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Vol. 11 No. 40 (1396)

July 2017

عوامل مؤثر بر پرداخت‌های غیر رسمی در نظام‌های سلامت: مرور نظام‌مند

  • رضا جهانگیری
  • آیدین آرین خصال

akhlāq-i pizishkī i.e., Medical Ethics, Vol. 11 No. 40 (1396), 17 July 2017 , Page 73-92
https://doi.org/10.22037/mej.v11i40.17983 Published: 2017-07-24

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Abstract

زمینه و هدف: پرداخت‌های غیر رسمی پدیده‌ای است که نظام سلامت بسیاری از کشورها با آن رو به رو بوده‌اند. این مرور نظام‌مند با هدف شناسایی ماهیت و انواع پرداخت‌های غیر رسمی و علل آن انجام شده است.

مواد و روش‌‌ها: واژگان کلیدی «پرداخت‌های غیر رسمی» یا «پرداخت غیر قانونی» یا «زیرمیزی» و «نظام سلامت» در پایگاه‌های اطلاعاتی داخلی و خارجی PubMed، Magiran، IranMedex، SID، Science Direct، HMIC و Scopus به زبان فارسی و انگلیسی، در بازه زمانی 2000 تا 2016 جستجو شدند.

ملاحظات اخلاقی: صداقت و امانت‌داری در انتخاب و گزارش یافته‌ها و استناددهی به متون رعایت گردید.

یافته‌ها: سی ‌و سه مقاله کامل برای مطالعه و تحلیل انتخاب شد. پرداخت‌های غیر رسمی یا غیر قانونی فاقد یک تعریف جهان‌شمول بوده و نگرش به آن‌ها در جوامع مختلف، متفاوت می‌باشد. علل پرداخت‌های غیر رسمی در سه دسته دلایل پرداخت‌کنندگان (دریافت خدمات باکیفیت، سریع‌تر و احترام)، دلایل دریافت‌کنندگان (پایین‌بودن دستمزدها و تعرفه‌ها، اعمال کسورات غیر منطقی از سوی سازمان‌های بیمه) و ضعف‌های نظام سلامت (ناکارآمدی بیمه‌ها در تأمین ‌مالی، نظارت ناکافی بر نحوه اعمال تعرفه‌ها و کمبود نیروی انسانی در برخی حرف) دسته‌بندی شد.

نتیجه‌‌گیری: پرداخت‌های غیر رسمی با هر نیت، انگیزه و علتی، عواقب جبران‌ناپذیر و بی‌عدالتی را به دنبال دارد. هزینه‌های کمرشکن، نابرابری در دسترسی به خدمات و کیفیت آن‌ها و نابرابری در پیامدهای سلامت، از اصلی‌ترین عواقب پدیده پرداخت‌های غیر رسمی محسوب می‌شوند. واقعی‌شدن تعرفه‌ها در کنار تقویت بیمه‌ها، اطلاع‌رسانی و آگاه‌ساختن بیماران از حقوق خود و بهبود نظارت برای کاهش پرداخت‌های غیر رسمی توصیه می‌گردد.

Keywords:
  • پرداخت‌های غیر رسمی؛ پرداخت‌های غیر قانونی؛ نظام مراقبت سلامت؛ عدالت؛ مرور نظام‌مند

How to Cite

جهانگیری ر., & آرین خصال آ. (2017). عوامل مؤثر بر پرداخت‌های غیر رسمی در نظام‌های سلامت: مرور نظام‌مند. akhlāq-I Pizishkī i.E., Medical Ethics, 11(40), 73–92. https://doi.org/10.22037/mej.v11i40.17983
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