Civil services

BMJ 1995; 311 doi: (Published 09 December 1995) Cite this as: BMJ 1995;311:1577
  1. Judith Hollis-Triantafillou, general practitioner
  1. Athens, Greece

    “By the way,” said my husband, as he was half way out of the door, “they've changed the system of payment for the “dimosio” patients. The procedure's the same but you have to go to …” He produced a scrap of paper with a scribbled address and thrust it into my hand before making a quick escape. My heart sank as I looked at the address—right across town with impossible parking—and, wisely as it turned out, set aside a whole morning for the job.

    The dimosio or civil servants' insurance scheme is just one of over 250 separate health insurance and pension organisations which exist in Greece, defying all attempts by successive governments to combine them into a single unified system. Doctors working in primary care can choose to accept patients with such insurance cover, but the remuneration is miserly and the bureaucratic procedures for getting paid are unbelievably complicated.

    Signed slips of paper are completed for each visit and when a sufficient pile has accumulated, the doctor sorts them into categories, sends or takes them to the central administration offices, fills in several forms, and after a variable period of time is informed that (in my case) she can collect her payment from the local tax office. She then has to attend in person or send a substitute identified by a formalised legal document drawn up, stamped, and sealed by a notary public; collect a statement from the tax department declaring she has no outstanding tax debts; and armed with this, her identity card, and official receipt book, wait in several queues for various papers to be stamped and signed before finally getting her hands on the money, minus tax, of course, which has already been deducted. The payment can be made in cash or by cheque but in either case she then has to go to her own bank and wait in more queues to pay it into her account or—if the banks are closed by that time, as frequently happens—secrete it at home over the weekend and pray for no break-ins.

    Negotiating all these hurdles used to take me several days but I had got it down to a fine art by getting to know a few of the personnel who operate the system. More to the point they knew me; they knew that the tall foreign iatrina often had trouble with official Greek and might need some help in filling in the endless forms which are apparently essential for even the simplest transactions in the public sector. Now, in the process termed “decentralisation,” I was to be uprooted from my familiar system, sent miles to a wrong address—it eventually proved to be five floors of impressive but nameless offices above the Cosmos supermarket—to wait in twice as many queues, clutching an increasing pile of papers and praying that I hadn't forgotten written evidence of some essential item of information such as my mother's maiden name.

    The man in front of me was trying to recover his mother's funeral expenses, the woman behind me was vainly trying to convince them that her husband was bedbound, paralysed and doubly incontinent, needing 24 hour care, and quite incapable of attending in person to plead his case. In such company I considered myself fortunate to eventually get paid (I took the cash and stashed it behind the radiator for the weekend) and actually managed a spark of sympathy for the harrassed civil servants struggling with desperate politeness to operate an impossibly archaic system. There came to my mind the immortal words of one of my young bilingual patients who, when asked on a recent trip to England, “And what does your father do Vassili?”, had replied with great pride, “He's a simple servant.”

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