The evolution of health care reforms in Greece: charting a course of change (original) (raw)
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Plus ça Change: Health Sector Reforms in Greece
Journal of Health Politics, Policy and Law, 2005
Changes in the health care sector in Greece since the pathbreaking introduction of the National Health System (NHS) in 1983 have been sluggish. Twenty years after its inception and a series of attempts to reform it, the NHS remains centralized, fragmented in terms of coverage, and quite far removed from its principles of equity and effi ciency. Being part of an idiosyncratic welfare state, the health care system is bound to refl ect the particularities of Greek society and economy, namely, clientelism, a weak formal—and a thriving informal—economy, the lack of a strong administrative class, a weak labor movement, and strong organized interests. As a result, several ambitious reform plans have failed repeatedly owing to an array of interrelated economic, political, and social factors that channel potential changes toward the trodden path. This constellation creates unfavorable conditions for the introduction and implementation of major reforms.
National Health Policy In Greece: Regulations Or Reforms ? The Sisyphus Myth
European Research Studies Journal, 2008
This paper attempts an evaluation of health care reforms and regulations in Greece. The main findings indicate that the existing Conservative Government has kept but not developed some previous Social-democrats' major reforms concerning decentralisation and hospital management arrangements. The government also announced new regulations concerning the pharmaceutical sector and the procurement procedures of the national health units. On the other hand, precedent regulations for primary health care were to be postponed and the fundamental financing issue of the system has been neglected. In addition, this paper intends to take parallel account that terms such as globalisation and enlargement are still within the European perspective of the country. Overall, the Greek NHS seems to be developed and enlarged, besides the lack of strong political will to consider reforms and even regulations, into a continuous managerial process, assessment and public dialogue. In this sense, there is a continuing gap between-on the one hand-principles and goals and-on the other hand-rational planning, political issues and implementation process, all resulting in a never-ending reform scenario.
Exploring health care reform in a changing Europe: Lessons from Greece
European Journal of General Practice, 2013
The economic crisis is the major theme in the Eurozone and its impact on public health and outcomes is largely discussed. Under this pressure, concerns of further inequalities exist that may have an impact on the burden of several diseases in certain European countries. In this context, Greece is currently an issue of top interest in any international economic discussion. Although the background of the recession has been largely discussed as a political crisis, its health eff ects on the population, as well as the key role of primary care and general practice/family medicine in health care reform remain to be explored. Serving both the worldwide trend of orienting health care systems towards strengthened primary care and the inner need for minimizing the demand and lessening the burden from the dysfunctional and costly hospital-care system, the economic crisis sets the perfect timing for prioritizing primary health care. In this article a unique window of opportunity for health care reform in Greece is examined, attempting to establish the axes of an example of how health care system can be reshaped amidst the economic crisis. Equity, quality, value framework, medical professionalism, information technology and decentralization emerge as topics of central interest. There is no doubt that Europe is transitioning under challenging social, economic and public health perspectives. However, taking Greece as an example, the current economic situation sets a good timing for health care reform and the key messages of this paper could be used by other countries facing similar problems.
Interest Groups and Health System Reform in Greece
West European Politics, 2005
Despite the establishment of the National Health System in Greece in the early 1980s, the institutional framework remained largely unchanged due to opposition from interest groups and large setup costs, thus allowing the powerful stakeholders to preserve their privileges. Not until almost two decades later was reform attempted in order to rationalise and modernise purchasing and delivery. The objective of this paper is to analyse the ambitious reform attempt of 2000 through the lens of rational choice institutionalism, identifying the initial goals of the reform, the reactions of the key stakeholders and the legislative outcome.
2018
Este artigo analisa o impacto das políticas restritivas ditadas pela Troika no sistema de saúde grego. A maioria das medidas introduzidas durante a primeira fase das reformas (2010-2014) foram medidas de consolidação fiscal resultantes do aumento das barreiras ao acesso aos serviços de saúde e uma deterioração da saúde da população. Políticas que tendencialmente promoveriam as metas do sistema de saúde tais como cobertura universal, aquisição estratégica, avaliação da inovação tecnológica, medidas de saúde pública, mudança de internamento para cuidados em ambulatório, integração e coordenação de cuidados de saúde primários e secundários foram negligenciadas, enquanto que outras, por exemplo, a Organização Nacional para a Prestação dos Serviços de Saúde, a Rede Nacional de Cuidados Primários de Saúde e grupos de diagnóstico homogéneos (GDH) na versão grega, não foram bem planeadas nem implementadas devido aos exigentes objetivos reformistas e aos prazos impostos pelos memorandos. Emb...
Greece's healthcare system and the crisis
Anais do Instituto de Higiene e Medicina Tropical, 2018
Abstract The present paper discusses the impact of restrictive policies dictated by Troika on Greece's health care system. The majority of the measures introduced during the first wave of reforms (2010-2014), were fiscal consolidation measures resulting in increasing barriers to access to health services and a deterioration of the health of the population. Policies likely to promote health care system goals such as universal coverage, strategic purchasing, Health Technology Assessment, public health measures, shifting from inpatient to ambulatory care, and integration and coordination of primary and secondary care, were neglected, while some other, e.g. the National Organization for the Provision of Health Services, the National Primary Health Care Network and Diagnosis Related Group-Greek Version, were not well planned and implemented, due to extremely strict reform targets and schedules imposed by the Memoranda. Although after 2015 these neglected issues came to the forefront of the health policy agenda, issues for further consideration remain in relation to the scope and depth of social health insurance, the adequacy of public health funding , the development of a resource allocation mechanism, the reorganization of the hospital sector, the development of physical rehabilitation , long-term and palliative care and the strengthening of public health services. Using the health system as a case study, we argue that "hard" Europeanization mechanisms characterized by fiscal austerity and internal devaluation resulted to the retrenchment of the Greek welfare state.
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The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The health status of the Greek population has strongly improved over the last few decades and seems to compare relatively favourably with other OECD and European Union (EU) countries. The health system is a mixture of public integrated, public contract and public reimbursement models, comprising elements from both the public and private sectors and incorporating principles of different organizational patterns. Access to services is based on citizenship as well as on occupat...