Journal of

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Background: The different effective factors on out of pocket payment (OOP)have been introduced as follows: low salary of the employee's, low governmental tariff, chronic disease, gifts to personnel, physician and other cadre's requests, fear of bad or no services. In addition OOP has negative effects on the accessibility of services .This article studies the distribution of effective factors on OOP (formal and informal) through cardiac patients and its side effects.
Materials & Methods: This is a descriptive-exploratory study. The data were collected byinterviews and questionnaires reliability of which was approved by specialists and their validity were approved by simulation-in Shahid Madani hospital in Tabriz in the winter of 2010.
Results: all the persons studied had an experience of OOP. Formal payments included the free cost of the services with no insurance cover and the margin between the tariff and the rate that the physician or the hospital declares (83% of OOP). In addition 10% of persons encountered informal payments 80% of which was due to the physician's request and 20%as a gift. The results describes the OOP`s side effects so that 52% of patients faced a postpone in getting services because of the OOP and 72% pointed that OOP has had an enormous effect on providing the necessary needs of the families.
Conclusion: The high rate of OOP and the weak performance of insurance system will result in injustice and intensifies the unfavorable effects of OOP on the health system and society.

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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.