Greeks are digging deep into their pockets because of the economic and organizational crisis in the public health system. With a gray economy approaching 500 million euros in under-the-table payments for faster access to health services and a total private expenditure of up to 5.5 billion euros, the health system promises everything and nothing. A poll by MRB published in Kathimerini last week showed the low degree of satisfaction with hospitals and the Social Security Foundation (IKA). Now, a feasibility study by the economic department of the National School for Public Health (ESDY), headed by Professor Yiannis Kyriopoulos, confirms that the problem is indeed chronic. «There are waiting lists at hospitals and social security fund clinics. It is this bottleneck that has created the bribe system. In order to move up the waiting list, people pay according to their ability,» Kyriopoulos told Kathimerini. Kyriopoulos said this was a paradox, since Greece has 50,000 hospital beds, 60,000 doctors and 400 primary healthcare points (180 medical centers and 250 IKA polyclinics). There is a high concentration of advanced medical technology (such as magnetic resonance imaging equipment), the population’s health indicators are positive and the demand for services is moderate (five visits to a doctor per person per year). «In my view, this paradox is due to the very low wages paid to health professionals. It is not an ethical, social issue; it is above all financial. A wage of 800 euros per month for a doctor working in primary healthcare, according to Greek society’s income structure, pays for two hours of work. Because power lies in the hands of consumers who pay and the doctors who treat them and who set the value of services, we have these circumventions of the system – spending on private healthcare and bribes.» Hospitals in the public sector and services provided by IKA and other funds do not satisfy the demands of people, who nowadays expect more humane conditions and more care, independence and dignity when undergoing medical tests or surgery. As in comparative surveys carried out with the cooperation of the World Health Organization, most complaints are made by people in low-income groups, but protests also come from higher income groups. Most complaints concern the standard of accommodation, lack of respect from staff, particularly administrative staff, health workers’ habit of beginning an examination or treatment without the patient’s permission and the lack of «proper attention.» Only 32.7 percent and 36.5 percent of those polled had a positive view of the quality of the environment in outpatient and inpatient departments respectively. As a result, Greeks fork out amounts totaling 5.5 million euros to pay for private care or in under-the-table payments. Kyriopoulos quoted from a family budget survey, currently under way, which has found that the total annual outlay by households on private healthcare has jumped from an average of 1,250 euros in 1998 to 1,600-1,700 euros. Over a third of this amount went on dental care, of which state funds meet only about 10 percent. About 45 percent of the cost of medication comes out of patients’ own pockets, as they prefer to pay rather than wade through the bureaucracy required to get approval for prescriptions. Private outlay represents 43.8 percent of national spending on health, and as much as 50 percent in outpatient care. Meanwhile, thousands of households are going bankrupt due to healthcare expenses. According to the World Health Organization, about 2.5 percent of Greek families spend more than 40 percent of their income on a health problem, whether chronic or acute. The corresponding average figure for the European Union is 0.4 percent.