Introduction:
Health is a fundamental social good and a key pillar of social cohesion and sustainable development. In Greece, successive crises—particularly the prolonged economic recession and the COVID-19 have exposed and intensified longstanding structural weaknesses in the public healthcare system. Fiscal constraints, understaffing, and increased demand for services have placed significant pressure on public provision. Within this environment, informal payments, widely known as “fakelaki,” remain an entrenched form of corruption. This practice undermines equitable access to healthcare, disproportionately affects vulnerable populations, and reinforces social inequalities. It also erodes trust in public institutions and weakens confidence in the state’s capacity to ensure fairness and transparency. The present study explores patient perceptions of informal payments and examines the broader socio-institutional factors that contribute to the persistence of this phenomenon.

Methods:
The study draws on primary survey data collected between March and May 2023 from 2,072 participants selected through a screening sampling method. Descriptive statistics and non-parametric inferential analyses were conducted to assess preferences between public and private healthcare providers, perceptions of deficiencies in public healthcare services, attitudes toward informal payments, and levels of trust in public institutions. The analysis further sought to identify relationships between healthcare choices, financial pressures, perceived service quality.

Results:
Findings indicate an almost equal preference for public and private providers. However, a shift toward private services is linked to perceived inefficiencies in the public sector, including long waiting times, bureaucratic barriers, understaffing, and limited access to specialized care. Although most respondents morally oppose “fakelaki,” a notable minority express willingness to offer informal payments to secure faster or better-quality treatment. Several participants justify such payments as supplementary income for underpaid medical staff.

Conclusions:
Informal payments reflect systemic inefficiencies and low institutional trust. Addressing the issue requires transparency, accountability, and comprehensive reforms to strengthen equity and restore public confidence in healthcare provision.