Aims One of important and considerable topics in medical jurisprudence, the amount of money is that the physician receives for his or her medical treatment; But an important issue when is that the physician or other medical staff misuses does misuse from the patient and forbids that he/she selects in a manner freely and consciously and become the relationship between the physician and the patient to the amoral and emergency relationship; The unpleasant and ominous phenomenon that is seen today in the name of stealthy; Therefore, in order to protect the rights of the patient, This article seeks to answer the question of what are the consequences and legal effects of the unofficial PAYMENT, and what are the remedies and solutions to combat this problem in the just Islamic system? Methods In this study, in order to answer the research questions, it were described and analyzed based on the jurisprudents of Imamiya jurisprudence and internal rules and regulations. Findings Individuals dominate their property; so according to the narrative of ‘ it is not permissible for a Muslim to have money except for oneself’ , domination and capture of the person’ s property without their satisfaction is forbidden. Conclusion The challenging phenomenon of receive INFORMAL PAYMENT with any motivation will be accompanied by the spread of injustice and disorder in human society that is not in accordance with the Justice-centered system of Islam. Therefore, the right of claim for material and spiritual damages for patient or the patient’ s parents will be provided as rule of ‘ any money has void’ . In the light of measures such as loyalty to covenant, promotion of economic culture and ethics, awareness of citizenship rights, it is possible to direct the health system on the path of correct growth and training.

Background: INFORMAL PAYMENTs can cause delayed access to health care services, forcing people to sell their properties for cost of treatment; and as a result, they lose trust in the health system. Considering the importance of this issue, this study was conducted in 2016 to identify solutions to reduce and eliminate INFORMAL PAYMENTs in Iran’ s health system. Methods: Initially, solutions to reduce INFORMAL PAYMENTs were extracted by reviewing resources and searching Persian and Englishlanguage databases including Science direct, PubMed, Scopus, Medline, ISC, Magiran, SID using the following keywords: INFORMAL PAYMENTs, under the table PAYMENT, bribes, gratitude PAYMENT, and INFORMAL PAYMENTs/fees. Then, Iranian context specific solutions were obtained by performing semi-structured interviews with 19 individuals, who were aware of the problem. Next, the identified strategies were confirmed using Delphi technique and with the participation of 50 experts. Results: Various solutions were identified and confirmed to reduce or eliminate INFORMAL PAYMENTs in Iran’ s health system, which are divisible in different economical fields, such as PAYMENTs to providers based on performance, religious leaders’ fatwa (sociocultural), disclosing the offenders’ names (legal-political), and using family doctor system (structural). Conclusion: The proposed solutions can be used by policymakers and managers in the health sector to manage INFORMAL PAYMENTs. Careful identification of health care providers and recipients’ motivations and needs can be effective in recognizing and eliminating this phenomenon.

Background: INFORMAL health PAYMENT in several middle and low income countries is a serious impediment to health care reform. This PAYMENT is effectively a form of systemic corruption. INFORMAL health PAYMENTs have adverse impact on access and utilization of health services, efficiency, quality and equity. INFORMAL PAYMENTs lead to false information about the real costs of disease and the patient share of these costs and consequently wrong government policies. The objective of this paper is analyses of INFORMAL PAYMENTs among hospitals covered under Tehran University of medical sciences (TUMS) 2009.Materials & Methods: In this cross- sectional study, we used random sampling and selected finally 3 hospitals. Then in a simple random sampling, we recruited 300 discharged patients from general, surgery, emergency, ICU & CCU wards. All of the data are collected by interview and questionnaire. We analyzed data with Chi- Square, T-test, Annova, Bonferroni.Results: According to the findings, of the total 300 respondents in the study sample, about 3.7% had requested INFORMAL PAYMENT. 21% of respondents reported at least one INFORMAL PAYMENT. Cash PAYMENTs constituted the bulk of total INFORMAL PAYMENT (88.8%). In the majority of the cases, the Patient paid for appreciation (55.6%). All of the people who had paid INFORMAL PAYMENT, it has been paid to the servant and maid, Only in one case, in addition to the servant and maid, the Guardian has also been paid. None of the socio-economic characteristics of the family, insurance status, type of referral, PAYMENT form (voluntary or solicited) were related to the size of INFORMAL PAYMENTs. And there is a relationship between length of stay and size of INFORMAL PAYMENT (p-value=0.015). There isn't relationship between these factors- except marital status (p-value=0.042) - and frequency of INFORMAL PAYMENTs.Conclusion: It seems that training about INFORMAL PAYMENTs properly, increasing health sector resources, increasing official income levels, improving quantity and quality of health services and Trying to change the opinions which believes INFORMAL PAYMENTs are necessary (changing culture) can be effective in controlling INFORMAL PAYMENTs.

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. Conclusion: 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.

Aim: According to the negative impact of INFORMAL PAYMENT on the efficiency and equity of the health care system and considering the catastrophic expenditures made for poor and vulnerable groups, this study was conducted to investigate INFORMAL PAYMENTs and the associated factors in the educational hospitals affiliated with Shiraz University of Medical Sciences. Methods: The statistical population of the present descriptive-analytical study was all patients who were discharged from the teaching hospitals of Shiraz University of Medical Sciences (10 hospitals) in a specific month of the year 2018 (June). The sampling method was stratified random and 336 people were selected. Data collection tools were a questionnaire and a telephone interview with the patient or the patient's family. The questionnaire consisted of 40 questions in 6 sections. Data were analyzed by using SPSS software version 23, the T-test, ANOVA, and Pearson correlation coefficient. Results: The present findings show that the most INFORMAL PAYMENTs were payed to the physicians and then the nurses. Among the physicians, general surgeons (1241+236. 12) ghestiorthopedic specialists (1041+193. 64), and urologists (561+89. 59) have received the h level, amount, respectively. Other findings indicate that the variables of household income ormalfplace of residence and physician's specialty significantly affected the amount of in. (PAYMENT (P<0. 05 Conclusion: According to the results of the present study and in order to manage INFORMAL malrPAYMENTs, health managers and policymakers should plan for identifying the causes of info. PAYMENT and designing effective interventions

Background: One of the objectives of the health transformation plan (HTP) in Iran is to reduce out-of-pocket (OOP) PAYMENTs for inpatient services and eradicate INFORMAL PAYMENTs. The HTP has three phases: the first phase (launched in May 5, 2014) is focused on reducing OOP PAYMENTs for inpatient services; the second phase (launched in May 22, 2014) is focused on primary healthcare (PHC) and the third phase utilizes an updated relative value units for health services (launched in September 29, 2014) and is focused on the elimination of INFORMAL PAYMENTs. This aim of this study was to determine the OOP PAYMENTs and the frequency of INFORMAL cash PAYMENTs to physicians for inpatient services before and after the HTP in Kurdistan province, Iran.Methods: This quasi-experimental study used multistage sampling method to select and evaluate 265 patients discharged from hospitals in Kurdistan province. The study covered 3 phases (before the HTP, after the first, and third phases of the HTP). Part of the data was collected using a hospital information system form and the rest were collected using a questionnaire. Data were analyzed using Fisher exact test, logistic regression, and independent samples t test.Results: The mean OOP PAYMENTs before the HTP and after the first and third phases, respectively, were US$59.4, US$17.6, and US$14.3 in hospital affiliated to the Ministry of Health and Medical Education (MoHME), US$39.6, US$33.7, and US$13.7 in hospitals affiliated to Social Security Organization (SSO), and US$153.3, US$188.7, and US$66.4 in private hospitals. In hospitals affiliated to SSO and MoHME there was a significant difference between the mean OOP PAYMENTs before the HTP and after the third phase (P<.05). The percentage of INFORMAL PAYMENTs to physicians in hospitals affiliated to MoHME, SSO, and private sector, respectively, were 4.5%, 8.1%, and 12.5% before the HTP, and 0.0%, 7.1%, and 10.0% after the first phase. Contrary to the time before the HTP, no INFORMAL PAYMENT was reported after the third phase.Conclusion: It seems that the implementation of the HTP has reduced the OOP PAYMENTs for inpatient services and eradicated INFORMAL PAYMENTs to physician in Kurdistan province.

Backgrounds and objective: INFORMAL PAYMENTs are paid to individuals and organizations offering health services, either in cash or non-cash and are formed outside formal PAYMENT channels. The aim of current research is the study of identifying the ways of INFORMAL PAYMENTs, causes, effects and policies dealing with it. Methods: This paper is a review study, based on articles identified by search on authoritative sites (Medlib, SID, Pub Med, Science Direct and Google Scholar) using keywords (INFORMAL PAYMENT and unofficial PAYMENT), in which 128 articles were extracted and refined step by step. Finally, 20 articles were selected according to aims of the study. Findings: The findings of this study consist of five important sections, which include the definition of INFORMAL PAYMENTs, the existence causes of INFORMAL PAYMENTs, effects of INFORMAL PAYMENTs, and statistics of INFORMAL PAYMENTs in the world and Iran and policies of dealing with INFORMAL PAYMENTs. Conclusion: Due to the high prevalence of INFORMAL PAYMENTs and severe negative effects on justice and good governance, policy-makers must focus on this issue and decrease such effects. Although strategies to control INFORMAL PAYMENTs are limited, following strategies are proposed: Regulation PAYMENT and medical tariffs, regulating power abuse, providing incentives and increasing feeling of responsibility for healthcare professionals, and changes in public perception. Key word: INFORMAL PAYMENT, formal PAYMENT. Cash and non-cash PAYMENTs.

INFORMAL PAYMENTs in clinics raise ethical concerns in healthcare delivery. This cross-sectional questioner survey aims to evaluate the prevalence and related factors of INFORMAL PAYMENT in healthcare system in Iran.The study was carried out in 2013, prior to the implementation of the government' Health System Reform among physicians with different specialties. The questionnaire were distributed among the participants during the congresses and continuing medical education programs.In results; of the total specialist physicians, 276 returned the questionnaires. The response rate was 81.17%. and out of 276 returned questionnaires 257 fulfilled the inclusion criteria. The prevalence of INFORMAL PAYMENTs, among the physicians who were susceptible to receiving INFORMAL PAYMENTs, was relatively high (63.8%). The physicians who practiced in the private sector, as well as physicians who practiced in Tehran and those who had a positive attitude towards the INFORMAL PAYMENTs, received more INFORMAL PAYMENTs. From the viewpoint of the respondents, the main cause of INFORMAL PAYMENTs was unrealistic/unfair tariffs and the main consequence of INFORMAL PAYMENTs was the rising costs of patient care. This study showed that, unfortunately, more than half of the participants did not believe or did not decisively consider INFORMAL PAYMENTs as unethical. This confirms the importance of physicians’ education about the unethical practice of INFORMAL PAYMENTs. However, compare to private sectors, more supervision in public sector may be the main cause of less prevalence of INFORMAL PAYMENTs in public hospitals. In conclusion: Developing ethical guidelines to prevent INFORMAL PAYMENTs as well as more realistic and fair tariffs would help to decrease the incidence of INFORMAL PAYMENTs.

Background: INFORMAL PAYMENTs, as one of the components of out-of-pocket (OOP) PAYMENTs, are often a form of corruption and outside the official bill. The purpose of the present studywasto investigate the frequency of INFORMALPAYMENTsfor inpatient services and its related factors in Tehran, Iran. Methods: In this cross-sectional study, the samples included 450patientswhowere admitted to hospital’ s clinics affiliated to Shahid Beheshti University of Medical Sciences in Tehran, to receive follow-up and post-surgical care. After obtaining patient consent, data were collected via a 28-item questionnaire included two parts of patient’ s demographic characteristics and INFORMAL PAYMENTs experience that it’ s validity and reliability were confirmed. Data were analyzed using descriptive statistics and regression analyses in SPSS 16 software. Results: The findings showed 21. 1% of the patients had INFORMAL PAYMENTs, paid voluntarily, mostly in cash, for service’ s staff, in public hospitals, after discharge and, due to the employees’ proper behavior and attention. The average INFORMAL PAYMENTs per patient were 5, 304, 630 IRR (175. 4 USD). Therewasnosignificant relationshipbetweenthe INFORMALPAYMENTbehaviorandthe patient demographics characteristics (P > 0. 05). Conclusions: Despite the efforts made in the HTP to eliminate INFORMAL PAYMENTs in inpatient services, the goal has not been fully realized. A part of the PAYMENTs was paid at the provider’ s request and before the patient’ s admission that these compulsory INFORMAL PAYMENTs are illegal and unethical and therefore, must be controlled and eradicated. Policymakers can take steps to reduce INFORMAL PAYMENTs by improving the healthcare quality, supervision, setting salary and benefits, enforcing laws, and increasing staff incentives.

Background: One of the main goals of health sector evolution plan is reducing the amount of out of pocket PAYMENT by patients receiving hospital services in public sectors. This study aimed to assess the amount of out of pocket PAYMENT by inpatients in public hospitals affiliated to Shahid Beheshti University of Medical Science in Tehran city in 2015.Materials and Methods: In this cross-sectional study, 405 discharged patients from four public and teaching hospitals were selected using convenient sampling method. Data were collected using a researcher made checklist and investigating the hospital bills. In order to data analysis, descriptive statistics and regression analysis were utilized through SPSS Software version16.Results: The amount of out of pocket PAYMENT was 10.2 percent included 9.9 percent formal PAYMENT, 0.2 percent bought & brought goods and 0.1 percent INFORMAL PAYMENT. The most portion of the hospital costs was related to medical supplies and pharmaceuticals, surgeries services and hosteling with 32.6, 20.6 and 17.36, respectively. Type of hospital, having surgery, average length of stay, family size and gender had significant effect on the out of pocket PAYMENT amount (p£0.05).Conclusion: The amount of out of pocket PAYMENT by inpatient in public hospitals was in accordance with goal of the health sector evolution plan, which reveals the appropriate government support. It is recommended to tailor and implement enormous plans regarding outpatients and private sector in national level to attain sustained reduction in out of pocket PAYMENT.