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Chapter 4 | The impact of the crisis on the health system and health in Greece
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Another significant development has been the effort to achieve greater
decentralization of health care authorities. In June 2010, the new government
enacted a law to establish a new architecture for municipalities and regions
(known as the Kallikratis Plan). The Kallikratis Plan created 13 regions to
replace 76 prefectures and 1034 municipalities were reduced to fewer than 370.
Under the reorganization, regional health authorities were expected to play a
much greater role in managing and organizing human resources in the NHS
and in the provision of primary care services. However, to date, efforts to create
these more empowered decentralized regional authorities either have not been
implemented or have been substantially weakened. The existing regional health
authorities have weak co-coordinating functions and the health care system is
still characterized by strong centralization. A possible explanation is limited
administrative capacity, limited available economic resources and (currently)
the absence of a clear plan for reforming primary care (see also section 5.2).
More recently, (in February 2014) the Greek Parliament passed new legislation
on primary health care, establishing the National Primary Health Care
Network, coordinated by the regional health authorities. All primary health
care facilities under EOPYY, rural health centres and their surgeries as well as
the few urban health centres, are now under the jurisdiction of the regional
health authorities. The aim is for these facilities to function 24 hours a day,
seven days a week. In addition, the law provides for the establishment of a
referral system based on GPs. The effectiveness of this new measure will rely
heavily on robust implementation.
Purchasing and procurement
Under EOPYY, procurement of health supplies will be planned at the regional
level via the development of regional programmes for goods and services.
These programmes have to be adopted by the Co-ordination Committee for
Procurement, which is responsible for assigning a contracting authority and
the tender mechanism for each type of procurement. The Committee is able to
select either a company or a private agency as a contracting authority, in line
with its objective of achieving economies of scale and overall efficiency.
Hospital sector efficiency
Several measures have been introduced or are being attempted in the hospital
sector, involving structural reforms, changes to the hospital payment system
and reductions in the cost of hospital supplies.
Major restructuring of the public hospital sector has been targeted as part of
efficiency-enhancing efforts, with the Minister of Health announcing in July 2011
a plan to cut the current number of public hospital beds from 35 000 to 33 000
and reduce the number of clinics and specialist units from 2000 to fewer than