Health informal payments and their main determinants: The case of Iran

Abstract

Introduction: Informal payments are a serious obstacle to equitable access and universal health coverage in developing countries. This study aimed to identify the most important factors affecting health informal payments in Iran. Methodology: The cross-sectional and descriptive-analytical study was carried out on a study population of all Iranians who, at least once over the past year (i.e. 2017), had received healthcare services and were exposed to paying health informal payments. A sample of 1477 households was selected using a multi-stage stratified-cluster sampling method. The required data were collected using a researcher-made questionnaire and completed by face-to-face interviews with the heads of households. The main factors affecting the odds of making informal payments were identified using the Ordered Logistic Regression model. Results: Having basic health insurance coverage, awareness of health insurance entitlements, education, perceived behavioral control, and the pattern of health service utilization had, respectively, the highest effects on the odds of making informal payments for healthcare. The odds of making informal payments for patients with no awareness of the health insurance entitlements were 3.5, 3.6, and 6.7 times more than those with low, medium, and high awareness, respectively (Odds Ratio = 3.58, 3.69, 6.74; P < 0.001). Conclusion: The health policymakers, in addition to improving service financing, should plan to increase patients’ awareness, correct their false beliefs, change their attitudes, and improve social participation regarding health informal payments in order to reduce such transactions.