Evangelos Fragkoulis,
General Secretary of the Greek Union
of General Practitioners
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.
