Greece Country Health Profile Conference on the Future of Healthcare - PowerPoint PPT Presentation

State of Health in the EU Greece Country Health Profile Conference on the Future of Healthcare in Greece, Athens, 22 March 2018

1 Country Health Profiles 1. Highlights 2 . Health status of the population 3. Risk Factors 4. Health System (description) 5. Performance of Health System 5.1 Effectiveness 5.2 Accessibility 5.3 Resilience (efficiency & sustainability) 6. Key Findings  Released in November 2017 (in English and native language)  This presentation focuses on sections highlighted in bold

What are the trends in the health status of the population in Greece?

Life expectancy in Greece has increased less rapidly than in many other EU countries Only ½ year higher now than EU average, 2 years lower than in Spain and Italy Years Spain Greece EU 84 82 80 84 Years (in 2015 ) 83.0 82.7 82.4 82.4 82.2 81.9 81.8 81.6 81.6 81.5 81.3 81.3 81.1 81.1 81.0 80.9 80.8 80.7 80.6 78 76 82 74 80 72 78.7 78.0 70 78 77.5 77.5 76.7 75.7 76 75.0 74.8 74.7 74.6 74 72 70 Source: Eurostat Database.

People live longer, but less than half of remaining years of life at age 65 is free of health problem and disability Number of working-age people (15-64) per person aged 65+ Healthy life expectancy Unhealthy life expectancy 10.6 18.5 Greek men at 65 7.9 Greek women at 65 7.5 13.8 21.3 0 5 10 15 20 25 Years Note: Healthy life expectancy: Number of years that people can expect to live free of disability. Source: Eurostat Database (data refer to 2015).  Population ageing will increase the needs for health and long-term care, while there will be fewer working-age people to respond to these needs

How to ensure universal access to health care in a context of population ageing, now and in the future? (Access = Affordability + Accessibility to services)

The 2016 Law to provide minimum public health insurance coverage for all the population has been an important step towards universal health coverage Before, 2016, Greece was lagging behind nearly all And a growing proportion of poor people was reporting unmet health care needs due to cost EU countries in health insurance coverage… Total public coverage Primary private health coverage Croatia 100.0 Czech Republic 100.0 % of population Poorest income quintile Denmark 100.0 Finland 100.0 20 Richest income quintile Ireland 100.0 17.4 Italy 100.0 18 16.4 Latvia 100.0 Lithuania 100.0 16 13.9 Malta 100.0 Portugal 100.0 14 Slovenia 100.0 11 Sweden 100.0 12 10.1 United Kingdom 100.0 Austria 99.9 10 8.4 France 7.8 99.9 7 Spain 99.1 0.8 8 Germany 88.9 10.9 Netherlands 99.8 6 Belgium 99.0 3.3 Luxembourg 2.8 95.9 4 2.2 Hungary 95.0 Slovak Republic 0.9 94.2 0.8 0.6 2 0.2 Estonia 0 93.9 Poland 91.3 0 Bulgaria (2013) 88.2 2008 2009 2010 2011 2012 2013 2014 2015 Romania 86.0 Greece (2015) 86.0 Cyprus (2013) 83.0 70 80 90 100 % of population in 2015 Source: Eurostat (EU-SILC). Source: OECD (Health at a Glance: Europe 2016).

But it is also important to consider the comprehensiveness of health insurance coverage: what is covered and what proportion is covered? Only about 60% of health spending in Greece is publicly funded, compared with about 80% in the EU Source: OECD Health Statistics (data refer to 2015).

Effective access to care also needs to address other barriers beyond coverage Many Greek people report having difficulties accessing doctors or a health centre not only because of cost, but also because of distance to the doctor’s office and waitings to get an appointment and see a doctor Italy Spain EU Portugal Greece Distance to doctor’s office 0% 20% 40% 60% Spain EU Italy Portugal Greece Cost of seeing doctor 0% 20% 40% 60% Spain Italy EU Portugal Greece Delay in getting appointment 0% 20% 40% 60% Italy Spain EU Portugal Greece Waiting time to see a doctor on the day 0% 20% 40% 60% Response to the question: “ Thinking about the last time you needed to see or be treated by a GP, family doctor or health centre, to what extent did any of the following make it difficult or not for you to do so?” (% of respondents answering “very difficult” or “a little difficult”). Source: Eurofound (European Quality of Life Survey 2016).

The main problem is not a lack of doctors, but a lack of generalists, the uneven geographic distribution of doctors, and the lack of doctors in public facilities Generalists, 6% Other doctors (not defined), 19% Specialists, 75% Greece Note: In Portugal and Greece, data refer to all doctors licensed to practice, resulting in a large over-estimation of practising doctors (e.g. of around 30% in Portugal). In Austria and Greece, the number of nurses is under-estimated as it only includes those w orking in hospital. Sources: Eurostat Database and Health at a Glance 2017.

Primary Care Plan launched in 2017 is another step in the right direction • Creating an effective network of primary care services is one of the most urgent priorities to respond effectively to the needs of (ageing) population and reduce over-crowding of emergency departments and unnecessary hospital admissions • Other EU countries can provide some inspiration to strengthen primary care: • Portugal: Since 2007, a growing number of Family Health Units based on multi- professional teams (with 3-8 GPs and same number of nurses) responsible for delivering primary care to around 12000 people each (about 500 FHUs now) • But there is probably “no one fits all” solution , and various primary care models probably need to coexist and continue to evolve over time • The success of the primary care reform in Greece will likely depend on:  Having sufficient financial resources to support creation and development  Supporting innovative ways to deliver services effectively (e.g. telemedecine)  Coordinating effectively the various primary care units (regional authorities)

Universal and fairly comprehensive health coverage can be fiscally sustainable in Greece, provided that…  Efforts continue to reduce waste in health spending to ensure that resources are used effectively to respond to changing needs and ensure continued support for publicly-funded system  The revenue base to finance public spending on health is broadened to rely less on payroll taxes to raise sufficient resources to meet future needs

Wasteful spending can occur at all levels of the system for many reasons Patient Ineffective/inappropriate (low value) care Wasteful Duplication of services clinical care Preventable adverse events Clinician Actors Paying an excessive price Discarding unused inputs Operational waste Manager Overusing high-cost inputs (e.g. hospitals) Governance-related Ineffective administrative procedures waste Regulator and expenditure Errors & poor Poor Fraud and Poor Drivers decisions incentives corruption organisation Unintentional Intentional Source: OECD, Tackling Wasteful Spending on Health.

Despite many recent efforts to reduce hospital and pharmaceutical cost, most health spending in Greece continues to be allocated for these two big spending items % Inpatient care Outpatient care Long-term care Medical goods Collective services 100 4 5 5 5 6 7 8 9 90 12 20 14 22 21 19 20 28 80 2 70 26 18 10 9 15 2 12 A relatively small share of 60 spending is allocated to 25 outpatient care and long- 50 48 31 26 38 30 term care 30 40 34 30 20 40 33 32 30 29 26 26 23 10 0 Note: Countries are ranked by inpatient care as a share of health expenditure. Source: OECD Health Statistics 2017 and Eurostat Database (data refer to 2015).

A lot of efforts have been made in recent years to reduce pharmaceutical spending Introduction of prescription guidelines, coupled with country-wide prescription system to monitor doctors’ prescribing and pharmacies’ dispensing Million ( € ) Introduction of reference pricing for branded drugs based on the three lowest 7 000 EU prices and setting a maximum pricing 6 000 level for generics 5 000 Promoting use of generics in pharmacies and hospitals (although there is still room for 4 000 further progress) 3 000 2 000 Share of generic market (in volume, 2015) % 1 000 100 0 75 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 50 25 0 Note: The dotted line between 2007 and 2009 indicates estimates to fill missing data. Source: OECD Health Statistics 2017.

Broadening the revenue base to pay for growing public spending on health • Payroll taxes have historically been the main source of public funding in social health insurance systems, but:  Rationale to rely on employee and employer contributions is reduced when health insurance coverage becomes universal (not linked to employment status)  Excessive reliance on payroll taxes reduces incentives for people to work and employers to recruit (negative impact on employment)  May not provide sufficient revenue base to respond to future health care needs given demographic changes (shrinking size of working-age population) • In France, recent tax reform (since 1 January 2018) eliminated employee contributions for health care and replaced it by increase in a more general taxation covering broader revenue sources (capital gains, pensions, others) • But tax reforms are never easy to implement (there are “winners” and “losers”)