The relationship between healthcare providers and patients is often marred by financial issues, which present significant ethical challenges. These financial interactions can be categorized into direct and indirect communications, both of which give rise to various ethical dilemmas. In direct financial communication, issues such as under-the-table payments, fee splitting, self-referral, inappropriate referrals, induced demand, and unnecessary surgeries or hospitalizations are prevalent. These practices compromise the ethical standards of medical care. On the other hand, indirect financial communication occurs when a small portion of the healthcare cost is paid by the patient, while the majority is covered by intermediary institutions like insurance companies or the Ministry of Health. The family physician system, with accurate patient referrals and cost management, supports this model. Under such a system, service tariffs align with actual costs, creating "real" tariffs, and reducing opportunities for many ethical challenges to arise. The current health system provides practical examples of the disconnection of financial relationships, notably through policies such as the Accident Insurance Law (Article 92 of the Fourth Development Plan) and the family physician system within the Imam’s Relief Committee. Health centers involved in treating injured patients and staffed with experienced personnel have observed and reported significant improvements following the implementation of the Accident Insurance Law, highlighting the positive impact of financial disconnection on healthcare ethics. This study demonstrates that cutting financial ties between doctors and patients, through indirect financial communication models and accurate referral systems, is an effective solution to addressing a wide range of ethical challenges in healthcare.
