Greece Health Care
Sources: The Library of Congress Country Studies; CIA World Factbook
In the 1970s, Greece's expenditures for health care were lower than the average for Western nations, about 2.4 percent of the gross domestic product (GDP--see Glossary) for the first half of that decade. Publicly supported health facilities and private medical practices coexisted, and many doctors practiced in both areas. The definition between public and private treatment was unclear, and members of public plans often received care in both sectors. The public system, in which the patient-to-doctor ratio was very high, generally provided poor service for which patients had to endure long waits. Often patients in the public system, which nominally ensured free treatment, made informal payments to doctors to receive better care. (Private health care insurance did not exist in that period.) By 1984 such payments made up an estimated 51 percent of Greece's total health expenditures.
By the late 1970s, the poor infrastructure, lack of reliable care, and necessity of informal payments aroused public dissatisfaction and distrust in the state health system. In 1976 a government study identified major problems, including the lack of coverage for the poor, uneven geographical distribution, lack of coordination among government health agencies, and poor organization of finance and coverage in the public health insurance. The report also exposed the vast underground economy of the health system's informal payments, and it proposed three approaches for overall reform.
Opposition from the medical profession and politicians killed reform legislation in 1980. In 1983, however, the introduction of a National Health Service coincided with similar steps in other nations of southern Europe and heralded major restructuring of the legislative basis for the health care delivery system. Under the new program, the Ministry of Health, Welfare, and Social Security combines the subordinate functions of environmental health, occupational health, nutrition, and health education, formerly divided among other ministries. A Central Health Council, composed of professional experts and consumers, advises the ministry on policy matters. Devised by the Papandreou government, the plan defined the basic structure of the existing national health system.
The plan sought to place all health care under the state, to ensure equality of health care delivery, and to decentralize the health planning apparatus by establishing health councils in fiftytwo designated health districts. Another goal was reducing reliance on informal direct payments for treatment. Although the plan allowed existing private practices to remain, fee restrictions forced many out of business. To establish a full-time corps of physicians in the state system, doctors were prohibited from dividing their time between public and private facilities. New training programs were established to increase the supply of nurses. A major omission in the 1983 program was reform of the health care financing and insurance system; this aspect remains essentially as it was before 1983. In the mid-1980s, government expenditures on health care increased to between 4.5 and 5 percent of GDP.
The conservative ND government that took power in 1990 made some changes in the laws governing the National Health Service. To improve the choices available to patients, new private hospitals and clinics again were permitted, and many restrictions on privatesector care were abolished. Physicians in the public sector again could have supplementary private practices. The last provision was reversed when Papandreou returned to power in 1993. Full evaluation of the performance of the reform program since 1983--particularly in the areas of equity, access, and quality of care--has not been possible because Greek governments have not consistently publicized specific goals, and there is no mechanism to assess performance.
Public health services are funded by the state budget, together with mandatory contributions by employers and employees. In 1991 the official total expenditure on health care reached 5.3 percent of GDP--a low figure by Western standards--with about 70 percent of the total coming from public funds. However, another 1991 estimate, taking account of the continuing high rate of private expenditure, was 7.8 percent of GDP. The health insurance of all but 2 percent of Greek citizens comes from about 370 government insurance organizations, the services and costs of which vary greatly and none of which fully reimburses hospital costs. Many of the firms have accumulated huge deficits in the 1980s and 1990s.
In 1991 Greece had 138 public and 252 private hospitals, equipped with 35,773 and 15,500 beds, respectively. The ratio of beds to population, 5.1 to 1,000, was nearly the lowest among West European nations; according to the standards of the World Health Organization, Greece should have about 20,000 additional beds. The concentration of hospital beds in Athens, which has a surplus, has meant shortages elsewhere and requires that patients travel to Athens for treatment. In an average year in the early 1990s, about 78 percent of admissions are to public hospitals, in which the average occupancy rate is 75 percent, the average stay nine days. All public hospitals also offer outpatient and emergency care, the latter free of charge.
The number of doctors has increased dramatically since 1960, producing a surplus by 1980. The 1991 ratio of doctors to population, 3.4 per 1,000, was among the highest in Western Europe. However, most doctors work in Athens or Thessaloniki, creating shortages in many provinces. Anesthetists, orthopedists, and psychiatrists are especially lacking outside urban centers. Neither the 1983 nor the 1991 reform remedied this distribution problem. All of Greece has a shortage of professional nurses. In 1991 some 25,300 nurses were working in public hospitals, but only about onethird had full professional qualifications. All the major health care specialties experience shortages of nurses. Other trained health professionals, especially physical therapists, are also in short supply, as are support personnel such as occupational therapists and social workers. Personnel shortages in clinics were blamed for decreased vaccination availability since the mid-1980s. Wealthier Greeks often travel to hospitals in Britain, Germany, and Switzerland for major surgery.
Data as of December 1994
NOTE: The information regarding Greece on this page is re-published from The Library of Congress Country Studies and the CIA World Factbook. No claims are made regarding the accuracy of Greece Health Care information contained here. All suggestions for corrections of any errors about Greece Health Care should be addressed to the Library of Congress and the CIA.