title: Informal payments in the Greek health sector amid the financial crisis: old habits die last...
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.
authors: Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece. soulioti@hol.gr.|Centre for Health Services Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece. soulioti@hol.gr.
authors: Kyriakos
authors: K
authors: Souliotis
authors: Centre for Health Services Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors: Christina
authors: C
authors: Golna
authors: Centre for Health Services Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors: Yannis
authors: Y
authors: Tountas
authors: Centre for Health Services Management and Evaluation, National and Kapodistrian University of Athens, 123 Papadiamantopoulou str., 11527, Athens, Greece. olsiskou@nurs.uoa.gr.
authors: Olga
authors: O
authors: Siskou
authors: Centre for Health Services Management and Evaluation, National and Kapodistrian University of Athens, 123 Papadiamantopoulou str., 11527, Athens, Greece.
authors: Daphne
authors: D
authors: Kaitelidou
authors: Centre for Health Services Management and Evaluation, National and Kapodistrian University of Athens, 123 Papadiamantopoulou str., 11527, Athens, Greece.
authors: Lycourgos
authors: L
authors: Liaropoulos
mesh_terms: D000328:Adult; D000368:Aged; D057172:Economic Recession / Q000706:statistics & numerical data*; D005191:Family Characteristics; D005260:Female; D005382:Financing, Personal / Q000191:economics* / Q000706:statistics & numerical data; D006115:Greece; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Greek health care system; Health expenditure; Health policy; Hidden economy; Informal health payment; Tax evasion
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