Crisis hit Greece more severely than any other
European country posing a direct threat to health, but also offers Greek Health System a “questionable” advantage-
an opportunity to redesign the whole approach to healthcare. Political will to
conflict with interests of professional and social groups, in front of the
threat has been strengthen. Implementation of deep, strategic changes is
critical. Key target of an extensive reform is the “value for money”- effective
and efficient allocation of the scarce resources.
What was the response of the government
till now? The most radical change was the
merging of health insurance funds and the establishment of the unified “EOPYY”, a monopsony purchaser
with enhanced negotiating power. The formulation of a common package of
benefits eliminates social inequalities. Next most important measure taken was
the launch of an electronic prescribing system, which enables monitoring
doctors’ behaviour. Clinical practice guidelines for common diseases were
developed, aiming to provide evidence based and safe practice. Lots of measures
were imposed in order to tighten control over pharmaceutical expenditure.
What must be done? Health coverage must become a universal right
based on citizenship, rather than an employment benefit and is essential while
the unemployment rates rise. Re-orientation of the Health System to PC and
Public Health is necessary now more than ever. Restructuring the fragmented PC
is a high priority issue. A PC Network must be established with functional
integration of public and private PC
providers. The “family doctor” institution 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 faced by attracting specialists to
follow “on the job” training to become GPs. Physicians’ compensation by the public sector must be fair, otherwise they will not abandon
opportunistic behaviours. Changing the compensation system can impose incentives
to the physicians to be more productive and effective. Family doctors can be
reimbursed by a hybrid system of “capitation” and “pay for performance”-
linking payments to outcomes. Specialists could be paid by a combination of
“fee for service” and “global budget”. This would foster competition among
physicians, but also will discourage them from inducing demand and will promote the better geographical distribution
. The introduction of electronic medical records is critical for the
enhancement of efficiency of the system and also for monitoring physicians’
behaviour and conformity with clinical guidelines. Auditing mechanisms are necessary. More resources
must be allocated to prevention and health promotion policies. Unhealthy
lifestyles are popular in Greece and hamper the efficiency of the system.
I strongly believe that taking advantage
of the opportunity to re-engineer the Greek PC and the NHS generally, treating
the inefficiencies of the past, will guarantee the entire population access to
quality health care while keeping the cost in check. Budget cuts without major
reforms will lead to a Greek “Health
Tragedy”.
Evangelos Fragkoulis,
General Secretary of the Greek Union of General Practitioners
References
1)
Mossialos E, Allin S, Davaki K. Analysing the Greek
health system: a tale of fragmentation and inertia. Health Econ 2005; 14 (suppl 1): S151-S168
2)
Economou C. Greece: Health system review. Health Systems in Transition, 2010,
12(7):1–180
3)
OECD (2011), Health at a Glance 2011: OECD Indicators,
OECD Publishing. http://dx.doi.org/10.1787/health_glance-2011-en
