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Table 4 Informal patient payment factors related to internal context of health system

From: New insight into the informal patients’ payments on the evidence of literature: a systematic review study

Stewardship weaknesslack of legal support towards IPs
• Structural problems & inefficiencies of the health services providing network
• Weak management
• Lack of transparency & accountability
• Lack of partnership and cooperation with other parts & stakeholders
• Inefficiency in health information system
lack of regulation sanction and penalties for illegal behavior- Lack of regulation- lack of referral system-poor system design and structural weakness in providing services –duplication and fragmentation in health system- lack of control- limited management capacity- weak management in health system, hospital and medical center- related factors of resource allocation - less health insurance contribution- lack of private sector involvement- lack of support of health workers and professional association and their commitment or involvement-Lack of information- lack of data sources- lack of information on performance- lack of a comprehensive financial and tax reporting system-
Sustainable financing and social protection weakness• Inefficient use of resources due to unfocused approach of funding activities and interventions for financing purposes
• Lack of transparency in the health financing system
• Insufficiency and inefficiency of the insurance system
• Poor and vague definition of the basic benefit package
funding shortage in health system- inefficiency in financial management of health system- reliance on out-of-pocket payments- inefficiencies of payment mechanisms to providers- unrealistic, insufficient inequitable tariffs- Low income of doctors & medical personnel & deferred claims- inefficiency in financing health care system- insurance deduction & delayed reimbursement- Insurance coverage problems- Inadequate social protection for poor and other vulnerable groups
Human resources’ organizational behavior challenges• Health workforces’ perception and motivation
• Poor human resource management
• Social position or authority
• Moral/ ethical related issues
insufficient official income of health personnel and physicians-- lack of staff motivation- for higher standard of living in providers - lack of government attention to providers motivation- Imbalance in the distribution of medical staff - lack of control and monitoring on medical staff-
misuse of monopoly power and market position- physician competency -IPs for well-known physicians- Lack of training in ethics- Low moral standards of the medical profession- low moral and ethical reasons-
Challenges of drugs, medical products and services delivery provision process• The complexity & nature of the services
• Organizational feature of the health services provider
• inefficient patient complain process
• Quality of health care services
• Access to health care services
• irrational prescription
• Lack of medicine & other medical supplies
health workers providers specialty- length of stay- type of health services- kind of health services facilities- additional services- receiving special attention- better service quality- better care- skip waiting time- access to care -quick access to services- lack of access to health care services- scarcity of medicines and other supplies- irrational drug and treatment prescription- irrational diagnosis test prescription-
Change management weakness• Lack of political will
• Lack of follow up reform
• Reform failure
lack of the reform monitoring- lack of range of policy tools in system for eliminating IPs-