Introduction

On the 25th of June 2023, the center-right party Nea Democratia (New Democracy) secured a resounding victory in the second round of general elections, clinching a second term in office. Following the victory, Prime Minister Kyriakos Mitsotakis, who had prominently featured public health in his pre-electoral campaign, appointed Mr. Michalis Chrisochoidis, a former member of the Socialist party and former minister of citizen protection, as the new Health Minister of Greece.

Past Challenges and Future Prospects

During the handover ceremony at the health ministry, Minister Chrisochoidis acknowledged that reforming the National Health System would be a paramount task for his term. He recognised that while the pandemic had rightfully commanded attention, several persistent issues affecting citizens, particularly the vulnerable, had remained unresolved. The minister highlighted the urgency of constructing a reimagined National Health System, one that would guarantee high-quality services to all citizens regardless of their income, a pursuit which was now feasible, given the efficient handling of the COVID-19 pandemic.

The plan entails a comprehensive upgrade of the country’s 80 hospitals and 156 health centers, recruitment of 10,000 new staff members, predominantly nurses, and an enhancement of primary care through widespread free screenings. This initiative aims to make preventive healthcare accessible to all citizens for a range of serious diseases, facilitated by expanded online appointment options. Additionally, the ministry aims to synchronize its approach to mental health with prevailing European policies and integrate modern therapeutic and scientific methodologies. The ambitious reform is set to materialize with the allocation of 1.5 billion euros secured from the European Recovery Fund, with approximately 8% of these funds earmarked for health investments.

The Broader Context

Despite a noteworthy increase in funding for the Greek healthcare system, rising from 4.4 billion euros in 2019 to 5.2 billion euros in 2022, and an emphasis on capacity-building during the pandemic, persistent challenges continue to impact the majority of citizens. According to a 2021 OECD report, Greece’s per capita health expenditure (EUR 1,603) remains well below the EU average, accounting for 7.8% of GDP compared to the EU’s 9.9% in 2019.

Moreover, public sources contribute to just under 60% of Greece’s health spending, leaving a significant portion (35%) as out-of-pocket expenses for households, primarily comprising co-payments for medications and direct payments for services beyond the benefits package. This translates to Greece having the third-highest level of out-of-pocket payments as a share of health spending in the EU at 35%, more than double the EU average of 15.4%. Out-of-pocket expenses for pharmaceuticals constitute 13% of all health spending in Greece, a significant difference from just under 4% in the EU. Inpatient care costs also constitute a substantial share of health spending, standing at 11% of total health expenditure in Greece compared to 1% in the EU. This underscores the need to address the prevalence of private healthcare payments, potentially extending even to informal payments in public hospitals.

Furthermore, healthcare services are disproportionately concentrated in urban areas, while hospital bed rates per 1,000 population stand at 4.2 on average, below the EU’s 5.3. This inadequacy of hospital beds was evident during the second wave of the COVID-19 pandemic in 2020, during which the hospital increased the use of auxiliary beds, further highlighting the need for substantial improvements.

An Imperative for Holistic Reform

It is undeniable that the previous administration put forth commendable endeavors to tackle the challenges arising from COVID-19 and enhance the capacity and accessibility of the national healthcare system. These efforts included initiatives like exempting specific groups, such as those with low income and individuals dealing with chronic conditions, from co-payments, policies aiming at decreasing the use of auxiliary beds, via the collaboration with private clinics, and curbing pharmaceutical costs and reducing prices to enhance the affordability of medicines. Regarding the latter, such measures included introducing a clawback mechanism from the pharmaceutical industry should expenditure exceed pre-agreed ceiling, lowering the wholesale prices of medications based on reference pricing, enforcing the use of international non-proprietary names for prescriptions, and mandating generic substitution by pharmacists. However, significant issues like medicine availability, healthcare professional shortages, lengthy waiting lists, and accessibility hurdles remain substantial impediments in the lives of Greek citizens.

As the new Health Minister embarks on this mission, success will hinge on their ability to foster synergy among diverse interest groups, effectively allocate resources, and implement policies with precision. Navigating the challenges of healthcare reform requires not only political will but also active collaboration with experts, stakeholders, and the public to ensure that the reimagined healthcare system stands as a model of inclusivity, affordability, and efficiency.

Ultimately, the evolution of Greece’s healthcare system stands as a high-stakes bet for the government’s commitment to ameliorate the welfare of its citizens. A holistic reform agenda has the potential to alleviate longstanding grievances, foster a culture of wellness, and pave the way for a healthier and more prosperous future for all Greeks. The challenges ahead are formidable, but with strategic planning and resource upscaling, the goal of a comprehensive and accessible healthcare system is within reach.