title: Factors affecting the informal payments in public and teaching hospitals.
abstract: BACKGROUND
  Informal payments in the health sector of many developing countries are considered as a major impediment to health care reforms. Informal payments are a form of systemic fraud and have adverse effects on the performance of the health system. In this study, the frequency and extent of informal payments as well as the determinants of these payments were investigated in general hospitals affiliated to Tehran University of Medical Sciences.
  
  
  METHODS
  In this cross-sectional study, 300 discharged patients were selected using multi-stage random sampling method. First, three hospitals were selected randomly; then, through a simple random sampling, we recruited 300 discharged patients from internal, surgery, emergency, ICU & CCU wards. All data were collected by structured telephone interviews and questionnaire. We analyzed data using Chi- square, Kruskal-Wallis and Mann-Whitney tests.
  
  
  RESULTS
  The results indicated that 21% (n=63) of individuals paid informally to the staff. About 4% (n=12) of the participants were faced with informal payment requests from hospital staff. There was a significant relationship between frequency of informal payments with marital status of participants and type of hospitals. According to our findings, none of the respondents had informal payments to physicians. The most frequent informal payments were in cash and were made to the hospitals' housekeeping staff to ensure more and better services. There was no significant relationship between the informal payments with socio-demographic characteristics, residential area and insurance status.
  
  
  CONCLUSIONS
  Our findings revealed that many strategies can be used for both controlling and reducing informal payments. These include training patients and hospitals' staff, increasing income levels of employees, improving the quantity and quality of health services and changing the entrenched beliefs that necessitate informal payments.
authors.affiliation: PhD, Department of Health Economics, School of Health Management and information Sciences, Iran University of Medical Sciences, Tehran, Iran. a.abutorabi@yahoo.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Aboutorabi
authors.affiliation: PhD student of Healthcare Management, Department of Health Management & Economics, School of Health Sciences, Tehran University of Medical Sciences, Tehran, Iran. m.ghiasipour@gmail.com.
authors.forename: Maryam
authors.initials: M
authors.lastname: Ghiasipour
authors.affiliation: PhD, Department of Health Economics, School of Health Management and Information Sciences & Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran. rezapoor_a57@yahoo.com.
authors.forename: Aziz
authors.initials: A
authors.lastname: Rezapour
authors.affiliation: PhD, Department of Health Management & Economics, School of Health Sciences, Tehran University of Medical Sciences, Tehran, Iran. abolghasem.p@yahoo.com.
authors.forename: Abolghasem
authors.initials: A
authors.lastname: Pourreza
authors.affiliation: MSc of Public Administration, Department of Management Development and Resource Planning, Iran University of Medical Sciences, Tehran, Iran. ali.sarabi@gmail.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Sarabi Asiabar
authors.affiliation: PhD, Department of Microbiology, Faculty of Medical Sciences, Maragheh University of Medical Sciences, Maragheh, Iran. tanomanda@yahoo.com.
authors.forename: Asghar
authors.initials: A
authors.lastname: Tanoomand
keywords: Corruption; Informal payment; Iran; Under the table payment