CENTER FOR HEALTH SERVICES RESEARCH
DEPARTMENT OF HYGIENE, EPIDEMIOLOGY
AND MEDICAL STATISTICS
MEDICAL SCHOOL
UNIVERSITY OF ATHENS
WHO COLLABORATING CENTER
Yannis Tountas, MD, MPH, PhD
Professor of Social and Preventive Medicine
Director
President of the National Organization for Medicines

NHS
2.000 medical doctors
185 P.H. Centers
Health Services
Social Security
8.000 medical doctors
220 polyclinics
Private Sector
15.000 medical doctors
400 diagnostic centers
18.000 medical doctors
128 hospitals
26.000 beds
Taxation
1.600 medical doctors
12 hospitals
310 beads
Social Security
Financing
4.000 medical doctors
50 hospitals
15.000 beds
Private Payments

Social Security
Contributions
Private
Hospital
Sector
NHS
Hospitals
Taxation

 low levels of public expenditure
 inadequate personnel (mainly nursing)
 fragmented administrative framework
 insufficient management
 unorganized Primary Health Care
 lack of prevention and health promotion
 poorly regulated private sector
 health inequalities

 Overall, the economy of Greece has been underperforming.
 The economic freedom index has been dropping and now Greece ranks
40 out of 43 in the European region.
 This led to excessive debt as a percentage of the GDP and instigated the arrival of the Troika.
 This also led to three consecutive Memorandums of Understanding on how economic stability would be achieved (through budget cuts).
 As a result, health care reform, starting from health care funding, became a one way option for Greece.

Vision Statement: Restructuring of the NHS in order to develop a system which will improve citizen’s health by meeting their needs and which will ensure the system’s sustainability for the next generations.

Partners:
• Ministry of Health
• European Task Force
• Domain Leader: German Ministry of Health

Final decisions lie with the Minister of Health
The Health Reform Steering Committee approves the proposals of the sub-committees
Sub-committees submit reform proposals
Experts identified by the TFGR, the Domain Leader and International
Organisations provide technical assistance upon request by the MoH

Hospital
Management
Public
Health
DRGs
Primary
Health
Care
Health
Reform
Steering
Committee
Pricing and
Reimbursem ent of
Pharmaceuti cals
EOPYY E-Health
Health
Tourism
Human
Resources

Banks
Fund
Sea men
Fund
ETAA
OAEE
• Health insurance
Fund for Self
Employed
IKA
• Health insurance fund for private sector employees
OPAD
• Health Insurance
Fund for Public
Sector Employees
OGA
• Health Insurance
Fund for Farmers

Differentiated contributions
Different care levels
Different copayments
Health Insurance oligopsony
Economies of scale
Integration of processes, care packages, contributions and copayment levels

 The new Organization brought together 7 insurance funds and is responsible for purchasing health care services for 9,5 million insureds .
 EOPYY owns and operates a network of 300 primary care centers .
 There are also another 200 primary care services owned and operated by the NHS – these have not been integrated with EOPYY Centers.
 It also contracts the services of 6.000 employed Physicians as well as
5.000 contracted Physicians.
 There are access limitations, as physicians are reimbursed for up to 200 patient visits per month.
 This has resulted in patients having difficulties in accessing primary care services.

Common processes
Common care package
Common copayments
EOPYY
Care delivery?
Care financing?
Access to care?



Unemployment is rising – this means diminishing employee and employer contributions for EOPYY.
EOPYY budget is thus seriously challenged as to its sustainability for the future – will it be able to continue purchasing and providing quality services for its insureds?


Primary Health Care is more seriously impacted than other areas of EOPYY budget – as a result, insureds have to pay out of their pocket for primary care services.
This private financing is largely “uninsured” – there is no complementary, organized response by private health insurance targeted at this out of pocket spending.

Employed thousands
Unemployed thousands
Source: ELSTAT, Employment Survey, 2012

Pharmaceuticals
NHS Hospitals
Private
Primary Health Care accounts for only 7,6% of total EOPYY budget
Source: EOPYY, 2012

EOPYY doctor in his practice
EOPYY doctor in EOPYY center
NHS doctor in outpatient hospital department
NHS doctor in NHS Primary
Health Center
Doctor in Rural Health Center
Private doctor, paid out of pocket
Source: EOPYY, 2012

 There is also need for greater integration of Primary Care Services if to achieve economies of scale, whilst maintaining quality of service delivery and equitable access with wide coverage.
 To this end, the country would benefit from external expertise, with a track record of delivering integrated solutions in the organization and provision of primary care services, even within strict budgets .

Thank you