Greece HiT (2017)

The economic crisis has had a major impact on Greece’s health system. While in the past, long-needed reforms stagnated, the country’s Economic Adjustment Programme imposed by international lenders has acted as a catalyst to tackle an unprecedentedly large number of changes in the health sector since 2010.

These changes aimed to cut spending, reduce inefficiencies and improve monitoring within a very ambitious time frame, but not all have been successful. Squeezed to the limits, Greece’s health system now needs longer-term strategic measures that can ensure a balance of resources, improve responsiveness, and deliver high-quality services equitably and in appropriate settings.

Health financing shaped by significant fiscal constraints

Health expenditure has fallen by a quarter since the onset of the crisis, and Greece now has one of the lowest levels of health spending in the European Union. Just over 40% of this is paid out-of-pocket, placing a considerable burden on households.

Measures have mainly targeted overall public spending, including cost reductions and inefficiencies in the pharmaceutical and hospital sectors. The longer-term financial sustainability of the national health system will depend on securing adequate public resources and on their appropriate distribution.

Health service benefits now more equitable

Greece has addressed long-standing fragmentation and inequities in social health insurance contribution rates and benefits through the establishment of the National Organization for the Provision of Healthcare Services (EOPYY), which acts as a single purchaser of health services, and by standardizing the benefits package.

Universal coverage restored

Nearly 2.5 million people lost their health insurance coverage – and thus access to health services – during the crisis due to unemployment or inability to pay social health insurance contributions. A series of measures tried unsuccessfully to address the situation before remedial legislation restored coverage for the whole population in 2016.

Major overhaul of the primary care system the priority over the next 3 years

Currently, Greece has an underdeveloped primary care system. Patients face problems with access, continuity of care and coordination, as well as comprehensiveness of services. A new primary care plan, which relies on shifting more responsibilities for service planning and delivery to the regions, aims to establish first-contact, decentralized local primary care units staffed by multidisciplinary teams that also take on a gate-keeping role to specialist ambulatory care.