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Dimopoulou D, Sotiri D, Kousi D, Loulou G, Raptaki K, Neofytou A, Dasoula F, Tampouratzi M, Koloi A, Eleftheriou E, Vergadi E, Papadimitriou E, Zorbadaki I, Mavridi A, Miliordos K, Steletou E, Strempela M, Fragkou PC, Spoulou V, Michos A, Gkentzi D, Papaevangelou V, Ladomenou F, Grivea I, Syrogiannopoulos G, Galanakis E, Zaoutis T, Tryfinopoulou K, Tsolia MN. SARS-CoV-2 seroprevalence among children in Greece during Omicron variant period. Eur J Pediatr 2024; 183:2491-2499. [PMID: 38478132 DOI: 10.1007/s00431-024-05486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/05/2024] [Accepted: 02/13/2024] [Indexed: 04/23/2024]
Abstract
The Omicron variant is associated with increased transmissibility, but evidence about the impact of Omicron in seropositivity of children is limited. This study aims to evaluate SARS-CoV-2 seroprevalence in children during the different variants' subperiods. A prospective multicenter seroprevalence study was conducted in 7 University public hospitals in Greece from November 2021 to August 2022 (3 subperiods: November 2021-February 2022, March 2022-May 2022, June 2022-August 2022). Children from different age groups, admitted to the hospital or examined in outpatient clinics for reasons other than COVID-19 were enrolled. Neutralizing antibodies (Nabs), anti-Spike (anti-S) and anti-nucleocapsid (anti-N) SARS-CoV-2 IgG in serum were evaluated. A total of 2127 children (males:57,2%; median age:4,8years) were enrolled. Anti-N IgG seropositivity increased from 17,8% in the first sub-period to 40,7% in the second sub-period and then decreased in the third sub-period (36,7%). Anti-S IgG seropositivity appeared to have an increasing trend over the study period, starting from 34,8% and reaching 80,7%. Children aged 1-4 years old have significantly higher anti-N IgG titers compared to children aged 0-1 years old (p < 0,001). Infants have significantly lower anti-S IgG titers compared to all other age groups (p < 0,001). Immunocompromised children and infants have the lowest seropositivity for NAbs.Conclusions During the Omicron period, seropositivity significantly increased, as a result of higher transmissibility. Neonates and infants have lower antibody titers compared to other age groups, while young children aged 1-4 years old present higher antibody titers, suggesting that this age group may mount a higher antibody response. Continuous surveillance seroprevalence studies are needed in children, in order to identify the true extent of SARS-CoV-2 and guide the planning of adequate public health measures.
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Affiliation(s)
- Dimitra Dimopoulou
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Thivon and Leivadias, Athens, 30601, Greece
| | - Despoina Sotiri
- Central Public Health Laboratory, Hellenic Centre for Diseases Control and Prevention, Athens, Greece
| | - Dimitra Kousi
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, 15451, Greece
| | - Garyfallia Loulou
- Central Public Health Laboratory, Hellenic Centre for Diseases Control and Prevention, Athens, Greece
| | - Kalliopi Raptaki
- Central Public Health Laboratory, Hellenic Centre for Diseases Control and Prevention, Athens, Greece
| | - Ariadni Neofytou
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Thivon and Leivadias, Athens, 30601, Greece
| | - Foteini Dasoula
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Thivon and Leivadias, Athens, 30601, Greece
| | - Maria Tampouratzi
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Thivon and Leivadias, Athens, 30601, Greece
| | - Athina Koloi
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Thivon and Leivadias, Athens, 30601, Greece
| | - Eirini Eleftheriou
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Thivon and Leivadias, Athens, 30601, Greece
| | - Eleni Vergadi
- School of Medicine, Department of Paediatrics, University General Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Eleni Papadimitriou
- School of Health Sciences, Faculty of Medicine, Department of Paediatrics, University General Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Irini Zorbadaki
- Department of Pediatrics, Venizeleion General Hospital, Heraklion, Greece
| | - Artemis Mavridi
- Attikon University Hospital, National and Kapodistrian University of Athens, Third Department of Paediatrics, Athens, Greece
| | | | - Evangelia Steletou
- Medical School, Department of Paediatrics, University of Patras, Patras, Greece
| | - Maria Strempela
- First Department of Paediatrics, Aghia Sophia' Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi C Fragkou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Spoulou
- First Department of Paediatrics, Aghia Sophia' Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Michos
- First Department of Paediatrics, Aghia Sophia' Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Despoina Gkentzi
- Medical School, Department of Paediatrics, University of Patras, Patras, Greece
| | - Vassiliki Papaevangelou
- Attikon University Hospital, National and Kapodistrian University of Athens, Third Department of Paediatrics, Athens, Greece
| | - Fani Ladomenou
- Department of Pediatrics, Venizeleion General Hospital, Heraklion, Greece
| | - Ioanna Grivea
- School of Health Sciences, Faculty of Medicine, Department of Paediatrics, University General Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - George Syrogiannopoulos
- School of Health Sciences, Faculty of Medicine, Department of Paediatrics, University General Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Emmanouil Galanakis
- School of Medicine, Department of Paediatrics, University General Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Theoklis Zaoutis
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Thivon and Leivadias, Athens, 30601, Greece
| | - Kyriaki Tryfinopoulou
- Central Public Health Laboratory, Hellenic Centre for Diseases Control and Prevention, Athens, Greece
| | - Maria N Tsolia
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Thivon and Leivadias, Athens, 30601, Greece.
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Maltezou HC, Kontogianni S, Michailidou E, Vergadi E, Giannouchos TV, Steletou E, Sipsas NV, Galanakis E, Syrogiannopoulos GA, Roilides E. Effectiveness of COVID-19 vaccination against school absenteeism in children and adolescents hospitalized with COVID-19. Vaccine 2024; 42:2941-2944. [PMID: 38556391 DOI: 10.1016/j.vaccine.2024.03.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND COVID-19 vaccination has been recommended for children to protect them and to enable in-person educational and social activities. METHODS We estimated COVID-19 vaccination effectiveness (VE) against school absenteeism in children 5-17 years old hospitalized from September 1, 2021 through May 31, 2023. Full vaccination was defined as two vaccine doses. RESULTS We studied 231 children admitted to hospital with COVID-19, including 206 (89.2 %) unvaccinated/partially vaccinated and 25 (10.8 %) fully vaccinated. Unvaccinated/partially vaccinated children were absent from school for longer periods compared to fully vaccinated children (median absence: 14 versus 10 days; p-value = 0.05). Multivariable regression showed that full COVID-19 vaccination was associated with fewer days of absence compared to no/partial vaccination on average (adjusted relative risk: 0.77; 95 % CI: 0.61 to 0.98). COVID-19 VE was 50.7 % (95 % CI: -11.3 % to 78.2 %) for school absenteeism above the median duration of absenteeism. CONCLUSIONS Full COVID-19 vaccination conferred protection against school absenteeism in hospitalized school-aged children with COVID-19.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece.
| | | | - Elisavet Michailidou
- Third Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, and Hippokration General Hospital, Thessaloniki, Greece
| | - Eleni Vergadi
- Department of Pediatrics, Medical School, University of Crete, Heraklion, Greece
| | - Theodoros V Giannouchos
- Department of Health Policy & Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Evangelia Steletou
- Department of Pediatrics, School of Medicine, University of Patras, Patras, Greece
| | - Nikolaos V Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens Laiko General Hospital of Athens, Athens, Greece
| | - Emmanouil Galanakis
- Department of Pediatrics, Medical School, University of Crete, Heraklion, Greece
| | | | - Emmanuel Roilides
- Third Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, and Hippokration General Hospital, Thessaloniki, Greece
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Steletou E, Giannouchos T, Dimitriou G, Karatza A, Sinopidis X, Maltezou HC, Souliotis K, Gkentzi D. Parental concerns and vaccine hesitancy against COVID-19 vaccination for children in Greece: A cross-sectional survey. Vaccine 2024; 42:448-454. [PMID: 38185545 DOI: 10.1016/j.vaccine.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/13/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Parental hesitancy against children's COVID-19 vaccination remains a challenge globally. Although many studies have explored parental hesitancy, less is known about parental intentions towards COVID-19 vaccination of 6-month to 4-year-old children who were the last age group that became eligible for vaccination and for older children throughout the Omicron predominance period. METHODS We conducted a nationwide cross-sectional survey from November to December 2022 in Greece. We aimed to explore parental COVID-19 vaccination intentions for their children, reasons against vaccination, and to estimate the association between parents' intentions and child and parental characteristics and parental attitudes towards COVID-19 vaccination. RESULTS Of 431 parents, 243 (56.4 %) had not or did not intend to vaccinate their children against COVID-19. Most parents were vaccinated against COVID-19 (64.7 % no booster; 14.2 % at least one booster). Among parents with children under the age of 5, 13.0 % intended to vaccinate their children against COVID-19, while 47.3 % of parents with children 5 years of age or older reported intention or had already completed vaccination. The most common reasons against COVID-19 vaccination were fear of side effects (32.9 %), perceived short length of clinical trials (29.2 %), and the child having previously contracted COVID-19 (12.0 %). The strongest factors associated with intention or already completed vaccination were parental own vaccination against COVID-19, using a pediatrician or a healthcare professional as the main source of vaccine-related information for their children, agreeing with their pediatrician regarding COVID-19 vaccination, and trusting official healthcare guidelines. Stratified analyses by the two children's age groups (<5 and 5 to 17) yielded similar estimates. Among parents who had not or did not intend to vaccinate their children, 11.9 % would do so if recommended by a pediatrician. CONCLUSIONS Our findings highlight the need to incentivize healthcare professionals and pediatricians to inform parents about vaccines, clarify misconceptions and address concerns.
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Affiliation(s)
- E Steletou
- Department of Pediatrics, Patras Medical School, Greece.
| | - T Giannouchos
- Department of Health Policy & Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - G Dimitriou
- Department of Pediatrics, Patras Medical School, Greece
| | - A Karatza
- Department of Pediatrics, Patras Medical School, Greece
| | - X Sinopidis
- Department of Pediatrics, Patras Medical School, Greece
| | - H C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
| | - K Souliotis
- Department of Social and Education Policy, University of Peloponnese, Corinth, Greece; Health Policy Institute, Athens, Greece
| | - D Gkentzi
- Department of Pediatrics, Patras Medical School, Greece
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Steletou E, Metallinou D, Margeli A, Giannouchos T, Michos A, Kanaka-Gantenbein C, Papassotiriou I, Siahanidou T. Serum YKL-40 as a Potential Biomarker for Sepsis in Term Neonates-A Pilot Study. Children (Basel) 2023; 10:children10050772. [PMID: 37238320 DOI: 10.3390/children10050772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023]
Abstract
Although YKL-40 is a promising diagnostic biomarker of sepsis in adults, its value in neonatal sepsis is not known. The study objectives included assessing the levels and diagnostic value of serum YKL-40 in term neonates with sepsis and comparing YKL-40 with other commonly used inflammatory biomarkers. In this pilot case-control study, 45 term neonates (30 septic and 15 non-septic, as controls), 4 to 28 days old, were prospectively studied. The International Pediatric Sepsis Consensus Conference criteria were applied to diagnose sepsis. During the acute phase (admission) and remission of sepsis, blood samples were collected from cases (while from controls they were only collected once) for routine laboratory tests, cultures, and the measurement of serum YKL-40 levels via Elisa. In the acute phase of sepsis, YKL-40 levels were significantly elevated in comparison with remission (p = 0.004) and controls (p = 0.003). YKL-40 levels did not differ significantly between patients in remission and controls (p = 0.431). Upon admission, YKL-40 levels correlated positively with white blood count, absolute neutrophil count, and CRP levels. Via ROC analysis, it was shown that YKL-40 levels upon admission were a significant indicator of sepsis (AUC = 0.771; 95% CI 0.632-0.911; p = 0.003). Serum YKL-40 might be considered as an adjuvant biomarker of sepsis in term neonates.
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Affiliation(s)
- Evangelia Steletou
- Master of Science Program "Pediatric Infectious Diseases", School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitra Metallinou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Alexandra Margeli
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece
| | - Theodoros Giannouchos
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29150, USA
| | - Athanasios Michos
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece
| | - Christina Kanaka-Gantenbein
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece
| | - Ioannis Papassotiriou
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece
- IFCC Emerging Technologies Division, Emerging Technologies in Pediatric Laboratory Medicine (C-ETPLM), 20159 Milano, Italy
| | - Tania Siahanidou
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece
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Christodoulou I, Dietrich A, Hair N, Saha A, Steletou E, Pirrallo R, Burroughs Z, Crawford E, Giannouchos TV. Emergency department utilization and disposition outcomes by pediatric patients with cancer in Maryland and New York from 2013 to 2017. Pediatr Blood Cancer 2023; 70:e30369. [PMID: 37057811 DOI: 10.1002/pbc.30369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/22/2023] [Accepted: 03/29/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Pediatric patients with cancer commonly seek emergency department (ED) care, yet there is limited evidence on ED utilization patterns and disposition outcomes among these patients. METHODS Retrospective analysis of the Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases for Maryland and New York from 2013 to 2017. We compared ED visits and disposition outcomes for 5.8 million pediatric patients (<18 years old) with and without cancer, and used multivariable regressions to estimate associations between the number of ED visits, hospital (inpatient) admissions through the ED, and ED or inpatient mortality and sociodemographic and clinical factors within the cancer cohort. RESULTS Pediatric patients with cancer had more ED visits per year on average (2.4 vs. 1.5, p < .001), higher shares of admissions (56.8% vs. 6.6%, p < .001) and mortality (1.2% vs. 0.1%, p < .001) compared to those without cancer. Among patients with cancer, uninsured pediatric patients had fewer ED visits and lower risk of admission to a hospital through the ED compared to those with Medicaid coverage (total visits: incidence rate ratio [IRR]: 0.82, 95% confidence intervals [CI]: 0.75-0.90; admission: IRR: 0.75, 95% CI: 0.65-0.86). Mortality risks were higher for pediatric patients with cancer residing in areas with the lowest median household income, and with no health insurance coverage (IRR: 2.81, 95% CI: 1.21-6.51) compared to Medicaid. CONCLUSIONS Our findings emphasize the importance of enhancing health insurance coverage policies and social services for pediatric patients with cancer and their families to address clinical and nonclinical needs.
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Affiliation(s)
- Ilias Christodoulou
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ann Dietrich
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Nicole Hair
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Aniket Saha
- Department of Pediatrics, Division of Pediatric Hematology Oncology, Prisma Health Upstate Children's Hospital, University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Evangelia Steletou
- Department of Pediatrics, University of Patras Medical School, Patras, Greece
| | - Ronald Pirrallo
- Department of Emergency Medicine, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Zachary Burroughs
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Erika Crawford
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Theodoros V Giannouchos
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Miliordos K, Giannouchos T, Steletou E, Sanidas G, Karkania A, Vervenioti A, Dimitriou G, Gkentzi D. Parental attitudes towards vaccination against COVID-19 of children 5-11 years old in Greece. J Eval Clin Pract 2022; 28:943-947. [PMID: 35599609 PMCID: PMC9347632 DOI: 10.1111/jep.13701] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/03/2022] [Accepted: 05/09/2022] [Indexed: 12/31/2022]
Abstract
RATIONALE Vaccinating children against COVID-19 is critical to contain the ongoing pandemic. AIMS/OBJECTIVES The aim of the present study was to assess parents' and caregivers' intention to vaccinate their 5-11 years old children against COVID-19 and to estimate the association between vaccination intention and sociodemographic, clinical and contextual factors. METHOD We conducted a questionnaire-based survey on a convenience sample of parents in Patras, Western Greece. RESULTS Out of 366 study participants, around 48% reported their intention to vaccinate their child. The main factors associated with positive attitudes were paediatrician recommendation, parental vaccination, and reliance on the healthcare providers for decision making. Of note, 80% of the 190 parents who did not intend to vaccinate their children would vaccinate them if the paediatrician recommended it. CONCLUSION Interventions to further train healthcare professionals to establish rapport with parents, and to provide adequate information about vaccinations are crucial to address concerns related to COVID-19 vaccine benefits for children.
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Affiliation(s)
| | - Theodoros Giannouchos
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Evangelia Steletou
- Department of Pediatrics, University of Patras Medical School, Patras, Greece
| | - Georgios Sanidas
- Department of Pediatrics, University of Patras Medical School, Patras, Greece
| | - Aglaia Karkania
- Department of Pediatrics, Karamandaneio Children Hospital of Patras, Patras, Greece
| | - Aggeliki Vervenioti
- Department of Pediatrics, University of Patras Medical School, Patras, Greece
| | - Gabriel Dimitriou
- Department of Pediatrics, University of Patras Medical School, Patras, Greece
| | - Despoina Gkentzi
- Department of Pediatrics, University of Patras Medical School, Patras, Greece
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Giannouchos TV, Ukert B, Vozikis A, Steletou E, Souliotis K. Informal out-of-pocket payments experience and individuals' willingness-to-pay for healthcare services in Greece. Health Policy 2021; 125:693-700. [PMID: 33838935 DOI: 10.1016/j.healthpol.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 03/19/2021] [Accepted: 04/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Informal out-of-pocket payments to healthcare providers are not uncommon in the Greek health system. We explore individuals' willingness-to-pay (WTP) to secure zero out-of-pocket full coverage for healthcare services and medications and we estimate the impact of past informal payments and individuals' opinion about the legalization of informal payments on WTP. METHODS We conducted a survey of 2841 participants from November 2016 to February 2017. We obtained information on WTP using the contingent valuation method. A two-part regression model was used to estimate the association between WTP, informal payments, and respondents' opinion about legalizing such payments. RESULTS About 80% of the respondents were willing to pay an average of €95 per month to obtain free access to full healthcare coverage and medications. About 65% of the respondents were involved in an informal payment at least once during the past four months with an average payment of €247. Higher informal payments and supportive opinions towards the legalization of informal payments increased the likelihood of WTP and were also positively associated with increased WTP amounts overall (p < 0.001). CONCLUSIONS This survey reveals that individuals' WTP is critically affected by previous experiences and attitudes towards informal payments. Our results imply that the potential introduction of official fees might not suffice to limit informal payments and suggest the need for stricter regulatory policies.
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Affiliation(s)
- Theodoros V Giannouchos
- Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah, 30 S 2000 E, Salt Lake City, 84112, UT, USA; Population Informatics Lab, Texas A&M University, 212 Adriance Lab Rd, College Station, 77843, TX, USA; Laboratory of Health Economics & Management, Economics Department, University of Piraeus, Karaoli ke Dimitriou 80, 185 34, Piraeus, Greece.
| | - Benjamin Ukert
- Department of Health Policy & Management, School of Public Health, Texas A&M University, 212 Adriance Lab Rd, 77843, College Station, TX, USA
| | - Athanassios Vozikis
- Laboratory of Health Economics & Management, Economics Department, University of Piraeus, Karaoli ke Dimitriou 80, 185 34, Piraeus, Greece
| | - Evangelia Steletou
- University Regional General Hospital of Patras, University of Patras, 26504, Patras, Rion, Greece
| | - Kyriakos Souliotis
- Department of Social and Education Policy, University of Peloponnese, Damaskinou & Kolokotroni Str., 20100, Corinth, Greece
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