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Chapter 4 | The impact of the crisis on the health system and health in Greece
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physicians and the dispensing patterns of pharmacies. Use of e-prescribing
is also expected to serve as a tool to promote alignment with prescribing
guidelines, document the medication profile of the population, support the
process of applying clawbacks and enhance transparency by facilitating the
prescription claims procedure.
Overall, reductions in pharmaceutical expenditure are being pursued mainly by
price reductions, increased rebates (clawbacks imposed on private pharmacies
and pharmaceutical companies for both inpatient and outpatient drugs) and, to
some extent, control of the volume of consumption (e.g. via prescription control
mechanisms and e-prescribing). The reductions in outpatient pharmaceutical
expenses are being pursued not only through price reductions but also through
the introduction of innovative and more efficient ways of distributing expensive
drugs to chronically ill outpatients through public pharmacies, where prices are
lower than in private pharmacies. In this respect, the percentage of social health
insurance funds' pharmaceutical expenditure for drugs dispensed through
public pharmacies increased from 6.5% in 2009 to about 13% in 2011.
Reforms for pharmacies
Measures have also been introduced to liberalize the pharmacy market to
increase access and enhance efficiency: more than one pharmacist can now
work at the same pharmacy; new pharmacists can form partnerships with
incumbents; pharmacies can be established in closer proximity to each other;
hours of business have been extended; a decrease in the population threshold
for setting up a pharmacy has been implemented; and rebates can be imposed
on pharmacies, effectively reducing their profit margins.
4. Implications for health system performance
and health
4.1 Equity in financing and financial protection
Research conducted before the current economic crisis has documented amply
that the financing of the Greek health care system is significantly inequitable.
Public funding of the health sector is highly regressive, disproportionately
burdening the lower socioeconomic groups of society, for a number of reasons:
the high level of official and unofficial (hidden economy) private spending on
health, widespread tax evasion and the high proportion of indirect taxation
and social security contribution evasion (Liaropoulos et al., 2008; Siskou et al.,
2008; Economou & Giorno, 2009; Economou, 2010). The crisis exacerbated
existing problems, and many of the policy measures introduced under pressure
from bailout conditions have made health sector financing more inequitable.