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Chapter 4 | The impact of the crisis on the health system and health in Greece
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on the composition of health spending, resulting in reductions in salaries,
infrastructure and equipment.
The broad picture presented in the WHO report on the negative effects of
the crisis on the health sector is particularly pertinent to Greece. Additionally,
there seems to be certain unintended consequences affecting health care
system capacity. For example, health administrative and nursing personnel in
public health units decreased by 4% between 2008 and 2011, mainly through
retirement and migration. This has added to the existing shortages of nursing
personnel, generating serious concerns regarding the quality of services that
can be provided to patients. Another disquieting fact is the observed decline
in relative biomedical research productivity in Greece, starting shortly after
the initiation of the financial crisis; however, as yet, the precise consequences
of this are unclear (Falagas et al., 2012). This raises serious concerns regarding
the promotion of innovation, a key element for the development of the health
sector, as well as the volume and the quality of information provided in order
to monitor the impact of the current economic crisis.
However, one cannot ignore some of the positive steps that have been made
in the last few years. These include mainly the monitoring tools introduced
in hospital management with the aim of controlling resource utilization, the
introduction of a prospective hospital payment system, the implementation
of the OECD System of Health Accounts, the adoption of a betterdesigned
and more transparent procurement system and the development of
e-governance tools.
6. Conclusions
The economic crisis has highlighted the need for radical restructuring of the
Greek health care system towards its stated aim of providing high-quality
services equitably, universally and free at the point of delivery. So far, the
process of reform has been somewhat fragmented and a number of strategies,
procedures and methods for the optimization of the NHS still need to be put
in place. Adopted reform measures have decreased public health expenditure
across the board (leading to some curtailed services and longer waiting
times), increased user charges and reduced health worker numbers by cutting
salaries, without taking into account allocative efficiency during the resource
allocation process.
The WHO Regional Committee for Europe adopted in 2009 a resolution
urging its Member States to ensure that their health systems continue to
protect the most vulnerable, to demonstrate effectiveness in delivering
personal and population services and to behave as wise economic actors in
terms of investment, expenditure and employment. In addition, the WHO