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A Three Part Strategic Collaboration for Reforming the Health System in Greece - Integrating payers and providers -

CENTER FOR HEALTH SERVICES RESEARCH DEPARTMENT OF HYGIENE, EPIDEMIOLOGY AND MEDICAL STATISTICS MEDICAL SCHOOL UNIVERSITY OF ATHENS. WHO COLLABORATING CENTER. A Three Part Strategic Collaboration for Reforming the Health System in Greece - Integrating payers and providers -.

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A Three Part Strategic Collaboration for Reforming the Health System in Greece - Integrating payers and providers -

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  1. CENTER FOR HEALTH SERVICES RESEARCHDEPARTMENT OF HYGIENE, EPIDEMIOLOGY AND MEDICAL STATISTICS MEDICAL SCHOOLUNIVERSITY OF ATHENS WHO COLLABORATING CENTER A Three Part Strategic Collaboration for Reforming the Health System in Greece- Integrating payers and providers - YannisTountas, MD, MPH, PhD Professor of Social and Preventive Medicine Director President of the National Organization for Medicines

  2. Organization and financing of health services (2010)

  3. Participation of public funding in health expenditure coverage Private Hospital Sector Social Security Contributions NHS Hospitals Taxation

  4. Main problems • 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

  5. Additional Problems • 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.

  6. HEALTH IN ACTION 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.

  7. HEALTH IN ACTION Partners: • Ministry of Health • European Task Force • Domain Leader: German Ministry of Health Steering Committee

  8. HELTH IN ACTION GOVERNANCE STRUCTURE

  9. HEALTH IN ACTION COMMITTEES

  10. The establishment of a national health fund for Greece Banks Fund • Health insurance fund for private sector employees SeamenFund ETAA

  11. Aims of the National Health Fund Health Insurance oligopsony Economies of scale Integration of processes, care packages, contributions and co-payment levels

  12. Outlook of the new Organization • 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.

  13. The integration “gap” Care delivery? Care financing? Access to care?

  14. Is this sustainable? • 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.

  15. Trends in employment, Greece,2011-2012 Employed Unemployed thousands thousands Source: ELSTAT, Employment Survey, 2012

  16. 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

  17. 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

  18. 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.

  19. Solution II Come to Greece Thank you

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