Greece: #27 in the 2020 World Index of Healthcare Innovation

Introduction

Greece’s health care system ranked near the bottom of the World Index of Healthcare Innovation overall, with a score of 40.12 (#27). Greece, famously, struggles with a very high debt-to-GDP ratio of 185%. The Greek economy shrunk by 10 percent from 2008 to 2018, making it more difficult to finance its single-payer health care system.

Greece performed poorest on Quality, ranking 38th with a score of 44.13. Improving primary care remains a challenge for the Greek system, as secondary care services remain more developed in the country. Health expenditures for Greece are 8.4% of GDP — slightly lower than the EU average of 9.5%. Social health insurance and tax provide around 60% of the financing, while private spending makes up the remaining 40%.

Background

Greece once had a robust private health insurance market, similar to that of Germany and other Bismarckian countries, with a diversified range of premiums, benefits, and cost-sharing provisions. In 2011, this largely private insurance network was replaced with a single-payer system under the National Organization for the Provision of Health Services (EOPYY).

In contrast, the private sector includes for-profit hospitals, diagnostic centers, and independent practices. Most private providers enter into contracts with EOPYY to provide services outside the scope of the public sector, such as with private ambulatory services. The Greek health care system centers around its 283 hospitals, with 55% publicly and 45% privately owned. Approximately 65% of hospital beds are within public hospitals, and 35% within private.

Quality

Greece ranked second to last (30 of 31) regarding measures of preventable disease. The most common causes of death are cancer and cardiovascular disease, accounting for 65% of all deaths (largely due to the high prevalence of smoking and obesity). Additionally, the country’s aging hospital infrastructure ranked last (31st) resulting in an overall quality rank of 28th.

Choice

Greece ranked at the median for choice overall at 11th. In particular, Greece ranked highly at the freedom to choose health care services, at 6th. However, Greece’s affordability of health insurance ranked 25th, and its access to medical technologies ranked 15th.

Science & Technology

Greece ranked several spots below the median on innovation, at 18th overall. Greece’s highest subcategory came from its EHR adoption at 13th overall. However, its measures of medical and scientific innovation leveled off at 19th and 23rd, respectively.

Sustainability

Within the WIHI analysis, Greece ranked 26th overall in fiscal sustainability. While Greece ranked 2nd in curtailing the growth of health spending as a share of GDP over the last 10 years, largely due to austerity measures, its debt-to-GDP ratio remained high, ranking 30th.