1- Department of Public Health, Sirjan School of Medical Sciences, Sirjan, Iran
2- Department of Public Health, Behbahan Faculty of Medical Sciences, Behbahan, Iran ,jamshidbahmei@gmail.com
3- Tehran University of medical sciiences
2- Department of Public Health, Behbahan Faculty of Medical Sciences, Behbahan, Iran ,
3- Tehran University of medical sciiences
Abstract: (30 Views)
Background: Informal payments in healthcare are a major economic, social, and ethical challenge that can undermine equity in access to healthcare services and weaken public trust in the health system. This study aimed to explore patients' lived experiences of informal payments in Iranian hospitals.
Methods: This qualitative phenomenological study was conducted in 2025 across 12 public teaching hospitals in Tehran, Iran. Twenty-eight patients with experience of making or encountering informal payments were recruited using purposive sampling with maximum variation. Data were collected through in-depth semi-structured telephone interviews and analyzed using Colaizzi's seven-step phenomenological method. The trustworthiness of the findings was established according to Guba and Lincoln's criteria.
Results: Analysis of the interviews generated 17 subcategories and six major themes: encounters with informal payment requests, perceived coercion to pay, seeking psychological reassurance, psychological and social consequences of informal payments, perceived injustice in the healthcare system, and normalization and social acceptance of informal payments.
Conclusion: Informal payments create a complex and multidimensional experience for patients that extends beyond financial burden to undermine trust and perceptions of equity in healthcare. Developing transparent policies, strengthening regulatory oversight, and improving accountability within healthcare organizations may reduce informal payments, enhance public trust, and promote equitable healthcare delivery across the health system in Iran.
Methods: This qualitative phenomenological study was conducted in 2025 across 12 public teaching hospitals in Tehran, Iran. Twenty-eight patients with experience of making or encountering informal payments were recruited using purposive sampling with maximum variation. Data were collected through in-depth semi-structured telephone interviews and analyzed using Colaizzi's seven-step phenomenological method. The trustworthiness of the findings was established according to Guba and Lincoln's criteria.
Results: Analysis of the interviews generated 17 subcategories and six major themes: encounters with informal payment requests, perceived coercion to pay, seeking psychological reassurance, psychological and social consequences of informal payments, perceived injustice in the healthcare system, and normalization and social acceptance of informal payments.
Conclusion: Informal payments create a complex and multidimensional experience for patients that extends beyond financial burden to undermine trust and perceptions of equity in healthcare. Developing transparent policies, strengthening regulatory oversight, and improving accountability within healthcare organizations may reduce informal payments, enhance public trust, and promote equitable healthcare delivery across the health system in Iran.
Keywords: Informal Payments, Health Expenditures, Patients, Hospitals, Qualitative Research, Health Equity.
Type of Study: Research |
Subject:
Special
Received: 2026/06/26 | Revised: 2026/11/9 | Accepted: 2026/11/9
Received: 2026/06/26 | Revised: 2026/11/9 | Accepted: 2026/11/9
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