Greece: health system review

ABSTRACT

This analysis of the Greek health system reviews developments in itsorganization and governance, health financing, health care provision,health reforms and health system performance. The economic crisis hashad a major impact on Greek society and the health system. Health statusindicators such as life expectancy at birth and at age 65 are above the averagein the European Union but health inequalities and particular risk factorssuch as high smoking rates and child obesity persist. The highly centralizedhealth system is a mixed model incorporating both tax-based financing andsocial health insurance. Historically, a number of enduring structural andoperational inadequacies within the health system required addressing, butreform attempts often failed outright or stagnated at the implementation phase.The country’s Economic Adjustment Programme has acted as a catalyst totackle a large number of wide-ranging reforms in the health sector, aimingnot only to reduce public sector spending but also to rectify inequities andinefficiencies. Since 2010, these reforms have included the establishmentof a single purchaser for the National Health System, standardizing thebenefits package, re-establishing universal coverage and access to health care,significantly reducing pharmaceutical expenditure through demand and supply-sidemeasures, and important changes to procurement and hospital paymentsystems; all these measures have been undertaken in a context of severe fiscalconstraints. A major overhaul of the primary care system is the priority in theperiod 2018–2021. Several other challenges remain, such as ensuring adequatefunding for the health system (and reducing the high levels of out-of-pocketspending on health); maintaining universal health coverage and access toneeded health services; and strengthening health system planning, coordinationand governance. While the preponderance of reforms implemented so far havefocused on reducing costs, there is a need to develop this focus into longer-termstrategic reforms that enhance efficiency while guaranteeing the delivery ofhealth services and improving the overall quality of care.