From the North Sea to the Mediterranean? Constraints to Health Reform in Greece

Abstract

The report of an international experts' committee, recently invited by the Ministry of Health to review Greece's health care system, recommended the creation of a network of family doctors, reimbursed on a capitation basis. The committee also proposed that family doctors should manage a budget for the purchase, on behalf of their patients, of specialist and hospital services and drugs. The author examines the exportability of the fundholding experience from Britain to a country in which health care organization is very different, social health insurance is fragmented, private health care is large and growing, ambulatory health care services are provided by specialists, and behavioral-cultural factors cast doubt on the consequences of the proposed change. An attempt to implement fundholding in Greece is likely to have effects opposite to those intended. The more humble task of tackling the inequities and inefficiencies of the present system should be the starting point of all future reform projects.

Get full access to this article

View all access options for this article.

References

Saltman

R. B.

, and von Otter

Planned Markets and Public Competition: Strategic Reform in Northern European Health Systems. Open University Press, Buckingham, England, 1992.

Le Grand

, and Robinson

Evaluating the NHS Reforms. King's Fund Institute, London, 1994.

Abel-Smith

Report on the Greek Health Services. Ministry of Health, Welfare and Social Insurance, Athens, 1994.

Glennerster

Implementing GP Fundholding. Open University Press, Buckingham, England, 1994.

Glennerster

, and Le Grand

The development of quasi-markets in welfare provision in the United Kingdom. Int. J. Health Serv. 25(2): 203–218, 1995.

Organization for Economic Cooperation and Development. The Reform of Health Care: A Comparative Analysis of Seven OECD Countries. Paris, 1992.

Sheaff

What kind of health care ‘internal market’? A cross-Europe view of the options. Int. J. Health Plann. Manage. 9: 5–24, 1994.

Propper

Regulatory reform of the NHS internal market. Health Econ. 4: 77–83, 1995.

Glennerster

, and Matsaganis

The English and Swedish health care reforms. Int. J. Health Serv. 24(2): 231–251, 1994.

10.

Ferrera

The ‘southern model’ of welfare in social Europe. J. Eur. Soc. Policy 6: 17–38, 1996.

11.

Matsaganis

Is health insurance in Greece in need of reform?

Health Policy Plann. 6: 271–281, 1991.

12.

Ferrera

The rise and fall of democratic universalism: Health care reform in Italy, 1978–1994. J. Health Polit. Policy Law 20: 275–302, 1995.

13.

Bartlett

Quasi Markets in the Welfare State. SAUS Publications, Bristol, England, 1994.

14.

Figueras

Health Care Infrastructure Needs in the Lagging Regions. London School of Hygiene and Tropical Medicine, London, 1993.

15.

van de Ven

W. P. P. M.

Perestroika in the Dutch health care system: A demonstration project for other European countries. Eur. Econ. Rev. 35: 430–440, 1991.

16.

Ham

, and Brommels

Health care reform in the Netherlands, Sweden and the United Kingdom. Health Aff., Winter 1994, pp. 107–119.

17.

Hurst

Reform of health care in Germany. Health Care Financ. Rev. 12: 73–86, 1991.

18.

Theodorou

Ambulatory Care in IKA (in Greek). Athens, 1993.

19.

Niakas

Are the proposals of the international committee of experts for primary health care in Greece feasible? (in Greek). Primary Health Care 7: 33–38, 1995.

20.

Glennerster

Cohen

, and Bovell

Alternatives to Fundholding. Welfare State Programme Discussion Paper 123. London School of Economics, London, 1996.

21.

Ham

Population-centered and patient-focused purchasing: The U.K. experience. Milbank Q. 74: 191–214, 1996.