by Ali Reza Yusefi, Jamshid Bahmaei Background Informal patient payments remain a persistent and multifaceted challenge in many health systems, particularly in low- and middle-income countries. These payments, often made outside official channels, can undermine equity, transparency, and trust in healthcare delivery.
This qualitative study aimed to explore the underlying causes of informal payments and identify feasible management strategies from the perspectives of key stakeholders. Methods This applied study was conducted using a qualitative method and semi-structured interviews between September 10, 2024, and January 17, 2025.
A total of 31 participants, including senior policymakers from the Ministry of Health, hospital managers, medical specialists, nursing managers, hospital supervisors, health economics and healthcare management faculty members, and patients with experience of informal payments in Iranian hospitals, were selected through purposive and snowball sampling methods. Latent content analysis was employed for data analysis, and MAXQDA software (version 2022) was used to extract the main and subcategories.
Results Six main themes and 39 subcategories were identified regarding the causes of informal patient payments.
PLOS ONE (Medicine) published a clinical update in Research Highlights on 22 May 2026.
The item focuses on Exploring drivers and management strategies of informal patient payments in hospitals: A qualitative study in Iran.
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