ESPN Thematic Report on Inequalities in access to healthcare - Greece

The Greek healthcare system is characterised by the coexistence of a national health system (which is rather hospital oriented), compulsory work-related social insurance and a fairly strong private for-profit healthcare sector. Since 2011, a number of reforms have sought to rationalise the system and curb public expenditure on health. In this context, a new organisation was established, namely the National Organisation for the Provision of Health Services (EOPYY), to act as a single purchaser of healthcare services for the vast majority of the insured; since 2016 it has also covered the uninsured. This is considered an important step towards universal healthcare coverage. Insured people are entitled to access (free of charge) to all public primary (medical care, dental care and diagnostic examinations) and secondary (hospital treatment) healthcare services, while they also have access, though on a cost-sharing basis, to healthcare services delivered by certain private providers contracted with EOPYY. This also applies to uninsured citizens (including migrants) who are legally residents in Greece and to certain migrant vulnerable social groups (irrespective of legal status) – except that, unlike the insured, they are not entitled to access on a cost-sharing basis to private providers contracted with EOPYY. As to pharmaceutical care, the same co-payment rules apply to both insured and uninsured persons, though certain categories of persons are exempt from any co-payments – e.g. people on a very low income, refugees, prisoners, etc. The recent reforms in the Greek healthcare sector include the creation of an e-prescription system, the application of new pricing rules for pharmaceuticals and, most importantly, the establishment – as part of the National Health System (ESY) – of the National Network of Primary Healthcare (PEDY). This was created in 2014 to strengthen access to primary healthcare and thus to reduce overcrowding in hospital emergency departments and unnecessary hospital admissions. However, full functioning of this primary healthcare network was never achieved, mainly on account of financial limitations and administrative obstacles. Very recently (August 2017) new legislation was adopted with the aim of reforming and reorganising the primary healthcare system. Although the recent reform of the primary healthcare system is considered a long-overdue and positive development, it would appear that implementation is proceeding rather slowly.

Although healthcare reforms are developing in the right direction, some of them have focused on drastic cuts both in spending and in the scope of publicly provided services; also they have hardly touched on problems relating to access, equity and quality. Major problems remain with regard to accessibility to healthcare, creating inequalities in access, especially among certain groups of the population. Public underfunding of health, the increased burden of out-of-pocket payments (due to a decrease in household income), staff shortages and poor-quality provision in the public healthcare sector, and the uneven geographical distribution of doctors and healthcare facilities are among the main challenges that need to be addressed. For unless concerted action is taken to tackle these challenges, inequalities in access to healthcare will persist and will even widen further. Besides, these challenges should be seen in the context of the pressure imposed by population ageing, which is expected to increase significantly the demand for healthcare services. This in turn brings to the fore the need to ensure sufficient quality of service provision. A common denominator in addressing all these challenges effectively is securing sufficient financial resources; this is a challenge in itself, given the current fiscal constraints. Overall, although efforts have been made by the government to improve universal access to healthcare services, this has yet to be fully accomplished; meanwhile improving equity and service quality remain challenges that have not been met. There is a particular lack of mental health services for children and the elderly (to say nothing of refugees and migrants), and many geographical areas are lacking mental health services. Public healthcare infrastructure is missing and services for children are still not widely available, especially for children with disabilities. Particular reference should also be made to specific vulnerable population groups, such as Roma people, patients with chronic illnesses, refugees and migrants; they face notable inequalities in accessing healthcare services in Greece.

When examining available indicators from different sources with regard to the various dimensions of access to healthcare, one observes that in Greece certain indicators reflect the actual situation, while others have limitations and thus fall short of depicting a clear picture of some aspects of the healthcare sector. Moreover, there are areas of concern, including those dimensions of access to healthcare for which data or relevant indicators are missing. The development of new indicators (such as the range of services covered, the variation in coverage and the utilisation of services by different groups, etc.) and the regular updating of all relevant indicators would definitely allow a much more comprehensive picture to be painted of the situation with regard to inequalities in access to healthcare in Greece. That could be used, in turn, for policy-design purposes, in order to address effectively the inequalities identified