BACKGROUND Nowadays, a growing literature reveals how patients use informal payments to seek either better treatment or additional services, but little systematic review has been accomplished for synthesizing the main factors. The purpose of this study was to analyze the content of literatures to demonstrate the factors for informal patient payments. METHODS In this systematic review study, PubMed, Web of Science, Wiley Online Library, Science Direct, Ovid, Scopus, and Iranian databases were investigated without time limitation for eligible English and Persian studies. Achieved data were analyzed using content analysis approach and MAXQDA 10 software. RESULTS Themes related to informal payments in external context of health system were demographic features of health service consumers, patient's personality features and social & cultural backgrounds of the community. Health system challenges' themes were about stewardship weakness, and sustainable financing and social protection weakness. These were followed by human resources' organizational behavior challenges, drugs, medical products, and services delivery provision process challenges and finally change management weakness for reducing and dealing with IPs. CONCLUSION It appears that improving the quality of health care services and accurate monitoring of delivery processes, along with performing some strategies for regulating payroll and medical tariffs, strict rules and regulations and improving health staff motivation, would be effective ways against informal payments. Improving the health insurance contribution, promoting transparency & accountability in health system especially in financing, identify precise control mechanism, using empower patient/public related approach, modifying community perception, reinforcing social resistance to unofficial payments and rebuilt lost social capital in health care are some of the other recommendations in this field. To practice these strategies, a comprehensive and systemic vision and approach is needed, however, the key point is that before applying any strategy the impact of this strategy on access, efficiency, equity, and other health systems' goals and policies should be investigated due to the consideration.

中文翻译：

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根据文献证据对非正式患者支付的新见解：系统评价研究。

背景如今，越来越多的文献揭示了患者如何使用非正式支付来寻求更好的治疗或额外的服务，但很少有系统综述来综合主要因素。本研究的目的是分析文献内容，以证明非正式患者付款的因素。方法 在这项系统评价研究中，对 PubMed、Web of Science、Wiley Online Library、Science Direct、Ovid、Scopus 和伊朗数据库进行了不受时间限制的合格英语和波斯语研究。使用内容分析方法和 MAXQDA 10 软件对获得的数据进行分析。结果 卫生系统外部背景下与非正式支付相关的主题是卫生服务消费者的人口特征、患者的个性特征以及社区的社会文化背景。卫生系统挑战的主题是管理薄弱、可持续融资和社会保护薄弱。其次是人力资源的组织行为挑战、药品、医疗产品和服务提供流程的挑战，最后是减少和处理知识产权的变革管理弱点。结论 看来，提高医疗保健服务质量和准确监控交付流程，同时执行一些规范工资和医疗收费、严格规则和规定以及提高医务人员积极性的策略，将是打击非正式支付的有效方法。提高医疗保险缴费、提高卫生系统尤其是融资方面的透明度和问责制、确定精确的控制机制、使用与患者/公众相关的方法、改变社区观念、加强社会对非官方支付的抵制以及重建医疗保健中失去的社会资本等该领域的其他建议。要实施这些战略，需要一个全面、系统的愿景和方法，但关键是，在应用任何战略之前，应调查该战略对可及性、效率、公平性以及其他卫生系统目标和政策的影响，因为考虑。