Informal fees are payments made by patients to their health care provider that are over and above the official cost of services. Payments may be motivated by a combination of factors such as low supervision, weak sanctions, and inadequate provider salaries. The practice of soliciting informal fees from patients may result in restricted access to medical care and reduced care‐seeking behavior among vulnerable populations. The objective of this study is to examine nuanced health care provider perspectives on informal fee payments solicited from reproductive health patients in Kenya. We conducted in‐depth semistructured interviews in 2015–2016 among a sample of 20 public and private‐sector Kenyan health care workers. Interviews were coded and analyzed using an iterative thematic approach. More than half of participants reported that solicitation of informal fees is common practice in health care facilities. Providers reported low public‐sector wages were a primary driver of informal fee solicitation coupled with collusion among senior staff. Additionally, patients may be unaware that they are being asked to pay more than the official cost of services. Strategies for reducing this behavior include more adequate and timely remuneration within the public sector, educating patient populations of free or low‐cost services, and evidence‐based methods to increase provider motivation.

中文翻译：

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“如果大鱼都在做，那我为什么不在这里？”：肯尼亚的非正式费用支付和生殖保健提供者的动机。

非正式费用是患者向其医疗保健提供者支付的超出官方服务成本的费用。付款可能是由多种因素共同推动的，例如监管不力、制裁不力和供应商工资不足。向患者索取非正式费用的做法可能会导致弱势群体获得医疗服务的机会受限并减少寻求护理的行为。本研究的目的是检查卫生保健提供者对肯尼亚生殖健康患者收取的非正式费用的细微差别的看法。我们在 2015-2016 年对 20 名公共和私营部门肯尼亚卫生保健工作者的样本进行了深入的半结构化访谈。使用迭代主题方法对访谈进行编码和分析。超过一半的参与者报告说，在医疗机构中，索取非正式费用是一种常见做法。供应商报告称，公共部门的低工资是非正式收费以及高级员工之间勾结的主要驱动因素。此外，患者可能不知道他们被要求支付比官方服务成本更高的费用。减少这种行为的策略包括在公共部门内提供更充足和及时的报酬，教育患者群体获得免费或低成本服务，以及增加提供者积极性的循证方法。患者可能不知道他们被要求支付高于官方服务费用的费用。减少这种行为的策略包括在公共部门内提供更充足和及时的报酬，教育患者群体获得免费或低成本服务，以及增加提供者积极性的循证方法。患者可能不知道他们被要求支付高于官方服务费用的费用。减少这种行为的策略包括在公共部门内提供更充足和及时的报酬，教育患者群体获得免费或低成本服务，以及增加提供者积极性的循证方法。