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about 97 percent for hospital care.198 In theory,

fee-for-service basis, but reimbursement rates

are extremely low. Balance-billing is prohibited.

the uninsured can always receive treatment by

In theory, funds provide first-dollar cover-

walking into an NHS clinic or hospital. Only

age, with no deductibles and low copayments

about 8 percent of Greeks have private supple-

for only a few services. However, as discussed

mental health insurance, although this per-

below, most physicians demand "informal"

centage has risen substantially in the past few

years and further growth is predicted.199

payments in exchange for treatment.

In addition to the social insurance funds,

Accurate information on waiting lists is

the National Health Service employs physicians

difficult to come by. According to the WHO,

and operates hospitals. The NHS operates par-

"although `patient registries' at the hospital

allel to the social insurance funds, acting essen-

level do exist, there is no systematic data pro-

tially as a back-up mechanism, although it may

cessing available at any level of care," to pro-

vide adequate analysis.200 However, most

be the principal provider of health services in

some rural areas. It also provides health care for

observers agree that waiting lists are a severe

the uninsured and the elderly.

problem at almost every level of care, and par-

In addition to NHS hospitals, other public

ticularly bad at both NHS and public hospi-

hospitals contract with the social insurance

tals. An examination of waiting lists at Athens

funds. In both cases, the Ministry of Social

hospitals by the Ta Nea newspaper found the

Health and Cohesion determines not only the

wait for surgery was as long as six months; for

hospital's budget, but the number of person-

an outpatient appointment with either the

nel, the specialties of the personnel, salary lev-

hypertension or neurology departments, 150

els, number of beds, and the purchase of tech-

days. Even simple blood tests required a

month-long wait.201

nology. Budgets are rigidly monitored and hos-

pital administrators have little leeway.192

The Greek system has developed a level of

endemic corruption as patients have sought

Hospitals are reimbursed on a per diem pay-

ment system, a type of a fixed charge.193

ways around the system's rationing, bureaucra-

cy, and inefficiencies. For example, Greeks rou-

NHS hospitals in particular are considered

tinely provide physicians with "informal" pay-

substandard. Most suffer from severe staffing

ments for seeing a patient from a sickness fund

shortages caused by low pay and poor living con-

that has not contracted with the doctor, for

ditions in rural areas. It has been estimated that

moving a patient up in the queue, or for pro-

less than half of authorized medical positions are

actually filled.194 Low salaries have also led to per-

viding treatment outside government guide-

lines. In addition, physicians actively attempt

sonnel shortages in public hospitals associated

with social insurance funds.195

to persuade patients to move from a doctor's

sickness fund contract to the doctor's private

A series of reforms implemented in 2005

practice. Patients who switch pay out of pock-

imposed a referral requirement for hospital

et but receive faster and better care. Even NHS

admissions. Patients seeking free treatment in

physicians see private patients on the side.

a public NHS hospital must have a referral

(This practice was illegal until 2002 but went

from a general practitioner, who acts as a gate-

on despite the prohibition).202 Physicians also

keeper. Private practice physicians may not

Essentially, the

make referrals to public or NHS hospitals.196

receive payments for referrals to private hospi-

Greek health care

tals or diagnostic centers. Such informal out-

Unfortunately, general practitioners are in

of-pocket payments made up 42 percent of

severely short supply. Greece needs an estimat-

system is funded

total health expenditures in 2002, fully 4.5 per-

ed 5,000 general practitioners to meet demand.

through payroll

In actuality it has only around 600.197

cent of GDP.203 Essentially, the Greek health

taxes, general tax

care system is funded through payroll taxes,

Despite overlapping health plans, the Greek

general tax revenue, and bribery.

system falls short of universal coverage. About

revenue, and

In addition, the health care bureaucracy has

83 percent of the population is covered for pri-

bribery.

become highly politicized. Every staff appoint-

mary care (on par with the United States), and

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