Greek health ministry addresses informal payments in health sector


The Ministry of Health of Greece has initiated a dialogue with key stakeholders to better understand the root causes of informal payments in the health sector, analyse the potential implications for the health system and the population, and build consensus on feasible policy solutions.

Informal payments, or “under-the table” payments, are a type of out-of-pocket payment made directly by the users for health services. Formal out-of-pocket payments are stipulated in the terms of entitlement for health care. Informal payments, however, are additional payoffs made by users to secure health services.

Informal payments are part of the hidden economy and adversely affect financial protection, access to care and the efficiency of service delivery. Because of its informality, it is rather difficult to tackle the phenomenon, especially its impact on the poor and other vulnerable population groups. Addressing this issue, which is deeply ingrained in the system, will help Greece move towards improved financial protection and universal health coverage.

A roundtable on the topic was organized at the Ministry of Health on 7 November 2017, with the involvement of representatives of the Ministry of Health, Ministry of Finance, regional health authorities, hospital managements, professional associations and patients’ rights organizations, academia, WHO and the Organisation for Economic Co-operation and Development (OECD), and other experts.

The event is part of the on-going collaboration between the Ministry of Health and WHO in formulating policy options to reduce informal payments in the health sector. As part of this initiative, an initial situation analysis and key informant interviews were conducted on 17–23 July 2017. This was followed by the drafting of a policy brief with preliminary recommendations for quick fixes and longer-term interventions.

The policy brief, which will be available publicly at the end of the 2017, identifies measures which are feasible quick fix solutions for the Greek health system:

  • strengthening legal prohibition of informal payments and enforcement of preventive regulations
  • implementing a pay rise for health workers
  • disseminating information on entitlements to health service users
  • raising awareness
  • establishing well-organized channels to voice public opinions.

The workshop was carried out under the second phase of the Strengthening Capacity for Universal Coverage (SCUC2) initiative.


The SCUC initiative is carried out with funding from the European Union through a grant agreement between the European Commission and WHO Europe. Its general objective is to contribute to improving health and health equity in Greece, especially among the most vulnerable in the crisis-stricken population, by helping Greek authorities move towards universal health coverage and strengthen the effectiveness, efficiency and resilience of their health system.