Greece: Health System Review.

This analysis of the Greek health system reviews developments in its organization and governance, health financing, health care provision, health reforms and health system performance. The economic crisis has had a major impact on Greek society and the health system. Health status indicators such as life expectancy at birth and at age sixtyfive are above the average in the European Union but health inequalities and particular risk factors such as high smoking rates and child obesity persist. The highly centralized health system is a mixed model incorporating both tax-based financing and social health insurance. Historically, a number of enduring structural and operational inadequacies within the health system required addressing, but reform attempts often failed outright or stagnated at the implementation phase. The countrys Economic Adjustment Programme has acted as a catalyst to tackle a large number of wide-ranging reforms in the health sector, aiming not only to reduce public sector spending but also to rectify inequities and inefficiencies. Since 2010, these reforms have included the establishment of a single purchaser for the National Health System, standardizing the benefits package, re-establishing universal coverage and access to health care, significantly reducing pharmaceutical expenditure through demand and supply-side measures, and important changes to procurement and hospital payment systems; all these measures have been undertaken in a context of severe fiscal constraints. A major overhaul of the primary care system is the priority in the period 2018-2021. Several other challenges remain, such as ensuring adequate funding for the health system (and reducing the high levels of out-of-pocket spending on health); maintaining universal health coverage and access to needed health services; and strengthening health system planning, coordination and governance. While the preponderance of reforms implemented so far have focused on reducing costs, there is a need to develop this focus into longer-term strategic reforms that enhance efficiency while guaranteeing the delivery of health services and improving the overall quality of care.