en Public Administration & Health management and economics Public Administration & Health management and economics Original Research Original Research <p><strong>Background: </strong>Informal payments can cause delayed access to health care services, forcing people to sell their properties for cost of treatment; and as a result, they lose trust in the health system. Considering the importance of this issue, this study was conducted in 2016 to identify solutions to reduce and eliminate informal payments in Iran&rsquo;s health system.<br> <strong>&nbsp;&nbsp; Methods: </strong>Initially, solutions to reduce informal payments were extracted by reviewing resources and searching Persian and English-language databases including Science direct, PubMed, Scopus, Medline, ISC, Magiran, SID using the following keywords: informal payments, under the table payment, bribes, gratitude payment, and informal payments/fees. Then, Iranian context specific solutions were obtained by performing semi-structured interviews with 19 individuals, who were aware of the problem. Next, the identified strategies were confirmed using Delphi technique and with the participation of 50 experts.<br> <strong>&nbsp;&nbsp; Results:</strong> Various solutions were identified and confirmed to reduce or eliminate informal payments in Iran&rsquo;s health system, which are divisible in different economical fields, such as payments to providers based on performance, religious leaders&rsquo; fatwa (sociocultural), disclosing the offenders&rsquo; names (legal-political), and using family doctor system (structural).<br> <strong>&nbsp;&nbsp; Conclusion:</strong> The proposed solutions can be used by policymakers and managers in the health sector to manage informal payments. Careful identification of health care providers and recipients&rsquo; motivations and needs can be effective in recognizing and eliminating this phenomenon.<br> &nbsp;</p> Informal payment, Elimination informal payment, Bribery, Iran’s health system 915 922 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-3404-1&slc_lang=en&sid=1 Farhad Habibi Nodeh farhadhabb66@gmail.com 200319475328460036091 200319475328460036091 No Department of Health Management and Economics, Public Health School, Tehran University of Medical Sciences, Tehran, Iran. Ibrahim Jafari Pooyan ejaaf.p@yahoo.com 200319475328460036092 200319475328460036092 No Department of Health Management and Economics, Public Health School, Tehran University of Medical Sciences, Tehran, Iran. Iraj Harirchi I.harichi@tums.ac.ir 200319475328460036093 200319475328460036093 No Deputy of Minister, Ministry of Health, Treatment and Medical Education, Tehran, Iran, & Medical School, Tehran University of Medical Sciences, Tehran, Iran. Mohamad Arab arabmoha@tums.ac.ir 200319475328460036094 200319475328460036094 Yes Department of Health Management and Economics, Public Health School, Tehran University of Medical Sciences, Tehran, Iran.