Tehran University of Medical Sciences Health Technology Assessment in Action 2645-3835 10 2 2026 07 22 402 402 Mohammadreza Mobinizadeh National Institute of Health Research/Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran Farhad Habibi Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2025 02 02 2025 08 18 The prevalence of informal payments in healthcare can be traced back to several systemic issues that create an environment conducive to such practices. One significant factor is the inadequacy of official tariffs for medical services. Often, these tariffs do not align with the actual costs and expertise required for providing quality care. As a result, both patients and healthcare providers may feel compelled to engage in unofficial transactions to bridge the gap between what is officially recognized and what is necessary for adequate care. Another underlying cause is that economic instability and inflation have profound impacts on healthcare systems and can lead to an increase in informal payments by healthcare providers. This relationship can be examined from several angles. Firstly, during periods of economic instability, the cost of living for doctors and other healthcare professionals rises. Inflation can directly affect their purchasing power, compelling them to seek additional sources of income. As a result, some healthcare providers may resort to accepting informal payments to meet their daily expenses and maintain their standard of living. Secondly, during inflationary periods, delays in insurance reimbursements and a decrease in real income can place additional pressure on physicians. These delays may lead them to seek informal ways to secure their finances, one of which is accepting informal payments. Ultimately, for these solutions to be effective, there must be a significant increase in the income of healthcare providers. Ensuring that providers are fairly compensated for their services is essential to maintaining the quality of care. By addressing the financial pressures that lead to informal payments, we can reduce the risk of compromised care, ultimately lowering mortality rates and improving health outcomes for all. https://htainaction.tums.ac.ir/index.php/hta/article/view/402 https://htainaction.tums.ac.ir/index.php/hta/article/download/402/226