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Chapter 4 | The impact of the crisis on the health system and health in Greece
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“brain drain” may have a negative impact on the quality of health services and
the number of highly skilled personnel, which commonly have been trained at
a significant public cost.
Another example is the impact of repeated pharmaceutical price reductions in
order to reduce pharmaceutical expenditure, which also has led to an increase
in pharmaceutical parallel exports from Greece and shortages of medicines
in the country (Karamanoli, 2012). An alternative policy that would achieve
expenditure reductions would be to make stronger efforts to control the
volume of consumption and to improve and extend the implementation of
the e-prescribing system. Moreover, attention should be paid not only to price
and volume but also to innovative ways of distributing pharmaceuticals. For
example, public pharmacies could ensure lower distribution costs for specific
expensive drugs compared with private pharmacies. Additionally, procurement
reforms (e.g. e-procurement, the establishment of a Pricing Observatory for
Medical Supplies (since 2009) and more tendering and negotiations with
suppliers) have led to a significant reduction of hospital budgets and should be
encouraged further.
All of these factors highlight that the current health reform plan needs to be
more coherent, integrated and well designed. In this respect, it is indicative
that although the Ministry of Health and Social Solidarity established a Task
Force of Independent Health Experts (as was stipulated in the second MoU)
to assess and propose structural changes, as opposed to the fiscal measures
usually dictated by successive MoUs, the Task Force's proposals have not been
implemented (Health Task Force on Structural Changes in the Greek Health
Care System, 2012).
5.3 Implementation challenges
The current phase of health reform in Greece faces a number of challenges.
The first is the requirement to implement numerous, rapid and complex
changes. The international experience of implementing health care reforms
suggests that a big-bang approach based on the top-down imposition of a
grand plan is not the most appropriate way to introduce change (Figueras,
Saltman & Mossialos, 1997). However, in the case of Greece this fact has
not been taken into consideration since the required changes have been
rapid and in some cases not appropriately designed. Based on the provisions
of the MoUs, and under the extremely strict reform targets and timetables
imposed by its international creditors, the government has introduced a
number of health reforms that follow the “shock” doctrine rather than the
incremental approach.