the other hand, doctors and policymakers revealed several reasons for receiving informal payments from healthcare providers, including structural, ethical, and tariff-related issues, as well as those that demonstrate the provider's expertise and competence.

Understanding the reasons behind informal payments is crucial in addressing and ultimately eradicating them. This research has discovered the reasons behind unofficial payments in Iraq's healthcare system. An extensive grasp of the requirements and driving forces behind healthcare providers and recipients can efficiently identify and eradicate this practice. Policymakers who possess a thorough comprehension of the consequences associated with these payments can make more informed decisions, ensuring a collectively agreed-upon policy approach. Enhancing the wages of healthcare professionals in Iraq, taking into account their performance and expertise, and introducing payment systems that are tied to performance can play a crucial role in mitigating this issue. Additionally, promoting professional ethics training fosters trust and mutual understanding among individuals while highlighting the negative impacts of bribery.