Top

The European Journal of Health Economics

Published in:

01-03-2016 | Original Paper

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

Authors: Kyriakos Souliotis, Christina Golna, Yannis Tountas, Olga Siskou, Daphne Kaitelidou, Lycourgos Liaropoulos

Published in: The European Journal of Health Economics | Issue 2/2016

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.

Available only for authorised users

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

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.

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

European Commission. Study on corruption in the healthcare sector. October (2013)

Newhouse, J.P.: Medical care costs: how much welfare loss? J. Econ. Perspect. 6, 3–21 (1992)CrossRefPubMed

Souliotis, K.: Health policy in times of global economic crisis (in Greek). In: Siousiouras, P., Hazakis, K. (eds.) Globalization, European Union and Greece, pp. 761–781. Poiotita, Athens (2009)

Pavlopoulos, P.: The hidden economy in Greece. A first quantitative demarcation (in Greek). Institute for Economic and Industrial Research, Athens (1987)

Negreponte-Delivani, M.: Economics of the hidden economy in Greece (in Greek). Papazisis, Athens (1991)

Vavouras, I., Koutris, A.: The hidden economy. The extent of the phenomenon in Greece and abroad (in Greek). pp. 74–75. Papazisis, Athens (1991)

Tatsos, N.: The hidden economy and tax evasion in Greece (in Greek). Institute for Economic and Industrial Research, Athens (2001)

Siskou, O., Kaitelidou, D., Papakonstantinou, V., Liaropoulos, L.: Private health expenditure in the Greek health care system: where truth ends and the myth begins. Health Policy 88, 282–293 (2008)CrossRefPubMed

Economou, C.: Greece: Health System Review. Health Systems in Transition, vol. 12, no. 7. WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies, Copenhagen (2010)

10.

Economou, C., Kaitelidou, D., Kentikelenis, A., Maresso, A.: The impact of financial crisis on health and the health system in Greece. WHO Regional Office for Europe. European Observatory on Health Systems and Policies, Copenhagen (2013)

11.

Polyzos, N., Karanikas, H., Thireos, E., Kastanioti, C., Kontodimopoulos, N.: Reforming reimbursement of public hospitals in Greece during the economic crisis: implementation of a DRG system. Health Policy 109, 14–22 (2013)CrossRefPubMed

12.

Liaropoulos, L.: Greek economic crisis not a tragedy for health. BMJ 345, e7988 (2012)CrossRefPubMed

13.

OECD, Health data (2014)

14.

Greek System of Health Accounts: Center for Health Services Management and Evaluation. National and Kapodistrian Univeristy of Athens, Athens (2014)

15.

Souliotis, K.: Analysis of health expenditures in Greece 1989–2000, methodological clarifications and discoveries concerning the health system (in Greek). In: Kyriopoulos, J., Souliotis, K. (eds.) Health expenditures in Greece: methodological problems in measurement and their consequences for health policy, pp. 65–77. Papazisis, Athens (1992)

16.

Niakas, D., Mylonakis, J.: Choice of physician, private payment and patient satisfaction. Is there any relationship? Int. J. Healthc. Technol. Manag. 6, 288–295 (2005)CrossRef

17.

Souliotis, K., Dolgeras, A., Kontos, D., Economou, H.: Patient satisfaction from hospital care in Greece: results from a Household survey in the greater Athens region (in Greek). Prim. Health Care 14, 114–118 (2002)

18.

Souliotis, K.: The role of the private sector in the Greek health system (in Greek). Papazisis, Athens (2000)

19.

Tountas, Y., Karnaki, P., Pavi, E., Souliotis, K.: The unexpected growth of the private health sector in Greece. Health Policy 74, 167–180 (2005)CrossRefPubMed

20.

Liaropoulos, L., Siskou, O., Kaitelidou, D., Theodorou, M., Katostaras, Th: Informal payments in public hospitals in Greece. Health Policy 87, 72–81 (2008)CrossRefPubMed

21.

Kaitelidou, D., Tsirona, C., Galanis, P., Siskou, O., Mladovsky, P., Kouli, E., Prezerakos, P., Theodorou, M., Sourtzi, P., Liaropoulos, L.: Informal payments for maternity health services in public hospitals in Greece. Health Policy 109(1), 23–30 (2013)CrossRefPubMed

22.

Souliotis, K.: Economic inequalities and health policy (in Greek). Papazisis, Athens (2007)

23.

Souliotis, K.: Social and regional health inequities in Greece (in Greek). Topos 17, 49–72 (2001)

24.

Mossialos, E., Allin, S., Davaki, K.: Analysing the Greek health system: a tale of fragmentation and inertia. Health Econ. 14, 151–168 (2005)CrossRef

25.

Transparency International. Gloabal Corruption Report. Executive summary, p. xvi (2006)

26.

Balabanova, D., McKee, M.: Understanding informal payments for health care: the example of Bulgaria. Health Policy 62, 243–273 (2002)CrossRefPubMed

27.

Ensor, T.: Informal payments for health care in transition economies’. Soc. Sci. Med. 58(2), 237–246 (2004)CrossRefPubMed

28.

Cohen, N.: Informal payments for health care—the phenomenon and its context. Health Econ. Policy Law. 7(3), 285–308 (2012)CrossRefPubMed

29.

Souliotis, K., Kyriopoulos, J.: The hidden economy and health expenditures in Greece: measurement problems and policy issues. Appl. Health Econ. Health Policy 2, 129–134 (2003)PubMed

30.

Gaal, P., McKee, M.: Informal payment for health care and the theory of ‘INXIT’. Int. J. Health Plan. Manage. 19(2), 163–178 (2004)CrossRef

31.

Gaal, P., Belli, P.C., McKee, M., Szócska, M.: Informal payments for health care: definitions, distinctions, and dilemmas. J. Health Polit. Policy Law 31, 251–293 (2006)CrossRefPubMed

32.

Thompson, R., Witter, S.: Informal payments in transitional economies: implications for health sector reform. Int. J. Health Plan. Manag. 15, 169–187 (2000)CrossRef

33.

Miller, W.L., Grødeland, A.B., Koshechkina, T.Y.: If you pay, we’ll operate immediately. J. Med. Ethics 26, 305–311 (2000)PubMedCentralCrossRefPubMed

34.

Gaal, P., Evetovits, T., McKee, M.: Informal payment for health care: evidence from Hungary. Health Policy 77, 86–102 (2006)CrossRefPubMed

35.

Schneider, F.: The Influence of the economic crisis on the underground economy in Germany and the other OECD-countries in 2010: a (further) increase. ShadEcOECD2010.doc Revised Version (2010)

36.

Schneider, A., Buehn, F.: Shadow economies and corruption all over the world: revised estimates for 120 countries. Economics: The Open-Access, Open-Assessment E-Journal, 1. Version 2, http://www.economics-ejournal.org/economics/journalarticles/ 2007–2009

37.

Yfantopoulos, J.: Health Economics (in Greek). Theory and policy. Dardanos, Athens (2003)

38.

Hirschman, A.O.: Exit, voice, loyalty: responses to decline in firms, organizations and States. Harvard University Press, Cambridge (1970)

39.

Kentikelenis, A., Karanikolos, M., Papanicolas, I., Basu, S., McKee, M., Stuckler, D.: Health effects of financial crisis: omens of a Greek crisis. The Lancet, 378, 1457–1458 (2011)

Title: Informal payments in the Greek health sector amid the financial crisis: old habits die last...
Authors: Kyriakos Souliotis
Christina Golna
Yannis Tountas
Olga Siskou
Daphne Kaitelidou
Lycourgos Liaropoulos
Publication date: 01-03-2016
Publisher: Springer Berlin Heidelberg
Published in: The European Journal of Health Economics / Issue 2/2016
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI: https://doi.org/10.1007/s10198-015-0666-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2016

Tramadol and the risk of fracture in an elderly female population: a cost utility assessment with comparison to transdermal buprenorphine

Economic hardship and suicide mortality in Finland, 1875–2010

Access to primary care in Italy: time for a shake-up?

Willingness to pay for health insurance among the elderly population in Germany

Healthcare costs and resource utilization of asthma in Germany: a claims data analysis

Are some QALYs more equal than others?