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State of Health in the EU Greece Country Health Profile Conference on the Future of Healthcare in Greece, Athens, 22 March 2018
State of Health in the EU
Greece Country Health Profile
Conference on the Future of Healthcare in Greece, Athens, 22 March 2018
1 Country Health Profiles
1. Highlights
2. Health status of the population
3. Risk Factors
4. Health System (description)
5. Performance of Health System
5.1 Effectiveness
5.2 Accessibility
5.3 Resilience (efficiency & sustainability)
6. Key Findings
Released in November 2017 (in English and native language) This presentation focuses on sections highlighted in bold
What are the trends in the health status of the population in Greece?
Life expectancy in Greece has increased less rapidly than in many other EU countries Only ½ year higher now than EU average, 2 years lower than in Spain and Italy
Source: Eurostat Database.
83.0 82.7
82.4 82.4 82.2 81.9 81.8 81.6 81.6 81.5 81.3 81.3 81.1 81.1 81.0 80.9 80.8 80.7 80.6
78.7
78.0 77.5 77.5
76.7
75.7
75.0 74.8 74.7 74.6
70
72
74
76
78
80
82
84Years (in 2015)
70
72
74
76
78
80
82
84
Spain Greece EUYears
7.5
7.9
0 5 10 15 20 25
Greek women at 65
Greek men at 65
Healthy life expectancy Unhealthy life expectancy
Years
People live longer, but less than half of remaining years of life at age 65 is free of health problem and disability
Note: Healthy life expectancy: Number of years that people can expect to live free of disability.
Source: Eurostat Database (data refer to 2015).
Number of working-age people (15-64) per person aged 65+
10.6
Population ageing will increase the needs for health and long-term care, while there will be fewer working-age people to respond to these needs
18.5
13.8 21.3
How to ensure universal access to health care in a context of population
ageing, now and in the future?
(Access = Affordability + Accessibility to services)
The 2016 Law to provide minimum public health insurance coverage for all the population has been an important step towards universal health coverage
Before, 2016, Greece was lagging behind nearly all EU countries in health insurance coverage…
And a growing proportion of poor people was reporting unmet health care needs due to cost
Source: OECD (Health at a Glance: Europe 2016).
7
8.4 7.8
10.1 11
13.9
16.4 17.4
0.9 0.6 0.8
3.3 2.2
0.2 0
2.8
0
2
4
6
8
10
12
14
16
18
20
2008 2009 2010 2011 2012 2013 2014 2015
Poorest income quintile
Richest income quintile
% of population
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
99.9
99.9
99.1
88.9
99.8
99.0
95.9
95.0
94.2
93.9
91.3
88.2
86.0
86.0
83.0
0.8
10.9
70 80 90 100
CroatiaCzech Republic
DenmarkFinlandIreland
ItalyLatvia
LithuaniaMalta
PortugalSloveniaSweden
United KingdomAustriaFranceSpain
GermanyNetherlands
BelgiumLuxembourg
HungarySlovak Republic
EstoniaPoland
Bulgaria (2013)Romania
Greece (2015)Cyprus (2013)
Total public coverage Primary private health coverage
% of population in 2015
Source: Eurostat (EU-SILC).
But it is also important to consider the comprehensiveness of health insurance coverage: what is covered and what proportion is covered?
Only about 60% of health spending in Greece is publicly funded, compared with about 80% in the EU
Source: OECD Health Statistics (data refer to 2015).
Effective access to care also needs to address other barriers beyond coverage
Many Greek people report having difficulties accessing doctors or a health centre not only because of cost, but also because of distance to the doctor’s office and waitings to get an appointment and see a doctor
Distance to doctor’s office
Cost of seeing doctor
Delay in getting appointment
Waiting time to see a doctor on the day
0% 20% 40% 60%
Italy Portugal Greece Spain EU
0% 20% 40% 60%
Spain EU Italy Portugal Greece
0% 20% 40% 60%
Greece Portugal EU Italy Spain
0% 20% 40% 60%
Italy EU Portugal Greece Spain
Response to the question: “Thinking about the last time you needed to see or be treated by a GP, family doctor or health centre, to what extent did any of the following make it difficult or not for you to do so?” (% of respondents answering “very difficult” or “a l ittle difficult”). Source: Eurofound (European Quality of Life Survey 2016).
The main problem is not a lack of doctors, but a lack of generalists, the uneven geographic distribution of doctors, and the lack of doctors in public facilities
Note: In Portugal and Greece, data refer to all doctors licensed to practice, resulting in a large over-estimation of practising doctors (e.g. of around 30% in Portugal).
In Austria and Greece, the number of nurses is under-estimated as it only includes those w orking in hospital.
Sources: Eurostat Database and Health at a Glance 2017.
Greece
Specialists, 75%
Other doctors (not defined),
19%
Generalists,
6%
Primary Care Plan launched in 2017 is another step in the right direction
• Creating an effective network of primary care services is one of the most urgent priorities to respond effectively to the needs of (ageing) population and reduce over-crowding of emergency departments and unnecessary hospital admissions
• Other EU countries can provide some inspiration to strengthen primary care:
• Portugal: Since 2007, a growing number of Family Health Units based on multi-professional teams (with 3-8 GPs and same number of nurses) responsible for delivering primary care to around 12000 people each (about 500 FHUs now)
• But there is probably “no one fits all” solution, and various primary care models probably need to coexist and continue to evolve over time
• The success of the primary care reform in Greece will likely depend on:
Having sufficient financial resources to support creation and development Supporting innovative ways to deliver services effectively (e.g. telemedecine) Coordinating effectively the various primary care units (regional authorities)
Efforts continue to reduce waste in health spending to ensure
that resources are used effectively to respond to changing needs
and ensure continued support for publicly-funded system
The revenue base to finance public spending on health is
broadened to rely less on payroll taxes to raise sufficient
resources to meet future needs
Universal and fairly comprehensive health coverage can be fiscally sustainable in Greece, provided that…
Patient
Manager
Regulator
Clinician
Poor incentives
Drivers
Unintentional Intentional
Errors & poor decisions
Poor organisation
Fraud and corruption
Wasteful spending can occur at all levels of the system for many reasons
Preventable adverse events
Duplication of services
Ineffective/inappropriate (low value) care Wasteful
clinical care
Overusing high-cost inputs (e.g. hospitals)
Paying an excessive price
Operational waste Discarding unused inputs
Ineffective administrative procedures and expenditure
Governance-related
waste
Source: OECD, Tackling Wasteful Spending on Health.
Act
ors
40 33 32 30 29 26 26
23
25
26 31 30 30
48
38
34
2 12 10 15
18
2
9 26
28 20 21 19 14
20 22
12
5 8 6 7 9 4 5 5
0
10
20
30
40
50
60
70
80
90
100
% Inpatient care Outpatient care Long-term care Medical goods Collective services
Despite many recent efforts to reduce hospital and pharmaceutical cost, most health spending in Greece continues to be allocated for these two big spending items
Note: Countries are ranked by inpatient care as a share of health expenditure. Source: OECD Health Statistics 2017 and Eurostat Database (data refer to 2015).
A relatively small share of spending is allocated to outpatient care and long-term care
0
1 000
2 000
3 000
4 000
5 000
6 000
7 000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Million (€)
A lot of efforts have been made in recent years to reduce pharmaceutical spending
Introduction of prescription guidelines, coupled with country-wide prescription system to monitor doctors’ prescribing and pharmacies’ dispensing
Introduction of reference pricing for branded drugs based on the three lowest EU prices and setting a maximum pricing level for generics
0
25
50
75
100
%
Share of generic market (in volume, 2015)
Note: The dotted line between 2007 and 2009 indicates estimates to fill missing data.
Source: OECD Health Statistics 2017.
Promoting use of generics in pharmacies and hospitals (although there is still room for further progress)
Broadening the revenue base to pay for growing public spending on health
• Payroll taxes have historically been the main source of public funding in social health insurance systems, but: Rationale to rely on employee and employer contributions is reduced when
health insurance coverage becomes universal (not linked to employment status) Excessive reliance on payroll taxes reduces incentives for people to work and
employers to recruit (negative impact on employment) May not provide sufficient revenue base to respond to future health care needs
given demographic changes (shrinking size of working-age population)
• In France, recent tax reform (since 1 January 2018) eliminated employee contributions for health care and replaced it by increase in a more general taxation covering broader revenue sources (capital gains, pensions, others)
• But tax reforms are never easy to implement (there are “winners” and “losers”)
Key Findings from Greek Country Health Profile
• Life expectancy has continued to increase in Greece, but population ageing will continue to add pressures on health and long-term care systems
• Despite difficult economic and budgetary context, recent important reforms have started to address many barriers to access to care: The 2016 Law has been an important step forward to provide minimum health
insurance coverage to previously uninsured people The 2017 Primary Care plan has started to address an urgent priority to
strengthen access to primary care, but successful implementation will require sufficient funding over several years and innovative ways to deliver primary care services efficiently for the whole population
• Looking forward, universal and fairly comprehensive health coverage can be financially sustainable, provided that efforts continue to be made to reduce wasteful health spending and the revenue base to finance public spending on health continues to be broadened
ec.europa.eu/health/state oecd.org/health/health-systems/country-health-profiles-EU.htm
euro.who.int/en/about-us/partners/observatory/publications/country-health-profiles-EU
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