Greece: #27 in the 2022 World Index of Healthcare Innovation
Greece struggles to preserve affordability and quality amidst its long-running fiscal crisis.
By Gregg Girvan, Grant Rigney, and Avik Roy
Introduction
Greece ranked 27th in the 2022 World Index of Healthcare Innovation, compared to 26th in 2021 and 27th in 2020. Greece struggled across multiple dimensions, ranking 28th in Quality for a second year. Greece also struggled with Fiscal Sustainability, ranking 24th overall, primarily due to its high debt-to-GDP ratio of over 211 percent. Greece’s strongest dimension was Choice (11th).
Background
Western medicine as we know it traces much of its foundation to the contributions of Hippocrates, who was born on the Greek island of Kos around 460 B.C.
For much of the 20th century, Greece offered a robust private health insurance market similar to that of Germany and other former Bismarckian countries, with a diversified range of premiums, benefits, and cost-sharing provisions for patients. However, in 2011, after a protracted fiscal and economic crisis, Greece moved away from this largely private insurance network to a single-payer system administered by the National Organization for Healthcare Provision (EOPYY).
Accordingly, most private providers, for-profit hospitals, and diagnostic centers enter into contracts with the EOPYY to provide services outside the scope of the public sector insurance (e.g., private ambulatory services). Furthermore, the Greek healthcare system centers around 283 hospitals, 55 percent of which are publicly owned and comprise two-thirds of all hospital beds. In contrast, privately-owned hospitals account for 45 percent of Greece’s hospital infrastructure but comprise only one-third of its hospital beds. Improving primary care remains a challenge for the Greek system, as secondary healthcare services remain more developed in the country.
Greece devotes 7.8 percent of its GDP — slightly lower than the EU average of 9.5 percent— to health expenditures. Social health insurance and taxes provide roughly 60 percent of the system’s financing, while private spending makes up the remaining 40 percent.
Quality
Greece ranked 28th for Quality. Notably, Greece ranked second-to-last (31st) in both patient-centered care and pandemic preparedness. With cardiovascular disease and cancer deaths accounting for 65 percent of all deaths — primarily due to Greece’s high prevalence of smoking and obesity — ranked 25th in measures of preventable disease.
Choice
Greece ranked 11th for Choice — its strongest showing in the 2022 WIHI. Freedom to choose healthcare services was one of Greece’s strengths, where it ranked 6th. Greece ranked below the median in access to new treatments (24th) and affordability of health insurance (27th).
Science & Technology
Greece ranked 22nd in Science and Technology and 23rd in the three elements that comprise this dimension — medical advances, scientific discoveries, and health digitization.
Fiscal Sustainability
Greece ranked 24th for Fiscal Sustainability. While Greece performed will in growth in public health spending (2nd), it ranked second-to-last in national solvency (31st). Greece’s success in reining in spending growth stemmed from the post-recession austerity measures that lowered healthcare’s share of Greece’s GDP over the last decade (17th). Nonetheless, Greece’s overarching national debt continued to weigh it down because of a high debt-to-GDP ratio.
