Last update:
10-Dec-2008

OBJECTIVE It is called "the Greek paradox". Given the country's universal coverage by a public health insurance system, it is indeed paradoxical that Greece today has the most "privatized" health care system among EU countries. The aim of this paper was to analyze the reasons for and the nature of the extraordinary private expenditure in Greece.

METHOD A countrywide survey was used covering a randomized sample of 1,616 households. Regression analysis was used to determine the extent to which social and economic household characteristics influence the frequency of health services use and the size of household payments for such services. The influence of these characteristics in determining informal payments was investigated with the use of logistic regression. In all statistical analyses the P<0.05 level of significance was used.

RESULTS Total private household health expenditure was estimated at € 6,141 million. Of this, 68% was for outpatient services. The largest share was for dental services, absorbing 31.1% (€ 1,912 million or 1.5% of GDP) of the total out-of pocket health expenditure. The problems of understaffed public primary facilities lead rural dwellers to seek private outpatient care more often. The hospital sector absorbs less than 15% (or € 884 million) of household private health expenditure. A significant part (20%) of private payments for hospital care concerns informal payments within public hospitals. This amount is almost equal to formal payments in the form of cost sharing. Admissions to private hospitals are only 16% of total admissions, probably due to the political emphasis on public hospitals and the high cost of private hospital care.

CONCLUSIONS The rise in private health expenditure and the development of the private sector during the last 20 years in Greece is associated with public underfinancing. The private sector is rapidly closing the gap through increased investment, mostly in upgraded amenities and new technology. As a result, the complementary nature of private care in Greece is no longer disputed. It is, therefore, a matter of serious concern whether it will eventually undermine the constitutionally guaranteed free access and equitable distribution of health resources.

Key words: Health care in Greece, Ιnformal payments, Out-of pocket payments, Private health expenditure.