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Informal Health Payments in the SARS-CoV-2 Era: Options from Greece

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Integrity, Transparency and Corruption in Healthcare & Research on Health, Volume II

Abstract

The healthcare system’s major purpose is quality, but many times, it is getting challenging due to economic and health crises. One of these aspects is corruption with informal payments, expressed by illegal amounts from patients to healthcare staff to receive qualitative care. Contains black payments (better treatment), lost payments (equal or worst treatment), grey payments (undeclared payments with tax returns), and gratitude payments (bad healthcare). Greece is a country where informal payments are most detected, with less public revenue, delay in economic growth, and lack of financial sustainability. We focus on informal health payments in Greece and on effective solutions aiming to eliminate the phenomenon. More information must be given about the types of healthcare corruption and aspects of informal out-of-pocket healthcare payments globally and especially in Greece through surveys. However, are insufficient which argued by specific measures to prevent corrupt practices in health and secure a healthcare system with qualitative issues, i.e., elective surgery list, complaints of patients in healthcare authorities, sanctions, etc.

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References

  • Abdallah W, Chowdhury S, Iqbal K (2015) Corruption in health sector: evidence from unofficial consultation fees in Bangladesh, Working Paper No. 9270, The World Bank, Washington DC, USA

    Google Scholar 

  • Allin S, Davaki K, Mossialos E (2006) Paying for ‘free’ health care: the conundrum of informal payments in post-communist Europe. In: International T (ed) Global corruption report. Pluto Press, London, pp 63–75

    Google Scholar 

  • Athanasakis A, Kyriopoulos J, Souliotis K (2018) Pricing system of health services in Greece. MINDWORK Publications, Greece (in Greek)

    Google Scholar 

  • Baji P, Pavlova M, Gulasci L, Groot W (2015) Does the implementation of official user charges help to eradicate informal payments-Lessons to be learnt from the Hungarian experience. Front Public Health 3(185):1–3

    Google Scholar 

  • Bruckner, T. (2019). The ignored pandemic. How corruption in healthcare service delivery threatens Universal Health Coverage. Transparency International

    Google Scholar 

  • Buch Mejsner S, Kristiansen M, Eklund KL (2021) Civil servants and non-western migrants’ perceptions on pathways to health care in Serbia-A grounded theory, multi-perspective study. Int J Environ Res Public Health 18(10247):1–17

    Google Scholar 

  • Chereches RM, Ungureanu MI, Sandu P, Rus IA (2013) Defining informal payments in healthcare: a systematic review. Health Policy 110(2–3):105–114

    Article  Google Scholar 

  • Cohen N (2012) Informal payments for health care-The phenomenon & its context. Health Econ Policy Law 7(3):285–308

    Article  Google Scholar 

  • Di Tella R and Savedoff WD (2001) Diagnosis corruption: fraud in Latin America's public hospitals. Inter-American Development Bank, Washington DC, USA

    Google Scholar 

  • Doshmangir L, Sajadi HS, Ghiasipour M, Aboutorabi A, Gordeev VS (2020) Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran. BMC Public Health 20(539):1–14

    Google Scholar 

  • Economou C, Kaitelidou D, Katsikas D, Siskou O, Zafiropoulou M (2014) Impacts of the economic crisis on access to healthcare services in Greece with a focus on the vulnerable groups of the population. Soc Cohes Dev 9(2):99–115

    Google Scholar 

  • Ensor T, Duan-Moreno A (2002) Chapter 5 ‘Corruption as a challenge to effective regulation in the health sector’, Part 2 ‘Conceptual Issues.’ In: Saltman RB, Busse R, Mossialos E (eds) Regulating entrepreneurial behavior in European health care systems. Open University Press, USA, pp 106–124

    Google Scholar 

  • Gaal P, Belli PC, McKee M, Szocska M (2006) Informal payments for health care: definitions, distinctions & dilemmas. J Health Polit Policy Law 31(2):251–293

    Article  Google Scholar 

  • Gaal P, McKee M (2005) Fee-for-service or donation? Hungarian perspectives on informal payment for health care. Soc Sci Med 60(7):1445–1457

    Article  Google Scholar 

  • Gaitonde R, Oxman AD, Okebukola PO, Rada G (2016) Interventions to reduce corruption in the health sector. Issue No. 8, Cochrane Library, USA

    Google Scholar 

  • Garcia PJ (2019) Corruption in global health: the open secret. Lancet 394(10214):2119–2124

    Article  Google Scholar 

  • Garel P, Notarangelo P, Lopane F (2015) Out of pocket payments in healthcare systems in the European Union. HOPE-European Hospital & Healthcare Federation

    Google Scholar 

  • Giannouchos T, Vozikis A, Koufopoulou P, Fawkes L, Souliotis K (2020) Informal out-of-pocket payments for healthcare services in Greece. Health Policy 124(7):758–764

    Article  Google Scholar 

  • Gray-Molina G, DeRada EP, Yañez E (2001) Chapter 2 ‘Does voice matter? Participation and controlling corruption in Bolivian hospitals. In: Di Tella R, Savedoff WD (eds) Diagnosis corruption: fraud in Latin America’s Public Hospitals. Inter-American Development Bank, Washington DC, USA

    Google Scholar 

  • Grigorakis N, Floros C, Tsangari H, Tsoukatos E (2014) The effect of out-of-pocket payments on the income of hospitalized patients. Evidence from Greece, 7th Annual EuroMed Conference of the EuroMed Academy of Business ‘The Future of Entrepreneurship’, 18th–19th September 2014, Kristiansand, Norway, pp 1–20

    Google Scholar 

  • Gupta S, Davoodi H, Alonso-Terme R (2002) Does corruption affect income inequality & poverty? Econ Govern 3(1):23–45

    Article  Google Scholar 

  • Habibov N, Cheung A, Auchynnikava A (2017) Does social trust increase willingness to pay taxes to improve public healthcare? Cross-sectional cross-country instrumental variable analysis. Soc Sci Med 189:25–34

    Article  Google Scholar 

  • Habtu Y, Kaba M, Mekonnen H (2021) What do service providers in Southern Ethiopia think about barriers to using youth-friendly sexual & reproductive health services for adolescents?: Qualitative study. Reprod Health 18(32):1–15

    Google Scholar 

  • Horodnic AV, Williams CC (2018) Informal payments by patients for health services: Prevalence & Determinants. Serv Ind J 38(11–12):841–855

    Article  Google Scholar 

  • Horodnic AV, Williams CC, Polese A, Zait A, Oprea L (2017) Exploring the practice of making informal payments in the health sector: Some lessons from Greece. In: Polese A, Williams CC, Horodnic IA, Bejakovic P (eds) The informal economy in global perspective. Palgrave MacMillan, Varieties of Governance, pp 157–172

    Chapter  Google Scholar 

  • Hussmann K (2011) Addressing corruption in the health sector. Securing equitable access to health care for everyone, Issue No. 1, U4

    Google Scholar 

  • Jaen MH, Paravisini D (2001) Chapter 3 ‘Wages, captures & penalties In Venezuela’s public hospitals.’ In: Di Tella R, Savedoff WD (eds) Diagnosis corruption: Fraud in Latin America’s Public Hospitals. Inter-American Development Bank, Washington DC, USA, pp 57–94

    Google Scholar 

  • Kabaniha GA, Ataguba JEO, Kutzin J (2020) Global healthcare financing. In: Haring R, Kickbusch I, Ganten D, Moeti M (eds) Handbook of Global Health. Springer, Cham, pp 1–42

    Google Scholar 

  • Kaitelidou DC, Tsirona CS, Galanis PA, Siskou OC, Ml00adovsky P, Kouli EG, Prezerakos PE, Theodorou M, Sourtzi P, Liaropoulos L (2013) Informal payments for maternity health services in public hospitals in Greece. Health Policy 109(1): 23–30

    Google Scholar 

  • Kankeu HT, Ventelou B (2016) Socioeconomic inequalities in informal patients for health care: An assessment of the ‘Robin Hood’ hypothesis in 33 African countries. Soc Sci Med 151:173–186

    Article  Google Scholar 

  • Kassiser J (2006) The corrupting influence of money in medicine. In: International T (ed) Global corruption report. Pluto Press, London, pp 85–91

    Google Scholar 

  • Khodamoradi A, Ghaffari MP, Daryabeygi-Khotbehsara R, Sajadi HS, Majdzadeh R (2018) A systematic review of empirical studies on methodology & burden of informal patient payments in health systems. Int J Health Plan Manag 33(1):e26–e27

    Google Scholar 

  • Klitgaard R (1998). Strategies against corruption. Conference ‘Agencia Española de Cooperación Internacional Foro Iberoamericano sobre el Combate a la Corrupción’, Santa Cruz de la Sierra, pp 15–16

    Google Scholar 

  • Klitgaard RE, MacLean R, Parris HL (2000) Corrupt cities: a practical guide to cure & prevention. World Bank Publications, Washington DC, USA

    Google Scholar 

  • Koufopoulou P, Giannouchos T, Steletou E, Vozikis A, Ithakisios D, Souliotis K (2018) Informal economic transactions in greek health care sector: Quantitative survey results. 2nd Panhellenic Conference of Technology, Economy & Management ‘Healthcare Sector Growth: new, policies & challenges’, 9th November 2018. University of Piraeus, Greece (in Greek), pp 1–23

    Google Scholar 

  • Koufopoulou P, Vozikis A, Souliotis K, Samprakos A (2021) Informal health care payments in Greece: a flexible MIMIC model adaptation. J Appl Struct Equ Model 5(2):1–19

    Google Scholar 

  • Kyriopoulos J, Karalis G (1997) Recent evolutions in informal activities in greek healthcare sector. Epitheorisi Ygeias (in Greek), pp 46–47

    Google Scholar 

  • Lewis M (2000) Who is paying for health care in Eastern Europe & Central Asia?, Human Developent Sector Unit, Europe & Central Asia Region, World Bank, Washington DC, USA

    Google Scholar 

  • Lewis M (2007) Informal payments & the financing of health care in developing & transition countries. Health Aff 26(4):984–997

    Article  Google Scholar 

  • Liaropoulos L, Siskou O, Kaitelidou D, Theodorou M, Katostaras T (2008) Informal payments in public hospitals in Greece. Health Policy 87(1):72–81

    Article  Google Scholar 

  • Meskarpour-Amiri M, Assari A, Bahadori M, Ravangard R, Hosseini-Shokouh SM (2018) Informal payments for health care in Iran. Int J Health Govern 23(3):205–215

    Article  Google Scholar 

  • Meskarpour-Amiri M, Bohadori Z, Ravangard R (2019) Factors affecting informal patient payments: A systematic literature review. Int J Health Govern 24(2):117–132

    Article  Google Scholar 

  • Mossialos E, Allin S, Karras K, Davaki K (2005) An investigation of Caesarean sections in three greek hospitals. Eur J Public Health 15(3):288–295

    Article  Google Scholar 

  • Nundy S, Desiraju K, Nagral S (2018) Healers or predators? Healthcare corruption in India, Oxford University Press

    Google Scholar 

  • Onwujekwe O, Agwu P, Orijakor T, Mbachu C, Hutchinson E, Odii A, Obi U, Ogbozor A, Ichoku H, Balabanova D, McKee M (2018) Corruption in the health sector in Anglophone West Africa: Common forms of corruption & mitigation strategies. Working Paper No. 005, ACE SOAS Consortium

    Google Scholar 

  • Ozili P, Arun T (2023) Chapter 4 ‘Spillover of COVID-19: impact on the global economy. In: Akkucuk U (ed) Managing inflation & supply chain disruptions in the global economy. IGI Global Publisher, pp 41–61

    Google Scholar 

  • Papava V, Charaia V (2020) The coronomic crisis & some challenges for the Georgian Economy, Expert Opinion No. 136, Georgian Foundation for Strategic & International Studies

    Google Scholar 

  • Parmar D, Banerjee A (2019) Impact of an employment guarantee scheme on utilization of maternal healthcare services: results from a natural experiment in India. Soc Sci Med 222:285–293

    Article  Google Scholar 

  • Pavlopoulos P (1987) Shadow economy in Greece. First Quantitative Approach, IOBE, Greece (in Greek)

    Google Scholar 

  • Popovic D (2015) Assessment of corruption in the health care sector in Serbia, Background Document, SELDI/CLDS

    Google Scholar 

  • Pourtaleb A, Jafari M, Seyedin H, Behbahani AA (2020) New insight into the informal patients’ payments on the evidence of literature: a systematic review study. BMC Health Serv Res 20(14):1–11

    Google Scholar 

  • Raaphorst N, Van de Walle S (2018) A signaling perspective on bureaucratic encounters: How public officials interpret signals & cues. Soc Policy Adm 52(7):1367–1378

    Article  Google Scholar 

  • Savedoff WD (2007) Transparency & corruption in the health sector: a conceptual framework & ideas for Action in Latin American & the Caribbean, Health Technical Note No. 03, Inter-American Development Bank, Washington DC, USA

    Google Scholar 

  • Savedoff WD, Hussman K (2006) Why are health systems prone to corruption. In: International T (ed) Global Corruption Report 2006. Pluto Press, London, UK, pp 4–16

    Google Scholar 

  • Schaaf M, Topp SM (2019) A critical interpretive synthesis of informal payments in maternal health care. Health Policy Plan 34(3):216–229

    Article  Google Scholar 

  • Schneider F (2019) Size of the shadow economies of 28 European Union Countries from 2003 to 2018. The latest development. In: Vlachos V, Bitzenis A (eds) European Union. Palgrave MacMillan, Post Crisis Challenges & Prospects for Growth, pp 111–121

    Google Scholar 

  • Shahriari H, Belli P, Lewis M (2001) Institutional issues in informal health payments in Poland. Report on the Qualitative Part of the Study, Discussion Paper, HNP

    Google Scholar 

  • Siskou O, Kaitelidou D, Economou C, Kostagiolas P, Liaropoulos L (2008) Private expenditure & the role of private health insurance in Greece: Status quo & future trends. Eur J Health Econ 88(2–3):467–474

    Google Scholar 

  • Slot B, De Swart L, Weistra K, Oortwijn W, Van Wanrooj N, Raets T (2017) Updated study on corruption in the healthcare sector, Final Report, European Commission

    Google Scholar 

  • Souliotis K (2000) Private Sector contribution Greek health care system, PAPAZISI Publications (in Greek)

    Google Scholar 

  • Souliotis K (2018) Chapter 17 ‘Facing the impact of persistent economic crisis on healthcare in Greece: the need for a New Financing Paradigm.’ In: Saridi M, Souliotis K (eds) The impact & implication of crisis. a comprehensive approach combining elements of health & society, NOVA Science Publishers, New York, pp 293–303

    Google Scholar 

  • Souliotis K, Golna C, Tountas Y, Siskou O, Kaitelidou D, Liaropoulos L (2016) Informal payments in the Greek health sector amid the financial crisis: Old habits die last…. European Journal of Health Economics 17(2):159–170

    Article  Google Scholar 

  • Stepurko T, Pavlova M, Gryga I, Murauskiene L, Groot W (2015) Chapter 9 ‘Informal payments for healthcare services in Lithuania & Ukraine’, Part III ‘Informal Public Sectors & Welfare: State Internvention or Withdrawal?’. In Morris J, Polese A (eds) Informal economies in post-socialist spaces. Practices, Institutions & Networks, Palgrave MacMillan Press, pp 195–224

    Google Scholar 

  • Szende A, Culyer AJ (2006) The inequity of informal payments for health care: the case of Hungary. Health Policy 75(3):262–2710

    Article  Google Scholar 

  • Tatar M, Ozgen H, Sahin B, Belli P, Berman P (2007) Informal payments in the health sector: a case study from Turkey. Health Aff 26(4):1029–1039

    Article  Google Scholar 

  • Thomson S, Evetovits T (2020) Strengthening the health financing response to COVID-19 in Europe. WHO Regional Office for Europe, Copenhagen

    Google Scholar 

  • Tomini S, Groot W (2013) Paying informally for public health care in Albania: Scarce resources or governance failure? Appl Econ 45(36):5119–5130

    Article  Google Scholar 

  • Vian T (2008) Review of corruption in the health sector: theory, methods & interventions. Health Policy Plan 23(2):83–94

    Article  Google Scholar 

  • Vian T (2020) Anti-corruption, transparency & accountability in health: concepts, frameworks & approaches. Glob Health Action 13(1):1–24

    Google Scholar 

  • Vian T, Feeley FG, Domente S, Negruta A, Matei A, Habicht J (2015) Barriers to universal health coverage in Republic of Moldova: a policy analysis of formal & informal out-of-pocket payments. BMC Health Serv Res 15(319):1–15

    Google Scholar 

  • Williams CC, Horodnic IA, Horodnic AV (2016) Who is making informal payments for public healthcare in East-Central Europe? An evaluation of socio- economic & spatial variations. East J Eur Stud 7(1):49–61

    Google Scholar 

  • Yang J (2017) Informal payments & regulations in China’s healthcare system. Palgrave MacMillan, Red Packets & Institutional Reform

    Book  Google Scholar 

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Koufopoulou, P., Vozikis, A., Souliotis, K., Koutoupis, A. (2023). Informal Health Payments in the SARS-CoV-2 Era: Options from Greece. In: Çalıyurt, K.T. (eds) Integrity, Transparency and Corruption in Healthcare & Research on Health, Volume II. Accounting, Finance, Sustainability, Governance & Fraud: Theory and Application. Springer, Singapore. https://doi.org/10.1007/978-981-99-5502-2_10

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