Lancet (Jan 1, 2011): The Greek economic crisis: a primary health-care perspective

The Greek economic crisis: a primary health-care perspective

The Greek economic crisis has caused global concern owing to its side effects and risks involved for both the eurozone and the global economic community.

Analysis of the problem shows that the major sources of inadequacy are the severe structural weaknesses in Greek public administration, economy, and society, which lead to bureaucracy, corruption, low quality of services, and high costs.

Greek health care is a typical example of a bleeding economic sector. Although the total health-care expenditure rose from 5·3% of gross domestic product in 1991 to 9·7% in 2008, Greece has actually got worse in terms of global health outcomes.1

Why is that? Administrative barriers affect every aspect of the Greek healthcare system, with perhaps the largest insufficiencies located in primary care.2 In general, Greek primary care is highly fragmented, since there are several different public and private providers involved, with no coordination between them and no gatekeeping system.3

Some of the main reasons for the high primary health-care costs are the repetition of tests and prescriptions due to poor information transfer between providers and the vast induced demand for health-care services.

The latter is perhaps the most important factor and can be explained by the large number of specialists—the highest among countries of the Organisation for Economic Cooperation and Development—and the ineffectiveness of the existing control mechanisms of health insurance funds who incur the costs.4

We strongly believe that the above problems could be addressed by ensuring adequate political will and social consensus. The integration of all primary-care providers, the establishment of the multidisciplinary primary-care team, and the enactment of the family doctor institution are necessary to
obtain comprehensive, continuous, and efficient health care.5

The introduction and implementation of diagnostic and treatment guidelines in daily clinical practice could result in a better quality of care and a rationalisation of health-care expenditure. The induced demand for medical services seems an intractable problem, but might be controlled by a reduction in the production of new physicians.

Greece is struggling to manage its fiscal problems, overcome recession, and maintain a social welfare state. To achieve these goals and get out of the crisis, it is time for Greece to capitalise on moral, economic, political, and scientific support from international bodies and advanced nations by making drastic organisational reforms in all aspects of the public sector, including health care.

We declare that we have no conflicts of interest.

*Nikolaos Oikonomou, Yannis Tountas
nikolaos.emailaddress@gmail.com
Centre for Health Services Research, Medical School,
University of Athens, 115 27 Athens, Greece



References:
1 OECD. OECD health data 2010. Paris: OECD, 2010.

2 Tountas Y, Karnaki P. The ‘‘unexpected’’ growth of the private health sector in Greece. Health Policy 2005; 74: 167–80.

3 Mossialos E, Allin S, Davaki K. Analysing the Greek health system: a tale of fragmentation and inertia. Health Econ 2005; 14 (suppl 1): S151–68.

4 Oikonomou N, Mariolis A. Three trends that undermine the Greek health system: is there a way out? Eur J Gen Pract 2009;15: 67–68.

5 Lionis C, Symvoulakis EK, Markaki A, et al. Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review. Int J Integr Care 2009; 9: e88.