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Informal payments in the Greek health sector amid the financial crisis: old habits die last...

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Abstract

Background

Under-the-table informal payments are commonplace as reimbursements for health care services in Greece. As the country faces a severe financial crisis, the need to investigate the extent of such payments, their incidence and their impact on household income is pressing.

Methods

A survey of 2,741 persons from across the country was conducted between December 2011 and February 2012. The sample was defined via a multistage selection process using a quota for municipality of residence, sex and age. The maximum error margin was 2.41 % with a confidence interval of 95 %.

Results

The survey reports under-the-table payments for approximately 32.4 % of public hospital admissions. Private clinics, which display the bulk of out-of-pocket payments, naturally display the lowest under-the-table payments. The highest percentage of under-the-table payments in the private sector appears at visits to private practitioners and dentists (36 %). Informal payments are most frequently made upon request, prior to service provision, to facilitate access to care and to reduce waiting times, and at a much lower percentage, to post-service provision, and out of gratitude.

Conclusions

This survey reveals that, due to severe financial pressure, there is a growing unwillingness of citizens to pay informally and an increasing demand for these payments as a prerequisite for access to services or to redeem services provided. This “hidden” financial burden of at least 27 % impacts negatively on the living conditions of households and is not reported as purchasing ability or cost of living.

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Notes

  1. Eurozone countries include: Austria, Belgium, Finland, France, Germany, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Slovakia, Slovenia, Spain.

  2. In Greece, household health expenditure represents more than 95 % of private health expenditure. The contribution of private health insurance in the financing of the health system is very limited.

  3. The term private practitioners in this paper refers to those health professions who conduct their own private health outpatient clinics.

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Acknowledgments

The authors would like to express their gratitude to KAPPA RESEARCH for selection of the sample and the collection of data.

Conflict of interest

There are no any kind of conflict of interest.

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Authors and Affiliations

  1. Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece

    Kyriakos Souliotis

  2. Centre for Health Services Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Kyriakos Souliotis, Christina Golna & Yannis Tountas

  3. Centre for Health Services Management and Evaluation, National and Kapodistrian University of Athens, 123 Papadiamantopoulou str., 11527, Athens, Greece

    Olga Siskou, Daphne Kaitelidou & Lycourgos Liaropoulos

Authors
  1. Kyriakos Souliotis
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  2. Christina Golna
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  3. Yannis Tountas
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  4. Olga Siskou
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  5. Daphne Kaitelidou
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  6. Lycourgos Liaropoulos
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Correspondence to Kyriakos Souliotis.

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Souliotis, K., Golna, C., Tountas, Y. et al. Informal payments in the Greek health sector amid the financial crisis: old habits die last.... Eur J Health Econ 17, 159–170 (2016). https://doi.org/10.1007/s10198-015-0666-0

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  • DOI: https://doi.org/10.1007/s10198-015-0666-0

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