Groenewegen Peter P, Jurgutis Arnoldas
NIVEL - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands.
Department of Public Health, Klaipeda University, Klaipeda, Lithuania.
Qual Prim Care. 2013;21(6):369-78.
Greece is hit hard by the state debt crisis. This calls for comprehensive reforms to restore sustainable and balanced growth. Healthcare is one of the public sectors needing reform. The European Union (EU) Task Force for Greece asked the authors to assess the situation of primary care and to make recommendations for reform. Primary healthcare is especially relevant in that it might increase the efficiency of the healthcare system, and improve access to good quality healthcare.
Assessment of the state of primary care in Greece was made on the basis of existing literature, site visits in primary care and consultations with stakeholders.
The governance of primary care (and healthcare in general) is fragmented. There is no system of gatekeeping or patient lists. Private payments (formal and informal) are high. There are too many physicians, but too few general practitioners and nurses, and they are unevenly spread across the country. As a consequence, there are problems of access, continuity, co-ordination and comprehensiveness of primary care.
The authors recommend the development of a clear vision and development strategy for strengthening primary care. Stepped access to secondary care should be realised through the introduction of mandatory referrals. Primary care should be accessible through the lowest possible out-of-pocket payments. The roles of purchaser and provider of care should be split. Quality of care should be improved through development of clinical guidelines and quality indicators. The education of health professionals should put more emphasis on primary care and medical specialists working in primary care should be (re-)trained to acquire the necessary competences to satisfy the job descriptions to be developed for primary care professionals. The advantages of strong primary care should be communicated to patients and the wider public.
希腊深受国家债务危机的重创。这就需要进行全面改革以恢复可持续的平衡增长。医疗保健是需要改革的公共部门之一。欧盟希腊特别工作组要求作者评估初级保健状况并提出改革建议。初级医疗保健尤为重要，因为它可能提高医疗保健系统的效率，并改善获得优质医疗保健服务的机会。
基于现有文献、对初级保健机构的实地考察以及与利益相关者的磋商，对希腊初级保健状况进行了评估。
初级保健（以及总体医疗保健）的管理分散。没有守门制度或患者名单。私人支付（正式和非正式）费用很高。医生数量过多，但全科医生和护士数量过少，且在全国分布不均。因此，初级保健在可及性、连续性、协调性和全面性方面存在问题。
作者建议制定明确的愿景和发展战略以加强初级保健。应通过引入强制转诊实现二级保健的分级诊疗。应尽可能降低自付费用以确保获得初级保健服务。医疗保健的购买者和提供者的角色应分开。应通过制定临床指南和质量指标来提高医疗质量。卫生专业人员的教育应更加强调初级保健，在初级保健机构工作的医学专家应接受（再）培训，以获得必要的能力，以满足为初级保健专业人员制定的工作职责要求。应向患者和更广泛的公众宣传强大的初级保健的优势。
