Commission of Greece: Historically low investment in health – access to medical care is a challenge

The European Commission highlighted progress and “thorns” in the health sector in its conclusion of the 2023 National Reform Program and Greece’s 2023 Stabilization Program. The Commission focuses, among others, on Decreased public spendingto highlight once again the high levels of private payments and to emphasize the implementation of the planned reforms through the Recovery Fund, in order to reverse the history of underinvestment in health recorded by our country.

According to the data provided, Life expectancy in Greece exceeds that of the European Union (65.9 years vs. 64), although it has decreased significantly since 2019. This fact is attributed to the effects of the COVID-19 disease, which caused nearly three times more deaths in 2021 than in 2020. Greece’s performance is relatively satisfactory in terms of Avoid deaths from treatable causes. It is noted that in 2020 the main cause of death was cardiovascular disease, but malignant tumors were also an important factor.

However, medical care remains a challenge for our country, which records a much higher percentage of unmet need, compared to the EU average.

“Despite improvement over time, access to healthcare remains a challenge, as in 2021.” 6.4% of the population reported that medical care needs were not met due to costdistance or waiting time, compared to only 2.0% in the European Union,” the related results read.

As it turns out, the big “stakes” are primary health care (PHC) reform, higher inpatient costs – which are particularly linked to weaknesses in PHC, and controlling drug demand through structural measures as well. such as digital transformation in the sector.

Health costs are low

Total health spending in relation to GDP in Greece was lower than the EU average in 2020. In the same year, Total healthcare spending rose to 9.5% of GDP, compared to 10.9% in the European Union. As noted, this increase is in line with the upward trend across all Member States in 2020. However, it is clear that “In Greece, this is largely due to a significant contraction in the gross domestic product (by 9%, compared to 5.7% in the EU as a whole)” and “This is also reinforced by the fact that the share of health spending in total public spending decreased by 6.7% from 2019 to 2020.” The amounts spent per capita on inpatient care ( 605 euros), medicines (443 euros) and outpatient care (241 euros) are all below the EU average (863 euros, 457 euros and 737 euros, respectively).

However, in terms of spending on inpatient care and medicines, as a percentage of GDP, Greece ranks first among all member states. Conversely, Greece’s spending on outpatient care, as a percentage of GDP, is among the lowest among all member states.

With regard to spending on disease prevention, detection, surveillance and control programs, it was noted that it increased, but it is less than the European Union average (3.4%). This is due to a significant increase in the share of total spending on prevention in 2020 (1.8%, compared to 1.3% in 2019), which is largely due to 124% increase of spending (from €59 million to €132 million) for epidemiological surveillance and risk and disease control programmes. “The public health response to COVID-19 has led to similar budgetary developments across the EU,” she said.

High private payments

The overall share of health spending is relatively low (61.8% in 2020), while the rate of private payments is very high (33.4%, the second highest rate in the European Union). Public spending on health is expected to rise by 0.8 percentage points of GDP by 2070, compared to 0.9 percentage points for the European Union as a whole.

According to the result, policies to keep public spending on medicines under control face challenges. Among them is reimbursement, that is, mandatory refunds to the industry in case of exceeding the budget. “For 2023, it is likely that previously agreed budget ceilings will be met, The authorities negotiated higher cutsHowever, it notes that there are difficulties in controlling demand, through mandatory protocols and rational prescribing practices (eg to prevent overuse of antibiotics), both at the outpatient and inpatient level.

Primary care and the NHS

The conclusion of the European Commission also refers to the medical and nursing potential, confirming that Greece has the highest number of doctors and the lowest number of nursing staff per capita of all EU countries. However, the vast majority of physicians are specialists, while practitioners are only 7% of the total, compared to 26% It is the EU average and, as we have pointed out, reforms to strengthen primary care depend on achieving sufficient numbers of doctors and nurses. The Commission reports that “the recent reform measures focus on doctors and offer them new salaries.” However, it notes that the current coverage is still insufficient, which constitutes an obstacle to the full implementation of the reform. For this purpose, they are recommended additional measures that will strengthen existing incentives to create the foundation for integrated primary health care, “such as limiting reimbursement for services and prescriptions provided by social service providers not affiliated with the National Health Service Delivery Organization (EOPYY)”.

The Committee notes that health services and structures in Greece are highly concentrated in urban areas. Referring to NHS capacity, she noted that before the pandemic, there were 364 hospital beds per 100,000 inhabitants on average – a figure well below the EU average (387). “During the second wave of the COVID-19 pandemic in 2020, when there was a spike in cases, in some of the hardest hit areas, there were not enough hospital beds and the relevant capacity was sought in the private sector,” he said. notes.

Public Health

It is indicated in this conclusion that the comprehensive reform of the public health system, through the “Spyros Doxiadis” program, includes reforms in the provision of public health services, monitoring the health of the population and the environment, as well as in rapid response services. It also includes the comprehensive digital transformation of the public health sector.

Particularly in terms of access to electronic health records, Greece ranks below the EU average in the composite index. “In 2022, the MyHealth mobile app will be launched, but although 80-100% of citizens already have access to their health data through the online service, the range of data that can be accessed is somewhat limited,” he says.

Another measure to protect public health is the continued rationalization of the use of antimicrobials, in the context of broader efforts to promote the rational use of medicines. According to the Commission’s “assessment”, the situation in Greece has improved significantly, with daily consumption in 2021 falling to 67% of consumption in 2019. This decrease is higher than the decline recorded on average across the EU, by more than 18 percent. %, likely due to the COVID-19 pandemic. However, Greece remains one of the four member states that use the most antibiotics.

Finally, the commission notes that Historically low levels of healthcare investment He points to the reforms launched through the Recovery and Resilience Plan (RESP):

“Through its Recovery and Resilience Plan (RSAP), Greece plans to invest €1,486 million (4.9% of total RSA value). These investments are planned in the context of historically low overall levels of investment in the healthcare sector (as a percentage of total GDP). To form fixed capital).