<p>Annex: Survey on the extent of hidden payments in Greece Copyright: Souliotis K et al.</p><p>Α. GENERAL DATA </p><p>1. SEX male female</p><p>2. AGE GROUP  up to 25  26-35  36-50  51-65  65+</p><p>3. Place of residence (municipality)</p><p>4. Education Basic Intermediate Higher </p><p>University Post graduate PhD</p><p>5. Monthly income level up to 750 € 751 - 1.450 € 1.451 - 2.200 € 2.201 - 3.500 € 3.501 € +</p><p>6. Main source of income </p><p> employed retired self- employed other (pls. clarify)…………………...... </p><p>7. Self-evaluation of economic status Very good good average poor very poor</p><p>8. Social Insurance Fund</p><p>9. Private insurance yes no Β. HEALTH SERVICES UTILIZATION AND REIMBURSEMENT </p><p>1. Over the past 12 months, have you used any health care services?</p><p> yes no</p><p>2. If yes, what for? (you may select more than one answers)</p><p> visit to a physician [Α]  visit to a dentist [Β]  diagnostic tests [Γ]  hospitalization – treatment and follow up care [Δ]  hospitalization - surgery [Ε]  other (pls. clarify) ...... [Ζ]</p><p>3. For these services to whom did you go to? (You may select more than one answers – please note the reason why you turned to this specific service provider / Α,Β,Γ,Δ,Ε,Ζ)</p><p>A) PRIMARY HEALTH CARE (exc. hospitalizations)  (1) office-based physician or dentist (συμβεβλημένο ή μη με το ταμείο σας) [....]  (2) private diagnostic center (συμβεβλημένο ή μη με το ταμείο σας) [....]  (3) NHS primary Health Center [....]  (4) SIF owned health center [....] Β) HOSPITALIZATION (inc. day care)  (5) public hospital (University, NHS, SIF owned) [....]  (6) private clinic [....]</p><p>4. Did you pay out of pocket for any of those services? </p><p> (1) yes [ ] no [ ] amount : ...... €  (2) yes [ ] no [ ] amount: ...... €  (3) yes [ ] no [ ] amount: ...... €  (4) yes [ ] no [ ] amount: ...... €  (5) yes [ ] no [ ] amount: ...... €  (6) yes [ ] no [ ] amount: ...... € 5. if yes, was a receipt issued to you for the amount paid out of pocket; </p><p> (1) yes [ ] no [ ]  (2) yes [ ] no [ ]  (3) yes [ ] no [ ]  (4) yes [ ] no [ ]  (5) yes [ ] no [ ]  (6) yes [ ] no [ ]</p><p>6. If not, for what proportion of the amount paid did you get a receipt for? (select the answer and circle the number that correspond to the respective service providers)</p><p> No receipt at all (providers: 1 2 3 4 5 6)  Receipt for less than half the amount, at a ....% (providers: 1 2 3 4 5 6)</p><p> Receipt for more than half the amount, at a....% (providers: 1 2 3 4 5 6)</p><p>7. Who received the money you paid out of pocket?  physician (providers: 1 2 3 4 5 6 )  nurse (providers: 1 2 3 4 5 6 )  other staff (pls. clarify) ...... (providers: 1 2 3 4 5 6 )</p><p>8. Why did you pay out of pocket?  To gain access to services (providers: 1 2 3 4 5 6 )  To reduce waiting times (providers: 1 2 3 4 5 6 )  To receive better quality care (providers: 1 2 3 4 5 6 )</p><p>9. You paid this amount out of your pocket...  Prior to service provision, because it was asked of me (providers: 1 2 3 4 5 6 )  After service provision, because it was asked of me (providers: 1 2 3 4 5 6 )  Without being asked, to express my gratitude (providers: 1 2 3 4 5 6 )  Without being asked, because I considered it imperative (providers: 1 2 3 4 5 6 )</p><p>10. What is the impact of these out of pocket payments on your income and your living conditions; significant medium small no impact</p>