Table 3.

Informal patient payment factors related to external context of health system

Theme	Category	Code
Demographic features of health service consumers	• Individual features • Household features	Age- sex- marital status- occupation- education- income level- residency- religious- race- health status- health insurance coverage- number of family members- socio economic situation of the family-
Patient’s personality features	• patient perception & attitude • Patient beliefs • Patient feelings • Patient willingness • patient relationships	Informal payment necessity- value of health issues in return for any payment- satisfaction- fear- value and respect for the doctor- more welfare- choosing the right doctor- Supporting the doctor- patient physician relationship- patient- staff relationships- relationship with other patient and their suggestion-
Social & cultural backgrounds of the community	• Low Community participation (Civil Society) • Low Public/ patient awareness • Value culture (normative) Corruption culture • Lost trust	Lack of media participation & social campaign- lack of public participation- lack of social planner’s participation- low knowledge & public awareness- low patient awareness about health care services - low awareness of patient rights- gratitude & tradition- compulsory social behavior- social attitudes and beliefs-culture of corruption in country - corruption in health system- governance corruption- lack of trust in political system and official strategies-lack of trust in government- lack of trust in insurance-