The Health Outcomes in Recession: Preliminarily Findings for Greece

The Health Outcomes in Recession: Preliminarily Findings for Greece

Vassilis Fragoulakis (National School of Public Health, Greece), Elena Athanasiadi (“Attikon” University Hospital, Greece), Antonia Mourtzikou (“Attikon” University Hospital, Greece), Marilena Stamouli (Naval and Veterans Hospital, Greece) and Athanassios Vozikis (University of Piraeus, Greece)
DOI: 10.4018/978-1-5225-3168-5.ch006
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Abstract

The aim of the present study is to provide an overview of recent reforms in Greece as imposed by the fiscal adjustments. Potential harmful consequences of these vast healthcare reforms are also discussed, as a collateral victim of the recession, in which case the real “patient” is the overall healthcare system. Based on an extended review of the related literature, the economic crisis, currently numbering five years in Greece, was accompanied by vast healthcare reforms and significant cuts in spending. In particular, austerity measures implemented, impose that health expenditure should not exceed 6% as a share of GDP. Savings were expected to be accomplished through vast changes, including the redetermination of both pharmaceutical reimbursement and pricing, reduction of public servants and cost containment regarding payments to the private sector. So far, there is a significant rise in demand for public hospital services, following a significant drop for private providers, including maternity hospitals, dental offices and surgery clinics. At the same time, elevated prevalence of certain diseases is already reported, although many researchers dispute over a causal association between recession and these health outcomes. Conclusively, it can be argued that the financial crisis is a no easy way out, and the Greek healthcare system is challenged as both resources and demand are rapidly changing. What is yet to answer is whether these reforms, along with a co-existing rise in demand of health services, could jeopardize the quality of the system.
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Background: Greek Healthcare System Before The International Monetary Fund

Healthcare system in Greece was mainly financed by the public sector (national budget and public funds), although the private sector was expanding. Total health spending reached about 10.6% of GDP in 2010 (World development indicators 2011, 2011). Although Greece was below the average in terms of per capita health expenditure, the mean annual growth rate of expenditure was 6.9%, which was much higher than the average OECD growth (4.0%). The main category of expenditure, which led to excessive increases in total health expenditure, was the pharmaceutical expenditure (2.5% of GDP), with growth in real per capita expenditure for 2000-2009 reaching 11.1% (WHO Global Health Expenditure Database., 2011). Some of the factors responsible for the pharmaceutical expenditure include the low penetration of off-patented drugs, the absence of electronic prescription system, the over prescription and an overall lack of a robust regulatory framework (Tsiantou et al., 2009; Falagas et al., 2007; Vandoros & Stargardt, 2013).

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