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Out of pocket payments and social health insurance for private hospital care: Evidence from Greece

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  • Grigorakis, Nikolaos
  • Floros, Christos
  • Tsangari, Haritini
  • Tsoukatos, Evangelos

Abstract

The Greek state has reduced their funding on health as part of broader efforts to limit the large fiscal deficits and rising debt ratios to GDP. Benefits cuts and limitations of Social Health Insurance (SHI) reimbursements result in substantial Out of Pocket (OOP) payments in the Greek population. In this paper, we examine social health insurance's risk pooling mechanisms and the catastrophic impact that OOP payments may have on insured's income and well-being. Using data collected from a cross sectional survey in Greece, we find that the OOP payments for inpatient care in private hospitals have a positive relationship with SHI funding. Moreover, we show that the SHI funding is inadequate to total inpatient financing. We argue that the Greek health policy makers have to give serious consideration to the perspective of a SHI system which should be supplemented by the Private Health Insurance (PHI) sector.

Suggested Citation

  • Grigorakis, Nikolaos & Floros, Christos & Tsangari, Haritini & Tsoukatos, Evangelos, 2016. "Out of pocket payments and social health insurance for private hospital care: Evidence from Greece," Health Policy, Elsevier, vol. 120(8), pages 948-959.
  • Handle: RePEc:eee:hepoli:v:120:y:2016:i:8:p:948-959
    DOI: 10.1016/j.healthpol.2016.06.011
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    as
    1. Oluyele Akinkugbe & Chitalu Chama-Chiliba & Naomi Tlotlego, 2012. "Health Financing and Catastrophic Payments for Health Care: Evidence from Household-level Survey Data in Botswana and Lesotho," African Development Review, African Development Bank, vol. 24(4), pages 358-370.
    2. Vian, Taryn & Grybosk, Kristina & Sinoimeri, Zamira & Hall, Rachel, 2006. "Informal payments in government health facilities in Albania: Results of a qualitative study," Social Science & Medicine, Elsevier, vol. 62(4), pages 877-887, February.
    3. Lindelow, Magnus & Wagstaff, Adam, 2005. "Health shocks in China : are the poor and uninsured less protected ?," Policy Research Working Paper Series 3740, The World Bank.
    4. Francesco Pappadà & Yanos Zylberberg, 2014. "Austerity plans and tax evasion : theory and evidence from Greece," Cahiers de Recherches Economiques du Département d'Econométrie et d'Economie politique (DEEP) 14.01, Université de Lausanne, Faculté des HEC, DEEP.
    5. Kankeu Tchewonpi, Hyacinthe & Saksena, Priyanka & Xu, Ke & Evans, David B, 2013. "The financial burden from non-communicable diseases in low- and middle-income countries: a literature review," MPRA Paper 54534, University Library of Munich, Germany.
    6. Ensor, Tim, 2004. "Informal payments for health care in transition economies," Social Science & Medicine, Elsevier, vol. 58(2), pages 237-246, January.
    7. Wagstaff, Adam, 2008. "Measuring financial protection in health," Policy Research Working Paper Series 4554, The World Bank.
    8. O'Donnell, Owen & van Doorslaer, Eddy & Rannan-Eliya, Ravi P. & Somanathan, Aparnaa & Adhikari, Shiva Raj & Akkazieva, Baktygul & Harbianto, Deni & Garg, Charu C. & Hanvoravongchai, Piya & Herrin, Ale, 2008. "Who pays for health care in Asia?," Journal of Health Economics, Elsevier, vol. 27(2), pages 460-475, March.
    9. Roy, Kakoli & Howard, David Hill, 2007. "Equity in out-of-pocket payments for hospital care: Evidence from India," Health Policy, Elsevier, vol. 80(2), pages 297-307, February.
    10. Waters, Hugh R. & Anderson, Gerard F. & Mays, Jim, 2004. "Measuring financial protection in health in the United States," Health Policy, Elsevier, vol. 69(3), pages 339-349, September.
    11. Vassiliki Koutsogeorgopoulou & Manos Matsaganis & Chrysa Leventi & Jan-David Schneider, 2014. "Fairly Sharing the Social Impact of the Crisis in Greece," OECD Economics Department Working Papers 1106, OECD Publishing.
    12. Goranitis, Ilias & Siskou, Olga & Liaropoulos, Lycourgos, 2014. "Health policy making under information constraints: An evaluation of the policy responses to the economic crisis in Greece," Health Policy, Elsevier, vol. 117(3), pages 279-284.
    13. Olga Siskou & Daphne Kaitelidou & Charalampos Economou & Peter Kostagiolas & Lycourgos Liaropoulos, 2009. "Private expenditure and the role of private health insurance in Greece: status quo and future trends," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(4), pages 467-474, October.
    14. Xiaoyun Sun & Sukhan Jackson & Gordon Carmichael & Adrian C. Sleigh, 2009. "Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong Province," Health Economics, John Wiley & Sons, Ltd., vol. 18(1), pages 103-119.
    15. Siskou, Olga & Kaitelidou, Daphne & Papakonstantinou, Vasiliki & Liaropoulos, Lycourgos, 2008. "Private health expenditure in the Greek health care system: Where truth ends and the myth begins," Health Policy, Elsevier, vol. 88(2-3), pages 282-293, December.
    16. Ifanti, Amalia A. & Argyriou, Andreas A. & Kalofonou, Foteini H. & Kalofonos, Haralabos P., 2013. "Financial crisis and austerity measures in Greece: Their impact on health promotion policies and public health care," Health Policy, Elsevier, vol. 113(1), pages 8-12.
    17. Omar Paccagnella & Vincenzo Rebba & Guglielmo Weber, 2013. "VOLUNTARY PRIVATE HEALTH INSURANCE AMONG THE OVER 50s IN EUROPE," Health Economics, John Wiley & Sons, Ltd., vol. 22(3), pages 289-315, March.
    18. Liaropoulos, Lycourgos & Siskou, Olga & Kaitelidou, Daphne & Theodorou, Mamas & Katostaras, Theofanis, 2008. "Informal payments in public hospitals in Greece," Health Policy, Elsevier, vol. 87(1), pages 72-81, July.
    19. Jonas Schreyögg & Oliver Tiemann & Reinhard Busse, 2006. "Cost accounting to determine prices: How well do prices reflect costs in the German DRG-system?," Health Care Management Science, Springer, vol. 9(3), pages 269-279, August.
    20. Barros, Pedro Pita, 2012. "Health policy reform in tough times: The case of Portugal," Health Policy, Elsevier, vol. 106(1), pages 17-22.
    21. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications, The World Bank, number 6896, December.
    22. Alice sanwald & Engelbert Theurl, 2014. "What drives out-of pocket health expenditures of private households? - Empirical evidence from the Austrian household budget survey," Working Papers 2014-04, Faculty of Economics and Statistics, University of Innsbruck.
    23. Samia Laokri & Michèle Dramaix Wilmet & Ferdinand Kassa & Séverin Anagonou & Bruno Dujardin, 2014. "Assessing the economic burden of illness for tuberculosis patients in Benin: determinants and consequences of catastrophic health expenditures and inequities," ULB Institutional Repository 2013/173829, ULB -- Universite Libre de Bruxelles.
    24. Balabanova, Dina & McKee, Martin, 2002. "Understanding informal payments for health care: the example of Bulgaria," Health Policy, Elsevier, vol. 62(3), pages 243-273, December.
    25. Manos Matsaganis & Theodore Mitrakos & Panos Tsakloglou, 2009. "Modelling health expenditure at the household level in Greece," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(3), pages 329-336, July.
    26. Van Minh, Hoang & Kim Phuong, Nguyen Thi & Saksena, Priyanka & James, Chris D. & Xu, Ke, 2013. "Financial burden of household out-of pocket health expenditure in Viet Nam: Findings from the National Living Standard Survey 2002–2010," Social Science & Medicine, Elsevier, vol. 96(C), pages 258-263.
    27. Simou, Effie & Koutsogeorgou, Eleni, 2014. "Effects of the economic crisis on health and healthcare in Greece in the literature from 2009 to 2013: A systematic review," Health Policy, Elsevier, vol. 115(2), pages 111-119.
    28. Adam Wagstaff & Eddy van Doorslaer, 2003. "Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 921-933.
    29. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    30. Wagstaff, Adam & van Doorslaer, Eddy & van der Burg, Hattem & Calonge, Samuel & Christiansen, Terkel & Citoni, Guido & Gerdtham, Ulf-G & Gerfin, Mike & Gross, Lorna & Hakinnen, Unto, 1999. "Equity in the finance of health care: some further international comparisons1," Journal of Health Economics, Elsevier, vol. 18(3), pages 263-290, June.
    31. Eddy van Doorslaer & Owen O'Donnell & Ravindra P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Charu C. Garg & Deni Harbianto & Alejandro N. Herrin & Mohammed Nazmul Huq & Shamsia Ibragimo, 2007. "Catastrophic payments for health care in Asia," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1159-1184.
    32. Kakwani, Nanak & Wagstaff, Adam & van Doorslaer, Eddy, 1997. "Socioeconomic inequalities in health: Measurement, computation, and statistical inference," Journal of Econometrics, Elsevier, vol. 77(1), pages 87-103, March.
    33. Belli, Paolo & Gotsadze, George & Shahriari, Helen, 2004. "Out-of-pocket and informal payments in health sector: evidence from Georgia," Health Policy, Elsevier, vol. 70(1), pages 109-123, October.
    34. Ekman, Bjorn, 2007. "Catastrophic health payments and health insurance: Some counterintuitive evidence from one low-income country," Health Policy, Elsevier, vol. 83(2-3), pages 304-313, October.
    35. Samuel S. Lieberman & Adam Wagstaff, 2009. "Health Financing and Delivery in Vietnam : Looking Forward," World Bank Publications, The World Bank, number 2594, December.
    36. Polyzos, Nikolaos & Karanikas, Haralampos & Thireos, Eleftherios & Kastanioti, Catherine & Kontodimopoulos, Nick, 2013. "Reforming reimbursement of public hospitals in Greece during the economic crisis: Implementation of a DRG system," Health Policy, Elsevier, vol. 109(1), pages 14-22.
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    1. repec:eee:hepoli:v:122:y:2018:i:5:p:493-508 is not listed on IDEAS
    2. repec:eee:socmed:v:211:y:2018:i:c:p:338-351 is not listed on IDEAS

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