Alexis Benos*, Stathis Giannakopoulos**, Theodore Zdoukos***,
The ongoing health services reforms by the greek social-democratic governement: a fast way backwards
*Assistant Prof In Social Medicine,
**General Practitioner, Research Fellow,
***General Practitioner, Secretary of the Union of Physicians working in the NHS
Laboratory of Hygiene & Social Medicine, Medical Dept, Aristotle University of Thessaloniki, Greece
Contact: A. Benos
The Greek National Health System was founded in 1983, by the freshly elected Socialist government. During the eighteen years that followed, minor-scale reforms were attempted but never completed. Immediately after April´s 2000 elections the socialist government announced a major reform of the Greek National Health System.
The main characteristics of the health care system are:
- The complete lack of organized Primary Health Care, especially in urban areas.
- Chronic underfunding of the National Health System, mainly from the Public Insurance Funds, and the lowest per capita public expenses for health in E.U.
- The constantly increasing corruption in the public sector.
- The unrestrained development of the private sector supported by public funds.
- Bureaucratic, medical-centered services, mainly located in big urban centers, developed without reasonable design or unified quality criteria.
- Satisfactory access to the National Health System for all people, at least for urgent health problems.
Though it is a paradox, the same conclusions are included in the report that accompanies the new National Health System�s Reform Act, which proposes answers in not such a «socialistic» direction:
Introduction of the institution of the «personal doctor», a kind of «gate-keeper» based on a capitation system, while there is a dramatically low number of properly trained Primary care workers (GP�s, community nurses, health visitors etc.).
Introduction of an internal market based on the purchaser � provider split. Funds� management is granted to an autonomous, privatized �Fund Allocation Organization�. This organization will manage a closed budget, buying services from public as well as private sector, with main consideration on money saving, regardless the quality of services, the state denying any guaranty for covering the real health care needs of the population.
Creation of a new, bureaucratic corpse of managers in the public hospitals, with increased authorities, focused on profit making and money saving, running the hospitals like private enterprises rather than public institutions.
Privatization of crucial sectors of the hospitals (constructions, catering, cleaning).
Strengthening of the strategic role of the private sector, in favor of the big Health Trusts and against individual private doctors and small firms, with generous funding from public expenses. Expansion of this role to medical education.
A hypocritical effort to control corruption by legalizing it! (Offering private services into the hospitals and creating two uneven categories of patients, depending on their financial capabilities).
Lack of evidence based planning according to the local health care needs.
Last, but most important, equal free access to the system is denied to all non-insured citizens (long-term unemployed, immigrants), estimated to be approximately 10% of total population.
In conclusion, the reform carried out by the Greek social democratic government is an integrated, radical reform, based on the same neo-liberal European trends and rhetoric. These policies, enhancing in a cynical way the reemergence of the �inverse care law�, are imposed with only marginal reactions. The necessity of the emergence of a new social movement defending health as a social right is further discussed.