World Report
Greek Government plans health system overhaul Greece’s new Government promises to substantially reform the health system. But experts wonder whether the pledges can be implemented. Eva Karamanoli reports from Athens.
First days Panagiotis Kouroublis, the new Minister of Health, has captured media attention not only because of the enormity of the challenge awaiting him, but also because he lost his sight during his childhood while playing with a grenade that was buried in the ground since the German occupation. “I may be blind but I hear very well, and I am willing to hear anyone that has a suggestion to make in order to improve the National Health System”, was the first statement Kouroublis made. In his first days as minister, Kouroublis has held several meetings with stakeholders of the Greek health-care system. Among his first callers were the president of the Panhellenic Medical Association Michael Vlastarakos, the president of the Panhellenic Pharmaceutical www.thelancet.com Vol 385 February 28, 2015
Association Constantinos Lourantos, and the president of the Panhellenic Association of Pharmaceutical Industries Theodore Tryfon. The representatives of the associations seemed to share the priorities of the new government, but it’s still early days. “All the promises that the
“‘The implementation of the announcements depends on finding new resources for health care....’” government made are very welcome. Why would anyone oppose hiring more medical staff and doctors, free hospitalisation and medical treatment for everyone, the strengthening of Greek pharmaceutical companies? All these are certainly for the best. The real matter is for them to happen. Because most of the time promises never come true...I am waiting for the government to implement the promises”, Lourantos told The Lancet.
Some doctors seem sceptical too. “Funding health care, and especially hospitals, to meet the basic needs of the population, without the excesses and waste of the past, is the great challenge for every Minister of Health”, says George P Karamanolis, assistant professor in gastroenterology at the University of Athens. George Papatheodoridis, associate professor of medicine and gastroenterology and director of the Academic Gastroenterology Department at the Laiko General Hospital in Athens, says: “The implementation of the announcements depends on finding new resources for health care. During the last few years, the main problem has been that the resources allocated have dramatically decreased. The hospital managers basically try to cut back on expenses without examining whether those specific expenses could generate revenues for their hospitals.”
National drug company Scepticism Whether the pledges of the coalition government will be met will depend on the financial status of the country and on the funds available for health spending. “The implementation of the health programme depends directly on the financial resources available”, says Tryfon. He claims that “currently public spending on health is much lower than the European average and inconsistent with the health needs of the population. I find it necessary to increase the health budget of 2015 to at least 6% of GDP, in order to address the problems and upgrade health indicators. If this happens announcements will be materialised. Otherwise I am afraid that the social crisis will continue—something that surely nobody wants”.
One of the central announcements of the government on the health-care front is the establishment of a national pharmaceutical company, to support and boost Greek drug companies
Alexandros Vlachos/epa/Corbis
The electoral victory of Greece’s left-wing Syriza party at the end of last month and its aftermath have captured the attention of the world. Most of the media coverage has focused on the nail-biting negotiations on Greece’s debt and the future of its bailout programme. But health care, for which the cost of 5 years of austerity has hit hardest, is among the new government’s top priorities. As with most other areas, the new Greek Government plans a major overhaul of health-care policy. It aims to offer universal access to medical care for the uninsured, abolish the €5 fee for hospital treatment and the €1 fee for prescription drugs, hire additional staff for hospitals, expand primary health-care provision to take the pressure off hospitals, reorganise health-care units, and re-evaluate health and managerial staff.
Panagiotis Kouroublis is sworn in as Greece’s new Minister of Health
761
Pacific Press/Contributor
World Report
The new Greek Government plans to abolish the €5 fee for hospital treatment
and the production of homegrown medical products. According to minister Kouroublis: “We will try to convince our European partners that the exit from the crisis is directly linked to growth. Our aim is to support the sectors associated, and one of them is the production of medicine. Greece could become the ‘Switzerland of the South’”. The minister invited the heads of the Greek drug companies to work together in that direction. However, they seem reluctant to heed his call. “The issue is whether such a move is necessary”, says Tryfon. “Greek pharmaceutical companies account for 70% of the needs of the country with high quality and low cost remedies. Those remedies can be bought at prices 75% lower than those imported. I see no reason to commit valuable resources and time in order to cover needs that are already covered. The same applies to establishing a state pharmaceutical company. We already have 160 firms that adequately cover the needs of the country.” Karamanolis agrees: “There was in the past a state pharmaceutical company, but its efficiency was limited. There are remarkable Greek companies that produce generic medications and I think that if they are given the appropriate incentives and cooperate with government bodies in the pricing, pharmaceutical expenditure can be brought under control.” 762
Papatheodorides says the idea could be effective: “Theoretically, the establishment of a national pharmaceutical company is not a bad move. However, the experience so far, from the operation of various state agencies in Greece, is not encouraging. Most are underperforming because of their inadequate staff. However if such a body could work efficiently, it would be to the benefit of the citizens. The impact of the establishment of a government body in the state for private pharmaceutical companies will depend on what rules are set out, but also on the ‘strength’ of the private companies”.
“The whole system must be rebuilt from scratch. There is no space for small improvements aiming at immediate political benefits’...” The president of the Panhellenic Medical Association Michael Vlastarakos also notes the adequacy of Greek private pharmaceutical companies. “The Greek pharmaceutical industry is currently blooming and reliable medicine is being manufactured. We support local medicine production. Any changes in the current status should be discussed beforehand. I believe that no one can overlook development but rules should be set.”
Free medical care The government’s goal of providing free basic medical care to all is lauded by health-care stakeholders. But the same question crops up repeatedly— how will the Greek state be able to afford it? “The €5 fee is the only revenue for the hospitals that does not come from the government budget. It is important to note that the uninsured and immigrants are exempt from it”, says Karamanolis. “This measure [universal access to medical care] had also been announced by the previous government, but it
was not implemented because of lack of resources. The free provision of health services, especially in a country undergoing a financial crisis, is extremely important. However, in order for announcement to be implemented, new resources for health must be found. Note that in the last few years, the funds allocated for this purpose fell continuously”, Papatheodorides explains. The Panhellenic Medical Association also wants universal access to health care. “We want the abolition of the €5 and €1 fees and it is important that they not be replaced by other measures. Spending on health care must be increased, through government grants. About €400 million is needed for all the uninsured to be covered”, says Vlastarakos.
Hospital shake-up Another issue that will cause great debate is the reorganisation of the hospital system. The previous government tried to do it but their plans backfired. Hospitals performing poorly were shut down, but the remaining facilities were strained by the increase in patients. The result was a decrease in the quality of medical care. “The efforts so far aimed only at the reduction of costs, and that’s not right. Restructuring of the health system and modernisation of hospital administration must be geared toward the provision of high-quality health care”, says Vlastarakos. “The whole system must be rebuilt from scratch. There is no space for small improvements aiming at immediate political benefits”, says Karamanolis. Papatheodorides says the selection of hospital managers will be crucial to any reforms. “The performance of hospital management depends on the ability and the qualifications of the persons selected. Selection based on partisan criteria never helped.”
Eva Karamanoli www.thelancet.com Vol 385 February 28, 2015
Greek Government plans health system overhaul Greece’s new Government promises to substantially reform the health system. But experts wonder whether the pledges can be implemented. Eva Karamanoli reports from Athens.
First days Panagiotis Kouroublis, the new Minister of Health, has captured media attention not only because of the enormity of the challenge awaiting him, but also because he lost his sight during his childhood while playing with a grenade that was buried in the ground since the German occupation. “I may be blind but I hear very well, and I am willing to hear anyone that has a suggestion to make in order to improve the National Health System”, was the first statement Kouroublis made. In his first days as minister, Kouroublis has held several meetings with stakeholders of the Greek health-care system. Among his first callers were the president of the Panhellenic Medical Association Michael Vlastarakos, the president of the Panhellenic Pharmaceutical www.thelancet.com Vol 385 February 28, 2015
Association Constantinos Lourantos, and the president of the Panhellenic Association of Pharmaceutical Industries Theodore Tryfon. The representatives of the associations seemed to share the priorities of the new government, but it’s still early days. “All the promises that the
“‘The implementation of the announcements depends on finding new resources for health care....’” government made are very welcome. Why would anyone oppose hiring more medical staff and doctors, free hospitalisation and medical treatment for everyone, the strengthening of Greek pharmaceutical companies? All these are certainly for the best. The real matter is for them to happen. Because most of the time promises never come true...I am waiting for the government to implement the promises”, Lourantos told The Lancet.
Some doctors seem sceptical too. “Funding health care, and especially hospitals, to meet the basic needs of the population, without the excesses and waste of the past, is the great challenge for every Minister of Health”, says George P Karamanolis, assistant professor in gastroenterology at the University of Athens. George Papatheodoridis, associate professor of medicine and gastroenterology and director of the Academic Gastroenterology Department at the Laiko General Hospital in Athens, says: “The implementation of the announcements depends on finding new resources for health care. During the last few years, the main problem has been that the resources allocated have dramatically decreased. The hospital managers basically try to cut back on expenses without examining whether those specific expenses could generate revenues for their hospitals.”
National drug company Scepticism Whether the pledges of the coalition government will be met will depend on the financial status of the country and on the funds available for health spending. “The implementation of the health programme depends directly on the financial resources available”, says Tryfon. He claims that “currently public spending on health is much lower than the European average and inconsistent with the health needs of the population. I find it necessary to increase the health budget of 2015 to at least 6% of GDP, in order to address the problems and upgrade health indicators. If this happens announcements will be materialised. Otherwise I am afraid that the social crisis will continue—something that surely nobody wants”.
One of the central announcements of the government on the health-care front is the establishment of a national pharmaceutical company, to support and boost Greek drug companies
Alexandros Vlachos/epa/Corbis
The electoral victory of Greece’s left-wing Syriza party at the end of last month and its aftermath have captured the attention of the world. Most of the media coverage has focused on the nail-biting negotiations on Greece’s debt and the future of its bailout programme. But health care, for which the cost of 5 years of austerity has hit hardest, is among the new government’s top priorities. As with most other areas, the new Greek Government plans a major overhaul of health-care policy. It aims to offer universal access to medical care for the uninsured, abolish the €5 fee for hospital treatment and the €1 fee for prescription drugs, hire additional staff for hospitals, expand primary health-care provision to take the pressure off hospitals, reorganise health-care units, and re-evaluate health and managerial staff.
Panagiotis Kouroublis is sworn in as Greece’s new Minister of Health
761
Pacific Press/Contributor
World Report
The new Greek Government plans to abolish the €5 fee for hospital treatment
and the production of homegrown medical products. According to minister Kouroublis: “We will try to convince our European partners that the exit from the crisis is directly linked to growth. Our aim is to support the sectors associated, and one of them is the production of medicine. Greece could become the ‘Switzerland of the South’”. The minister invited the heads of the Greek drug companies to work together in that direction. However, they seem reluctant to heed his call. “The issue is whether such a move is necessary”, says Tryfon. “Greek pharmaceutical companies account for 70% of the needs of the country with high quality and low cost remedies. Those remedies can be bought at prices 75% lower than those imported. I see no reason to commit valuable resources and time in order to cover needs that are already covered. The same applies to establishing a state pharmaceutical company. We already have 160 firms that adequately cover the needs of the country.” Karamanolis agrees: “There was in the past a state pharmaceutical company, but its efficiency was limited. There are remarkable Greek companies that produce generic medications and I think that if they are given the appropriate incentives and cooperate with government bodies in the pricing, pharmaceutical expenditure can be brought under control.” 762
Papatheodorides says the idea could be effective: “Theoretically, the establishment of a national pharmaceutical company is not a bad move. However, the experience so far, from the operation of various state agencies in Greece, is not encouraging. Most are underperforming because of their inadequate staff. However if such a body could work efficiently, it would be to the benefit of the citizens. The impact of the establishment of a government body in the state for private pharmaceutical companies will depend on what rules are set out, but also on the ‘strength’ of the private companies”.
“The whole system must be rebuilt from scratch. There is no space for small improvements aiming at immediate political benefits’...” The president of the Panhellenic Medical Association Michael Vlastarakos also notes the adequacy of Greek private pharmaceutical companies. “The Greek pharmaceutical industry is currently blooming and reliable medicine is being manufactured. We support local medicine production. Any changes in the current status should be discussed beforehand. I believe that no one can overlook development but rules should be set.”
Free medical care The government’s goal of providing free basic medical care to all is lauded by health-care stakeholders. But the same question crops up repeatedly— how will the Greek state be able to afford it? “The €5 fee is the only revenue for the hospitals that does not come from the government budget. It is important to note that the uninsured and immigrants are exempt from it”, says Karamanolis. “This measure [universal access to medical care] had also been announced by the previous government, but it
was not implemented because of lack of resources. The free provision of health services, especially in a country undergoing a financial crisis, is extremely important. However, in order for announcement to be implemented, new resources for health must be found. Note that in the last few years, the funds allocated for this purpose fell continuously”, Papatheodorides explains. The Panhellenic Medical Association also wants universal access to health care. “We want the abolition of the €5 and €1 fees and it is important that they not be replaced by other measures. Spending on health care must be increased, through government grants. About €400 million is needed for all the uninsured to be covered”, says Vlastarakos.
Hospital shake-up Another issue that will cause great debate is the reorganisation of the hospital system. The previous government tried to do it but their plans backfired. Hospitals performing poorly were shut down, but the remaining facilities were strained by the increase in patients. The result was a decrease in the quality of medical care. “The efforts so far aimed only at the reduction of costs, and that’s not right. Restructuring of the health system and modernisation of hospital administration must be geared toward the provision of high-quality health care”, says Vlastarakos. “The whole system must be rebuilt from scratch. There is no space for small improvements aiming at immediate political benefits”, says Karamanolis. Papatheodorides says the selection of hospital managers will be crucial to any reforms. “The performance of hospital management depends on the ability and the qualifications of the persons selected. Selection based on partisan criteria never helped.”
Eva Karamanoli www.thelancet.com Vol 385 February 28, 2015
