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

Abstract

Tax evasion of self-employed doctors as well as the informal payments made to doctors in public health structures are identified as the two main parameters of Shadow Economy in this sector. In this study, a quantitative survey of 1,022 physicians was conducted to research the attitudes and perceptions of physicians. Although the physicians are mostly opposed to antisocial and unlawful behaviours, they are more tolerant with shadow economy phenomena. The research highlighted a correlation between tax evasion and informal payments where the increase of one phenomenon increases the intensity of the other. ‘Tax evasion’ in the conscience of physicians functions as a ‘corrective mechanism’ in the sector’s charges, which satisfies patients and physicians in the sector of self-employed doctors, acquiring characteristics of ‘Inxit’ of the well-known theory of Gaal and McKee. Informal Payments, on the other hand, as research has shown, act as an incentive for unsatisfied physicians to remain within the public health system. However, they have a negative impact on the employment relationships of health executives while at the same time, they significantly exacerbate the quality of services provided by public health institutions. Deterioration of quality in the ‘organisation’ with open channels of ‘exit’ and ‘voice’, given that there is no ‘loyalty’ of patients in the public health system, as research shows, leads to the conclusion that Informal Payments take on characteristics of ‘utilitarian silence’ on the part of patients, rather than characteristics of an alternative to ‘exit’, ‘protest’—of the well-known ‘EVL’ theory of Hirschman (1970) —or, ultimately, to ‘Inxit’.