title: At first glance, informal payments experience on track: why accept or refuse? Patients' perceive in cardiac surgery department of public hospitals, northeast of Iran 2013.
abstract: Patient's Informal payments is among the main source of health care financing in some countries. This paper aimed at determining the patient informal payments and relative factors in Cardiac Surgery Departments (CSD) in hospitals affiliated to Mashhad University of Medical Sciences (MUMS) in 2013.
  
  
  
  In this cross-sectional study, 316 discharged patients were selected using multi-stage sampling. Data gathering tool was a questionnaire which was filled by structured telephone interviews. We used quantitative content analysis for open-ended questions besides descriptive statistics and nonparametric tests by SPSS 16 at 0.05 Sig level.
  
  
  
  Sixteen (5.93%) patients made voluntary informal payments. The purpose of payment was: "gratitude" (43.75%), satisfaction with health services provided" (31.25%) and (18.75%) for better quality of services. About 75% of the payments were occurred during receiving health care services. The main causes were "no request for informal payments" (98.14%), "not affording to pay for informal payments" (73.33%) and "paying the hospital expenses by taking out a loan" (55.91%). Responders said they would pay informally in demand situation (51.85%) just for patient's health priority, 40.71% would also "search for other alternative solutions" and 27.33% "accepted the demand as a kind of gratitude culture". Twenty four patients (8.9%) had experienced mandatory informal payments during the last 6 months. The minimum amount of payment was 62.5$ and the maximum was 3125$. There was a significant relationship between the way of referring to medical centers and informal patient's payment (P ≤0.05).
  
  
  
  Despite the widespread prevalent belief about informal payments in public hospitals -particularly to the well-known physicians - such judgment cannot be generalized. The main reasons for the low informal payments in the current study were the personality characteristics of the physicians and hospital staff, their moral conscience and commitment to professional ethics, cultural factors and social-economic status of the patients. Health care system should notify people about their rights specially the payments calculation mechanism and methods. Better communication with the public and especially the media can help to correct attitude toward these payments.
authors.affiliation: Department of Management Sciences and Health Economics, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Vafaei Najar
authors.affiliation: Department of Management Sciences and Health Economics, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Ebrahimipour
authors.affiliation: Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran. pourtaleba901@gmail.com.|School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. pourtaleba901@gmail.com.
authors.forename: Arefeh
authors.initials: A
authors.lastname: Pourtaleb
authors.affiliation: Biostatics and Epidemiology Department, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Habibollah
authors.initials: H
authors.lastname: Esmaily
authors.affiliation: Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.|School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Jafari
authors.affiliation: Department of Management Sciences and Health Economics, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Zohre
authors.initials: Z
authors.lastname: Nejatzadegan
authors.affiliation: Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Yasamin Molavi
authors.initials: YM
authors.lastname: Taleghani
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000191:economics* / Q000592:standards; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D005382:Financing, Personal / Q000191:economics / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards; D006779:Hospitals, Public / Q000191:economics; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D011787:Quality of Health Care / Q000191:economics / Q000592:standards; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Hospital; Informal payments; Iran; Mashhad