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 €1549 (±992), representing 7.9% of the mean annual per capita income in Greece. Mean informal payment was €848 (±714). For 56.3% of the respondents, it was at the obstetrician's request, on top of formal payment of €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. © 2012 Elsevier Ireland Ltd. All rights reserved.