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136 Economic crisis, health systems and health in Europe: country experience
Regional Committee invited Member States to step up the monitoring and
analysis of ongoing changes in living conditions, to assess health system
performance and to articulate realistic policy options aimed at responding
to the negative impacts of the economic crisis on health and health systems
(WHO Regional Office for Europe, 2009).
The analysis of the Greek case stresses the significance of this resolution, given
that the health reform process in Greece could probably be implemented
in a way that is more consistent with the resolution. While several reform
measures instigated as responses to Greece's sovereign debt crisis are going
in the right direction, more attention could be devoted to the public health
effects of the crisis and the economic adjustment policies. Since 2010, the
public health system has had to cope with a decrease in available resources and
an increase in demand. As the crisis deepens and public expenditure declines,
access to care becomes an issue of concern, particularly for low income and
vulnerable groups, with as yet unknown effects on the health outcomes of
the population. As the data of our analysis indicate, private expenditure as a
share of total health expenditure has been increasing during the crisis period
(compared with a falling trend between 2005 and 2009).
In this context, five priorities should be reconsidered by health policy-makers:
• equitable access to services;
• greater empowerment of citizens in decision-making about the services they
need and their treatment options;
• restructuring of the health system towards a patient-centred, primary care
system;
• greater decentralization and regionalization of decision-making and
provision; and
• increasing the accountability of the health sector.
There is also a need to rethink and to promote a public debate on the health
budget not as a financial burden but as a developmental tool, with the need
to address not only economic dimensions but also the welfare of citizens. In
other words, resetting the social values underlying the health care system is a
prerequisite for establishing a new paradigm for its sustainable development.