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Table 4 Themes and subthemes related to causes and practical solutions of IPs

From: Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran

ThemeFactors associated with IPsProposed practical solution
Modifying, adjusting and applying policy interventionsImplementing proper reforms and programsEstablishing a referral system and family physician program.
Eliminating the direct relationship between a patient and a provider.
Using Clinical and Ethical Guidelines.
Timely yearly notification of tariffs.
Increasing the share of health funding from the public budget.
Trust to the healthcare systemIncreasing transparency in processes in the health system.
Culture makingInstitutionalization of professional ethics.
Changing the culture of gratitude through informal payments.
Mechanisms of tariffs settingRationalization of medical tariffs.
Setting medical tariffs based on the total cost.
Payment systemRatification of financing and payment system.
Avoiding any payment inequity between different medical groups.
Public and private regulationsPreventing the employment of physicians in both public and private sectors (avoiding dual practice).
Supervision, Monitoring and EvaluationMechanisms of monitoring and supervisionOrganizing systematic supervision, monitoring and evaluation.
The proper response to patients’ complaints and following up the demand.
The role of MoHME’s in supervision.
The supportive role, control and supervision of the Medical Council.
Mechanisms of reward and punishmentLegislation, preventative regulation conforming with the amount of impact.
Strict and efficient dealing with offenders and issuing timely warnings.
Actors and StakeholdersRole of actors and stakeholdersThe supportive role of insurance organizations from physicians and patients.
Using the suggestions and advice of all stakeholders.
Professional responsibility.
Informing patients and other stakeholders.
Policy advocacyStrengthening the role of stewardship, regulation and policymaking of MoHME.
Avoiding any discrimination in the medical community.
Suitable distribution of resources in the healthcare system.
Health Insurance organizations approachAvoid reimbursement delays in insurance claims.
Effective coverage of people.