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Chapter 4 | The impact of the crisis on the health system and health in Greece
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order to support insufficient health care budgets, they represent the worst option
for financing the health sector as they cause inequalities affecting mostly the
poor and vulnerable groups (Liaropoulos et al., 2008; Kaitelidou et al., 2013).
An increase in voluntary PHI between 2003 and 2012 has been observed
(Table 4.2), although this still remains low compared with other EU Member
States (Siskou et al., 2009). A number of factors explain people's reluctance
to pay for additional insurance, including economic recession, social and
cultural factors (e.g. low average household income), high unemployment and
obligatory and full coverage by social insurance.
Government spending on prevention and public health services also was cut
by around 13% even though this sector was already underfinanced in Greece.
While the mean per capita expenditure on such services in EU Member States
was €75.8 in 2009, the amount for Greece was estimated at €26.2, with further
cuts reducing it to €23.1 in 2012 (OECD, 2013). Similarly, the expenditure
for outpatient public curative services in Greece is 2.7 times lower than the EU
mean for these services (OECD, 2013).
Summing up, Table 4.2 highlights the overall reductions in health care spending
between 2009 and 2012. There have been consistent reductions not only in
total current health expenditure but also in the public share of that expenditure
(including spending by social health insurance funds, which decreased by
29.3% between 2009 and 2012). The changes in government spending on
health by each subsector during the same period is shown in Fig. 4.2. It is clear
that reductions have occurred across the board in hospital inpatient (curative
and rehabilitative) care (7%), outpatient care (34.6%) and pharmaceuticals and
other medical non-durable products (44.2%).
Fig. 4.2 Government spending on health by sector in Greece, 2009–2012
7
6.9
6.4
2009 2012
Percentage GDP
6
5
4
3
2
2.6
1.7
5.2
2.9
1
0
Inpatient curative
and rehabilitative
care
Source: OECD, 2013.
Outpatient and
diagnostic
laboratories
Pharmaceuticals
and other
non-durables
0.29
0.2
Prevention and
public health
services