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374 Economic crisis, health systems and health in Europe: country experience
• Because of new labour market regulations, all health professionals have
common working times of eight hours per day and 40 hours per week as
the standard (before several health professionals had reduced work time, e.g.
radiologist had six hours per day compared with the general eight hours)
(2009 onwards).
Payment to providers
• EHIF reduced health services prices by 6% from 2009. The objective was
to balance the health insurance budget without diminishing access to
care. Cuts in primary care were relatively low (3%). However, before the
crisis, health service expenditures (also prices) increased very rapidly and,
therefore, the cuts did not represent a big economic shock for providers;
in addition, the cuts were temporary and by 2012 the EHIF had increased
health service prices to pre-crisis levels.
Overhead costs: restructuring the Ministry of Health and purchasing agencies
• No response reported.
Provider infrastructure and capital investment
• The capital costs financing scheme was reformed by financing it from the
state budget as allocations to the EHIF, thereby releasing EHIF funds
to finance other costs of service provision (2008). The first allocation of
€8 million was transferred from the state budget to the EHIF in 2008.
However, in 2009, the reform was reversed and EHIF had to cover this
expenditure from regular health insurance revenues, as before. (Note
capital costs in this context are part of health service prices and not
separate allocations.).
Priority setting or protocols to change access to treatments, coordination
of care and patterns of use
• Establishment of an HTA programme in 2012 that provided projectbased
support to establish an HTA centre.
• Revision of clinical guidelines development process supported by WHO
(2010–2011).
Waiting times
• The EHIF increased the maximum waiting time for outpatient specialist
visits from four to six weeks (2009).
Health promotion and prevention
• Excise tax for both alcohol and tobacco was increased in 2008 (twice), 2010,
2011 (only for tobacco), 2012, 2013 and 2014.