Department of Health Policy & Management, School of Public Health, Texas A&M University, 212 Adriance Lab Rd, College Station, TX, 77843, USA; Population Informatics Lab, Texas A&M University, 212 Adriance Lab Rd, College Station, TX, 77843, USA.
Laboratory of Health Economics & Management, Economics Department, University of Piraeus, 75 Mikras Asias Str., 11527 Goudi (2nd Floor), Athens, Piraeus, Greece.
Health Policy. 2020 Jul;124(7):758-764. doi: 10.1016/j.healthpol.2020.04.005. Epub 2020 May 23.
Informal out-of-pocket (OOP) payments for healthcare services are not unusual in Greece.
This study estimates the association between respondent and incident-level characteristics and informal payments.
A survey of 4218 households was conducted from November 2016 to February 2017. We analyzed healthcare incidents by all household members within the past four months. Multivariate negative binomial regression analysis was used to estimate the association between respondents and incident-level characteristics and informal OOP payments to providers.
A total of 3494 healthcare incidents were reported by 3183 household-representatives. More-than-half (63 %) of all incidents involved informal activity (median=€150). About 30 % of those were related to provider requested payments. Using hospital, dental, diagnostic/screening, and emergency department services compared to primary care services and having oncological and surgical conditions were among the strongest predictors of higher rates for informal payments. The use of specific providers for reasons related to trust, reputation, referral, and lack of alternatives was also associated with higher rates of informal payments. Provider requested and skip the line payments were associated with larger OOP amounts compared to gratitude payments.
This survey reveals that informal payments occur for higher-need and less cost-responsive healthcare services particularly in areas where patients lack alternatives. Health policy and regulatory interventions, including stricter control of the financial reporting system are essential to limit informal payments.
在希腊，医疗服务的非正规现金支付并不罕见。
本研究旨在评估受访者和事件水平特征与非正规支付之间的关系。
2016 年 11 月至 2017 年 2 月期间对 4218 户家庭进行了调查。我们对过去四个月内所有家庭成员的医疗事件进行了分析。采用多变量负二项回归分析评估受访者和事件水平特征与向提供者支付非正规现金之间的关系。
共有 3183 户家庭代表报告了 3494 次医疗事件。超过一半（63%）的事件涉及非正规活动（中位数=€150）。约 30%的事件与提供者要求的支付有关。与初级保健服务相比，使用医院、牙科、诊断/筛查和急诊部门服务以及患有肿瘤和外科疾病是导致非正规支付率较高的最强预测因素之一。出于信任、声誉、转诊和缺乏替代方案等原因选择特定提供者也与较高的非正规支付率有关。与感谢支付相比，提供者要求支付和插队支付与较大的自付额有关。
这项调查显示，非正规支付发生在需求较高和对成本反应较低的医疗服务中，特别是在患者缺乏替代方案的地区。卫生政策和监管干预措施，包括对财务报告系统的更严格控制，对于限制非正规支付至关重要。
