Discussion topics
  • Assessment of the implementation of changes in Primary Healthcare
  • Incentives and counter-incentives for medical professionals
  • Hurdles and challenges in the operation of Local Healthcare Units (ToMY)
  • Services provided to citizens by Local Healthcare Units

ROUND TABLE I

Primary Healthcare

The progress of the various changes that the government is promoting in the Primary Healthcare system is not unhindered. About 100 Local Healthcare Units (ToMY) have been established so far, while the Ministry of Health aims to open 50 more by the end of the year.

The initial plan included a total of 250 units which were supposed to be put into operation until the summer of 2018; however, this goal was hindered mostly by the fact that very few general practitioners and pathologists responded to the State’s call for expression of interest.

Self-employed doctors’ interest in signing contracts with EOPYY (the Greek National Healthcare Services Provider) is markedly faint. According to medical associations the cause are the low fees, despite the government’s – delayed – efforts to improve the framework regarding new contracts and medical fees.

The family doctor system was put into effect on August 1st but it is not yet viable due to the inadequate number of medics. Indicatively, so far only 600 doctors have agreements with EOPYY, while there are approximately 1,700 general practitioners, pathologists and pediatricians according to updated records.

Therefore, the lack of available doctors is the main hindrance in the implementation of the new – greatly disputed by medical associations – system where the family doctor refers patients to other services of the Hellenic National Health System or to specialized doctors who have agreements with EOPYY.

The government maintains that this system will be put into effect gradually starting on January 1st 2019, until there are enough family doctors to cover the whole population of Greece. This means that, until then, the insured will be entitled to visit EOPYY’S doctors of all specialties free of charge and without previous reference by a general practitioner.

ROUND TABLE I

Primary Healthcare

The progress of the various changes that the government is promoting in the Primary Healthcare system is not unhindered. About 100 Local Healthcare Units (ToMY) have been established so far, while the Ministry of Health aims to open 50 more by the end of the year.

The initial plan included a total of 250 units which were supposed to be put into operation until the summer of 2018; however, this goal was hindered mostly by the fact that very few general practitioners and pathologists responded to the State’s call for expression of interest.

Self-employed doctors’ interest in signing contracts with EOPYY (the Greek National Healthcare Services Provider) is markedly faint. According to medical associations the cause are the low fees, despite the government’s – delayed – efforts to improve the framework regarding new contracts and medical fees.

The family doctor system was put into effect on August 1st but it is not yet viable due to the inadequate number of medics. Indicatively, so far only 600 doctors have agreements with EOPYY, while there are approximately 1,700 general practitioners, pathologists and pediatricians according to updated records.

Therefore, the lack of available doctors is the main hindrance in the implementation of the new – greatly disputed by medical associations – system where the family doctor refers patients to other services of the Hellenic National Health System or to specialized doctors who have agreements with EOPYY.

The government maintains that this system will be put into effect gradually starting on January 1st 2019, until there are enough family doctors to cover the whole population of Greece. This means that, until then, the insured will be entitled to visit EOPYY’S doctors of all specialties free of charge and without previous reference by a general practitioner.

Discussion topics
  • Assessment of the implementation of changes in Primary Healthcare
  • Incentives and counter-incentives for medical professionals
  • Hurdles and challenges in the operation of Local Healthcare Units (ToMY)
  • Services provided to citizens by Local Healthcare Units

ROUND TABLE II

Healthcare Funding

The various financial support programmes (memorandums) do not appear to have cured the chronic problems in the funding of the Greek NHS. Besides, even before 2009, Greece had the highest expenditure rate in the private healthcare sector in Europe.

The truth is that, before the memorandums, the NHS was kept in balance by the high fees in the private medical sector. The imposition of stringent restrictions on public expenditure combined with the reduction of citizens’ income, caused total imbalance and relevant costs were passed on to patients.

According to certain studies and statistics, basic health indicators such as infant mortality and life expectancy, were significantly reduced in Greece during the “memorandum era”.

Of course, the memorandums came with measures such as the creation of EOPYY, strict adherence to budgets, electronic prescriptions etc., which were crucial for the control of healthcare-related expenditure, but their application was rushed and often unfair, thus yielding poor results.

The harsh reality is that the government failed to keep healthcare expenditure under control in all the spectrum of medical services, therefore had to resort to the clawback and rebates system.

Discussion topics
  • Distortions that remain unresolved
  • Funding and effectiveness
  • Quality control of Healthcare Providers
  • Application of DRG’s system in hospital care
  • Uniform rules in the public and private healthcare sector
Discussion topics
  • Budget ceilings related to in-patient and out-patient healthcare
  • Pharmaceutical expenditure check
  • Health Technology Assessment – Negotiations
  • Incentives for generic medicinal products
  • Coverage of uninsured citizens

ROUND TABLE III

Pharmaceutical policies

Most of memorandum measures were applied in the pharmaceutical sector. This was not unfair, given that in the period 2004-2009 there was an uncontrollable increase in pharmaceutical expenditure by the Greek NHS as well as private organizations.

Despite a series of measures that have been taken since then, pharmaceutical spending is still out of control. At the same time, EOPYY’s budget is “closed”, meaning that there is an increase in the amounts that the pharmaceutical companies are called to return, which has rendered the medical care system non-viable.

It is estimated that in 2018 pharmaceutical industries will return approximately 1.1 billion euros, while EOPYY’s budget amounts to 2 billion and another 700 million correspond to costs incurred by patients. This means that Greece’s annual pharmaceutical spending is worth about 3.8 billion euros, of which the State covers just 2 billion!

The current government recognizes that the 2-billion-euro budget is totally inefficient to cover existing needs, therefore it has decided to increase it gradually following economic development rates. In addition, two important initiatives are being promoted:

  • The creation of the Health Technology Assessment Committee
  • The cross-party Committee on pharmaceutical policies

However, this action is the target of severe criticism due to the fact that decisions are taken without necessary deliberations and consultation with patients, which would allow the latter to participate in the decision-making process.

ROUND TABLE III

Pharmaceutical policies

Most of memorandum measures were applied in the pharmaceutical sector. This was not unfair, given that in the period 2004-2009 there was an uncontrollable increase in pharmaceutical expenditure by the Greek NHS as well as private organizations.

Despite a series of measures that have been taken since then, pharmaceutical spending is still out of control. At the same time, EOPYY’s budget is “closed”, meaning that there is an increase in the amounts that the pharmaceutical companies are called to return, which has rendered the medical care system non-viable.

It is estimated that in 2018 pharmaceutical industries will return approximately 1.1 billion euros, while EOPYY’s budget amounts to 2 billion and another 700 million correspond to costs incurred by patients. This means that Greece’s annual pharmaceutical spending is worth about 3.8 billion euros, of which the State covers just 2 billion!

The current government recognizes that the 2-billion-euro budget is totally inefficient to cover existing needs, therefore it has decided to increase it gradually following economic development rates. In addition, two important initiatives are being promoted:
– The creation of the Health Technology Assessment Committee
– The cross-party Committee on pharmaceutical policies

However, this action is the target of severe criticism due to the fact that decisions are taken without necessary deliberations and consultation with patients, which would allow the latter to participate in the decision-making process.

Discussion topics

• Budget ceilings related to in-patient and out-patient healthcare
• Pharmaceutical expenditure check
• Health Technology Assessment – Negotiations
• Incentives for generic medicinal products
• Coverage of uninsured citizens

ROUND TABLE IIII

New Healthcare Technologies

The use of new technologies in the healthcare sector is of vital importance as it may significantly improve citizens’ access to means of prevention, diagnosis and cure. At the same time, new technologies may contribute decisively to rational decision-making and cost-control procedures related to Healthcare Policies.

Unfortunately, Greece is lagging behind in the use of new technologies in the health sector, despite that in the last 30 years hundreds of millions of euros from national and European sources have been spent. It is clear that the main cause of this is the lack of a consistent strategic plan for the development and optimal utilization of new technologies in healthcare.

On the other hand, it is true that in the last 2 years the government has taken interesting initiatives towards this direction and has committed to implement the following 5 policies:

  • National Healthcare Interoperability Framework
  • Integrated Information System in Primary Healthcare in cooperation with IDIKA S.A. (Electronic Governance of Social Insurance S.A.)
  • Installation of RIS-PACS systems in all public healthcare facilities
  • Integrated Information System for the management of blood donation throughout Greece
  • Expansion of GRNET’s (in Greek: EDET or Hellenic Research and Technology Network) backup PACS system and healthcare cloud computing systems.

EOPYY has made progress by thoroughly renewing its web site and improving its communication with insured citizens and it should keep developing Electronic Governance systems by assessing health providers’ services and keeping their fees under control.

Discussion topics
  • Patients’ Electronic Files
  • Electronic Prescription Systems
  • BI (Business Intelligence) system in the Greek NHS
  • Electronic Procurements