Transcript Mr Yannis Tountas

CENTER FOR HEALTH SERVICES RESEARCH
DEPARTMENT OF HYGIENE, EPIDEMIOLOGY
AND MEDICAL STATISTICS
MEDICAL SCHOOL
UNIVERSITY OF ATHENS
WHO COLLABORATING CENTER
Yannis Tountas, MD, MPH, PhD
Professor of Social and Preventive Medicine
Director
President of the National Organization for Medicines
Organization and financing of health services (2010)
Health Services
NHS
Social Security
Private Sector
15.000 medical doctors
2.000 medical doctors
185 P.H. Centers
8.000 medical doctors
220 polyclinics
400 diagnostic centers
18.000 medical doctors
1.600 medical doctors
12 hospitals
310 beads
4.000 medical doctors
50 hospitals
15.000 beds
128 hospitals
26.000 beds
Taxation
Social Security
Financing
Private Payments
Participation of public funding in health expenditure
coverage
Social Security
Contributions
Private
Hospital
Sector
NHS
Hospitals
Taxation

low levels of public expenditure

inadequate personnel (mainly nursing)

fragmented administrative framework

insufficient management

unorganized Primary Health Care

lack of prevention and health promotion

poorly regulated private sector

health inequalities

Overall, the economy of Greece has been underperforming.

The economic freedom index has been dropping and now Greece ranks
40 out of 43 in the European region.

This led to excessive debt as a percentage of the GDP and instigated the
arrival of the Troika.

This also led to three consecutive Memorandums of Understanding on
how economic stability would be achieved (through budget cuts).

As a result, health care reform, starting from health care funding,
became a one way option for Greece.
Vision Statement: Restructuring of the NHS in order
to develop a system which will
improve citizen’s health by meeting
their needs and which will ensure the
system’s sustainability for the next
generations.
Partners:
• Ministry of Health
• European Task Force
• Domain Leader: German Ministry of Health
Steering Committee
Final decisions lie with the Minister of Health
The Health Reform Steering Committee approves the proposals of the
sub-committees
Sub-committees submit reform proposals
Experts identified by the TFGR, the Domain Leader and International
Organisations provide technical assistance upon request by the MoH
HEALTH IN ACTION COMMITTEES
Hospital
Management
Public
Health
DRGs
Primary
Health
Care
Pricing and
Reimbursem
ent of
Pharmaceuti
cals
Health
Reform
Steering
Committee
EOPYY
E-Health
Health
Tourism
Human
Resources
OAEE
Banks
Fund
• Health insurance
Fund for Self
Employed
IKA
Sea
men
Fund
OPAD
ETAA
OGA
• Health insurance fund
for private sector
employees
• Health Insurance
Fund for Public
Sector Employees
• Health Insurance
Fund for Farmers
Different care
levels
Differentiated
contributions
Different copayments
EOPYY
Health Insurance
oligopsony
Economies of scale
Integration of processes,
care packages,
contributions and copayment levels

The new Organization brought together 7 insurance funds and is
responsible for purchasing health care services for 9,5 million insureds.

EOPYY owns and operates a network of 300 primary care centers.

There are also another 200 primary care services owned and operated by
the NHS – these have not been integrated with EOPYY Centers.

It also contracts the services of 6.000 employed Physicians as well as
5.000 contracted Physicians.

There are access limitations, as physicians are reimbursed for up to 200
patient visits per month.

This has resulted in patients having difficulties in accessing primary care
services.
Common
processes
Care delivery?
Common
care package
Care financing?
Common copayments
Access to care?
EOPYY

Unemployment is rising – this means diminishing employee and employer
contributions for EOPYY.

EOPYY budget is thus seriously challenged as to its sustainability for the
future – will it be able to continue purchasing and providing quality
services for its insureds?

Primary Health Care is more seriously impacted than other areas of EOPYY
budget – as a result, insureds have to pay out of their pocket for primary
care services.

This private financing is largely “uninsured” – there is no complementary,
organized response by private health insurance targeted at this out of
pocket spending.
Trends in employment, Greece, 2011-2012
Employed
thousands
Source: ELSTAT, Employment Survey, 2012
Unemployed
thousands
EOPYY budget breakdown and impact on service
provision
Pharmaceuticals
NHS Hospitals
Private
Hospitals
Primary Health
Care
Other
Primary Health Care accounts
for only 7,6% of total EOPYY
budget
Source: EOPYY, 2012
As a result, patients increasingly pay out of
pocket for PHC
EOPYY doctor in his practice
EOPYY doctor in EOPYY center
NHS doctor in outpatient
hospital department
NHS doctor in NHS Primary
Health Center
Doctor in Rural Health Center
Private doctor, paid out of
pocket
Source: EOPYY, 2012
Solution I

There is also need for greater integration of Primary Care Services if
to achieve economies of scale, whilst maintaining quality of service
delivery and equitable access with wide coverage.

To this end, the country would benefit from external expertise, with
a track record of delivering integrated solutions in the organization
and provision of primary care services, even within strict budgets.
Solution II
Come to Greece
Thank you