Economou Charalampos, Kaitelidou Daphne, Karanikolos Marina, Maresso Anna
Panteion University of Social and Political Science, Greece.
University of Athens, Greece.
Health Syst Transit. 2017 Sep;19(5):1-166.
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.
对希腊卫生系统的这一分析审视了其组织与治理、卫生筹资、医疗服务提供、卫生改革及卫生系统绩效方面的发展情况。经济危机对希腊社会和卫生系统产生了重大影响。诸如出生时预期寿命和65岁时预期寿命等健康状况指标高于欧盟平均水平，但健康不平等现象以及吸烟率高和儿童肥胖等特定风险因素依然存在。高度集权的卫生系统是一种混合模式，包含基于税收的筹资和社会医疗保险。从历史上看，卫生系统内部存在一些长期的结构和运营缺陷需要解决，但改革尝试往往彻底失败或在实施阶段停滞不前。该国的经济调整计划起到了催化剂的作用，推动了卫生部门众多广泛的改革，目标不仅是减少公共部门支出，还在于纠正不公平现象和低效率问题。自2010年以来，这些改革包括为国家卫生系统设立单一采购方、规范福利包、重新建立全民覆盖和获得医疗服务的机会、通过需求侧和供给侧措施大幅降低药品支出，以及对采购和医院支付系统进行重大变革；所有这些措施都是在严峻的财政约束背景下实施的。2018 - 2021年期间的优先事项是对初级保健系统进行重大改革。还存在其他一些挑战，例如确保为卫生系统提供充足资金（并减少高额的自付医疗费用）；维持全民医保覆盖和获得所需卫生服务的机会；以及加强卫生系统规划、协调和治理。虽然迄今为止实施的改革大多侧重于降低成本，但有必要将这一重点发展为长期战略改革，在提高效率的同时保证卫生服务的提供并改善整体医疗质量。
