Shadow Economy in Physicians’ Sector: The Patients’ Point of View from Greece

Abstract

Tax evasion of self-employed doctors as well as the informal out-of-pocket payments (IOOPPs) to doctors in public health structures are identified as the two main parameters of shadow economy in physicians’ sector. A quantitative survey of 2,161 people was used in this study to research the attitudes and perceptions of patients towards the shadow economy in the physicians’ sector in Greece. The research showed that the category of self-employed doctors has the largest financial contribution to the overall shadow economy of the physicians’ sector, with the corresponding tax evasion amounting to 76.09%, compared to 23.91% of informal payments to public sector physicians. The research highlighted the correlation of ‘tax evasion’ and ‘IOOPP’ phenomena, where the change of one phenomenon changes the intensity of the other in the same direction. In an environment of distrust rather than ‘loyalty’, ‘IOOPPs’ further compromise the quality of the provided public health services and aggravate the already low public confidence, taking on more features of ‘utilitarian silence’ on the part of patients, rather than becoming an alternative to ‘exit/voice’ of the well-known theory of Hirschman (1970), or features of ‘INXIT’ of the theory of Gaal and McKee (2004). Last but not least, the research has shown that citizens resort to a range of unfair means to ensure better services, not limited to the use of ‘informal payments’ to public sector physicians, but even more intensely, to the use of personal, political and local-administration acquaintances.