Kyriakos Souliotis1,2, Christina Golna3, Yannis Tountas3, Olga Siskou4, Daphne Kaitelidou5, Lycourgos Liaropoulos5. 1. Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece. soulioti@hol.gr. 2. Centre for Health Services Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece. soulioti@hol.gr. 3. Centre for Health Services Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece. 4. Centre for Health Services Management and Evaluation, National and Kapodistrian University of Athens, 123 Papadiamantopoulou str., 11527, Athens, Greece. olsiskou@nurs.uoa.gr. 5. Centre for Health Services Management and Evaluation, National and Kapodistrian University of Athens, 123 Papadiamantopoulou str., 11527, Athens, Greece.
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.
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.
Entities:
Keywords:
Greek health care system; Health expenditure; Health policy; Hidden economy; Informal health payment; Tax evasion
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