Siskou Olga, Kaitelidou Daphne, Papakonstantinou Vasiliki, Liaropoulos Lycourgos
Center for Health Services Management and Evaluation, Faculty of Nursing, University of Athens, 123 Papadiamantopoulou Street, 11527 Athens, Greece.
Health Policy. 2008 Dec;88(2-3):282-93. doi: 10.1016/j.healthpol.2008.03.016. Epub 2008 May 19.
Greece today has the most "privatized" health care system among EU countries. Given the country's universal coverage by a public system this may be called "the Greek paradox". The objective of this paper is to analyze private health payments by provider and type of service in order to bring to light the reasons for and the nature of the extraordinary private expenditure in Greece.
We used a randomized countrywide sample of 1616 households. Regression analysis was used to determine the extent to which social and economic household characteristics influence the frequency of use of certain health services and the size of household payments for such services. In all statistical analyses we used the p<0.05 level of significance.
Out of the total private household health expenditure (euro6141 million), 66% is for outpatient services, with the largest share for dental services, absorbing 31.1% (euro1912 million or 1.5% of GDP) of the total out-of-pocket health expenditure. Rural dwellers seek private outpatient care more often, because of the understaffed public primary facilities. The hospital sector absorbs less than 15% (or euro884 million) of household private health expenditure. A significant part (20%) of hospital care financed privately concerns informal payments within public hospitals, an amount almost equal with formal payments in the form of cost sharing. Admissions to private hospitals are only 16% of total admissions. Our results indicate that this is a result of the political emphasis in public hospitals and of the considerably high cost of private hospital care.
The rise in private health expenditure and the development of the private sector during the last 20 years in Greece is associated with public under financing. The gap was filled by the private sector through increased investment, mostly in upgraded amenities and new technology. Today, the complementary nature of private care in Greece is no longer disputed, but is a matter of serious concern, as it undermines the constitutionally guaranteed free access and equitable distribution of health resources.
如今，希腊在欧盟国家中拥有最为“私有化”的医疗体系。鉴于该国由公共体系提供全民覆盖，这一情况可谓“希腊悖论”。本文旨在分析按医疗服务提供者和服务类型划分的私人医疗支出，以揭示希腊私人医疗支出异常的原因及本质。
我们采用了全国范围内1616户家庭的随机样本。运用回归分析来确定家庭社会经济特征在多大程度上影响某些医疗服务的使用频率以及家庭为此类服务的支出规模。在所有统计分析中，我们采用了p<0.05的显著性水平。
在家庭私人医疗总支出（6.141亿欧元）中，66%用于门诊服务，其中牙科服务占比最大，占自付医疗总支出的31.1%（19.12亿欧元或国内生产总值的1.5%）。农村居民因公共基层医疗机构人员配备不足，更常寻求私人门诊护理。医院部门吸收的家庭私人医疗支出不到15%（即8.84亿欧元）。私人资助的医院护理中有很大一部分（20%）涉及公立医院内部的非正式支付，这一金额几乎与以费用分摊形式的正式支付相等。私立医院的入院人数仅占总入院人数的16%。我们的结果表明，这是公立医院政治重点以及私立医院护理成本相当高的结果。
希腊过去20年中私人医疗支出的增加和私营部门的发展与公共资金不足有关。这一差距由私营部门通过增加投资来填补，主要投资于升级设施和新技术。如今，希腊私人医疗护理的补充性质不再有争议，但却是一个严重关切的问题，因为它破坏了宪法保障的免费就医机会和卫生资源的公平分配。
