Informal payments for maternity health services in public hospitals in Greece

Background: Private health expenditure for consuming maternity health services has been identified as an issue within public hospitals. Aim: To estimate level of private health expenditure, in the form of informal payments, for maternal services in public hospitals in Greece. Methods: The study population consisted of 160 women who had recently given birth in three provincial general hospitals and one general hospital in Athens. A three-part questionnaire was developed in order to collect financial information regarding the use of public obstetrics services in Greece. Results: The mean age of respondents was 29.5 (+/-5.6) years. There was a high rate of informal payments with 74.4% of women involved in informal transactions. Mean total private payments were (sic)1549 (+/-992), representing 7.9% of the mean annual per capita income in Greece. Mean informal payment was (sic)848 (+/-714). For 56.3% of the respondents, it was at the obstetrician's request, on top of formal payment of (sic)701 (+/-1351). Total informal payments were higher for women who gave birth in Athens (p < 0.001), for Greek women compared to non Greek (p < 0.001) and for deliveries that were conducted by women's personal obstetrician (p=0.001). Conclusion: There is a large black economy in the field of obstetric services, as 74.4% of women who used public maternity services had to pay under-the-table payments corresponding approximately to the net salary of an intern physician. There is a need for the state to adopt innovative strategies and mechanisms in order to reduce informal payments for obstetric services in the public sector. (C) 2012 Elsevier Ireland Ltd. All rights reserved.