Informal payments in public hospitals in Greece.

Unlabelled: Informal payments are an ingrained social institution in Greece. In some cases, they are also part of corruption in the health area, which includes a variety of other forms.

Objective: The objective of this paper is to measure and analyze the size and nature of informal payments in the Greek public hospitals, concentrating on payments made to health personnel to facilitate access to services and preferred providers.

Methods: We used a randomized countrywide sample of 1616 households, amounting to 4738 individuals. The survey methodology was telephone interviews with a questionnaire supported by the software of Computer Assisted Telephone Interviewing.

Results: Out of the total number of those reporting treatment in public hospitals (N=336), 36% reported at least one informal payment to a doctor. Of these, 42% reported it was given because of the fear of receiving sub-standard care (if they did not pay) and another 20% claimed that the doctor demanded such a payment. None of the socio-economic characteristics of the family were related to the size of extra (informal) payments. The probability of extra payments is 72% higher for patients aiming to "jump the queue", compared to those admitted through normal procedures. Also, surgical cases had a 137% higher probability for extra payments compared to non-surgical patients.

Conclusions: A very high percentage of informal payments are made in order to gain access to public hospitals and to receive a higher quality of services. Despite near universal coverage of the population by public health insurance, informal payments are widespread and a major source of inequity and inefficiency in the Greek health care system.