Economic crisis and primary healthcare in Greece: ‘disaster’ or ‘blessing’?

The current economic crisis hit Greece more severely than any other European country, posing a direct threat to health, but also offering the Greek health system a ‘questionable’ advantage – an opportunity to redesign the whole approach to healthcare. The political will to confront the interests of professional and social groups has been strengthened by the economic threats. The implementation of deep, strategic changes is critical, with the key targets being ‘value for money’ and effective and efficient allocation of the scarce resources.

What has been the response of the government to date? The most radical change was the merging of health insurance funds and the establishment of EOPYY, (National Organization for Healthcare Provision), a monopolistic purchaser with enhanced negotiating powers.¹ The formulation of a common package of benefits has offered the means to eliminate social inequalities. The next most important measure was the launch of an electronic prescribing system, which enables monitoring of doctors’ behaviour. Clinical practice guidelines for common diseases were developed, aiming to provide evidence-based and safe practice. Other measures were imposed to tighten control over pharmaceutical expenditure.

What still needs to be done? Health coverage must become a universal right based on citizenship, rather than an employment benefit – this is essential while the unemployment rates rise. Re-orientation of the health system to primary care and public health is now more necessary than ever. A primary care network must be established which functionally integrates public and private providers. The ‘family doctor’ system must be implemented, with responsibility for referring patients to other health services, ensuring continuous care. Citizens must have free choice of their personal doctor. The lack of GPs can be addressed by attracting specialists to retrain ‘on the job’ as GPs. Physicians’ compensation by the public sector must be fair, otherwise they will not abandon opportunistic practices. Changing the compensation system offers the opportunity to offer incentives to physicians to be more productive and effective. Family doctors could be reimbursed by a hybrid system of ‘capitation’ and ‘pay for performance’, linking payments to outcomes, and specialists could be paid by a combination of ‘fee for service’ and ‘global budget’. This would foster competition among physicians, but would also discourage them from inducing demand and promote better geographical distribution in the country. The introduction of electronic medical records is critical for the enhancement of efficiency of the system and also for monitoring physicians’ behavior and conformity with clinical guidelines. Auditing mechanisms are necessary. Finally, more resources should be allocated to prevention and health promotion policies – unhealthy lifestyles are popular in Greece and hamper the efficiency of the system.^2,3

Budget cuts without major reforms will lead to a Greek ‘health tragedy’, but I strongly believe that the opportunity to re-engineer health service, thereby treating the inefficiencies of the past, can offer the entire population access to quality healthcare while keeping the cost in check.