• Spending overview
• Policy overview
• Diseases overview

Spending overview

In 2008 Greece spent an estimated 9.8% of GDP on healthcare, higher than the OECD average. Between 2000 and 2008, healthcare spending per head in Greece increased significantly faster than in most other EU countries. This is partly a reflection of a lack of incentives to reduce costs in the Greek healthcare system. Total healthcare spending is expected to decline slightly in US dollar terms in 2009, in line with a contraction in GDP of an estimated 2.5%. As the economy gradually picks up, both public health spending and private spending on insurance, and out of pocket, will increase, albeit at a moderate pace, and is expected to reach US$43.2bn in 2013.

The public healthcare system (ESY), which was established in 1983, falls under the responsibility of the health and social solidarity ministry. It is funded by employers' and employees' social security contributions, as well as through general taxation. The main social insurance schemes are managed and administered by the employment and social protection ministry. Private health insurance is generally used as a supplement to publicly funded healthcare and has been growing in popularity. The rise in private health insurance and the development of the private sector is largely associated with underfinancing of the public sector. The 2009 budget also provided for public healthcare expenditure to rise by 6.9% year on year, but it is unlikely that healthcare spending will reach these levels as the Greek government comes under considerable pressure from the European Commission to reduce its budget deficit.

Policy overview

The Greek public healthcare system suffers from a considerable amount of corruption and inefficiency. Certain social insurance funds, such as noble funds, often used by civil servants, the banking sector and public utility employees, offer more extensive benefits and require smaller worker contributions. Powerful unions representing workers who use these funds have blocked attempts to merge noble funds with other social insurance funds or to allow other industry sectors to buy in. Patients sometimes offer informal payments to doctors to receive treatment when that doctor is not contracted to see patients from their social insurance fund, or to receive faster and better health care. In late 2008 the ND government began implementing a new accounting system in the healthcare system based on double-entry accounting and real-time submission of invoices. This will help to reduce corruption in the system, but unless bureaucracy is reduced and public-sector funding is increased, informal payments are likely to persist over the forecast period.

The main thrust of the national healthcare system reform plan initiated by the current government is the decentralisation of services to a series of regional health systems. All clinics operated by public-sector insurance funds will eventually be absorbed into the new structure. A new single financing agency will collect and manage the healthcare portion of social security funds and will purchase primary hospital services from national health service hospitals. The system will incorporate an earlier scheme to establish primary-care providers and to promote preventive medicine. The scheme will take time to come fully into effect. Legislation has also been drafted calling for the involvement of the private sector in the construction and management of public infrastructure, including hospitals under public-private partnership (PPP) and private finance initiative (PFI) schemes.

Diseases overview

Greece's health outcomes are generally good, but its healthcare system is coming under mounting demographic pressure. Life expectancy is already the fifth-highest in the euro area, and is forecast to reach 80.2 years in 2013. Nearly 20% of the population is 65 or older, and demands on the health system are growing as the population ages further. Greek longevity is all the more surprising given that Greece has the highest smoking rate in the world, with each person puffing over eight cigarettes every day according to ERC, a market research company. According to Eurostat, 37.6% of over-15s in Greece are daily smokers, the highest rate in the EU.

A moderate decrease in smoking is expected, partly owing to new legislation implemented in July 2009 that bans smoking in public places. Unrestricted smoking in restaurants, bars, cafés and workplaces is now illegal. According to the Health Consumer Powerhouse's 2008 Euro Health Consumer Index, Greece ranks 19th out of 31 countries in Europe. The country scored particularly poorly for patient rights and information, e-health, the range and reach of services provided and pharmaceuticals.