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Barriers and Facilitating Factors in Access to Health Services in Greece

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Barriers and Facilitating Factors in Access to Health Services in Greece BarriersBarriers andand facilitatingfacilitating factorsfactors inin accessaccess toto healthhealth servicesservices inin GreeceGreece Barriers and facilitating factors in access to health services in Greece Charalampos Economou Key Words DELIVERY OF HEALTH CARE HEALTH SERVICES HEALTH SERVICES ACCESSIBILITY UNIVERSAL COVERAGE GREECE Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø Denmark Tel.: +45 45 33 70 00; Fax: +45 45 33 70 01 Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). © World Health Organization 2015 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expres- sion of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are en- dorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. BARRIERS AND FACILITATING FACTORS IV IN ACCESS TO HEALTH SERVICES IN GREECE Acknowledgements This report was produced through the Contribution Agreement between the Ministry of Health of the Hellenic Republic and the World Health Organization (WHO) Regional Office for Europe for the Health Reform Support Programme 2013–2015 in the framework of the Health in Action initiative. One key element of the activities supported by WHO European Region under the Agreement relates to evidence generation regarding access to health care of vulnerable groups. In this context, the present study was conducted to identify barriers and facilitating factors in access to services of vulnerable groups in Greece, using the Tanahashi framework. Overall coordination and guidance for the study has been ensured by the Division of Health Systems and Public Health of WHO Regional Office for Europe, under the leadership of Hans Kluge, Divisional Director. The support of the local WHO Programme Management Team in Athens – represented by Wim Van Lerberghe, Senior Adviser on Primary Health Care and Health Systems, and Silviu Domente, Health Systems Analyst – in the design of the study and their fruitful discussions with researchers are gratefully acknowledged. Thanks also to Anastacia Alves Romaidis and Aspasia Kotsari from the WHO Programme Management Team in Athens who provided administrative and logistical support at all stages. As an external expert with relevant experience and practical skills in applying the Tanahashi framework, Stela Bivol, Director for Programmes, Center for Health Policies and Studies, Republic of Moldova was invited to support the national team in the initial stage, through practical guidance on the methodology and process. Charalampos Economou, Associate Professor of Health Policy, Panteion University was the senior local expert who liaised with Stela Bivol, coordinated the study and wrote the final report. Antonis Kostas managed all the technical work regarding the desk review; the Scientific Society for Social Cohesion and Development, headed by Theodoros Sakellaropoulos, managed the qualitative component of the study. The qualitative research coordinator was Daria Lazarescu and the interviewers were Eugenia Bellou, Mary Bouga, Magdalene Dosopoulou, Monica Kehagia, Bill Lolis, Georgia Passa and Mary Skourti. The participation of the many key informants and focus group participants whose ideas have informed this report is also gratefully acknowledged. BARRIERS AND FACILITATING FACTORS IN ACCESS TO HEALTH SERVICES IN GREECE V Table of contents Acknowledgements .......................................................................................................................................................... V Table of contents ................................................................................................................................................................ VI List of tables and figures .................................................................................................................................................. VII Abbreviations ...................................................................................................................................................................... IX 1. INTRODUCTION. AN OVERVIEW OF THE SITUATION .......................................................................................... 1 1.1. Economic, social and health effects of Greek structural adjustment programme ........................... 1 1.2. Reductions in public health spending ............................................................................................................ 3 1.3. Reductions in population’s coverage with health-care services ............................................................ 4 1.4. Problem of access to health-care services for vulnerable groups ......................................................... 6 1.5. Mandate and structure of the report .............................................................................................................. 8 2. METHODOLOGY OF THE STUDY ................................................................................................................................ 10 2.1. Tanahashi framework ........................................................................................................................................... 10 2.2. Desk review ............................................................................................................................................................. 13 2.3. Qualitative research .............................................................................................................................................. 14 3. FINDINGS OF THE DESK REVIEW ................................................................................................................................ 19 3.1. Availability coverage ............................................................................................................................................ 19 3.1.1. Infrastructure .............................................................................................................................................. 20 3.1.2. Human resources ....................................................................................................................................... 33 3.2. Accessibility coverage .......................................................................................................................................... 43 3.2.1. Geographical access and regional disparities .................................................................................. 43 3.2.2. Financial access and affordability ......................................................................................................... 51 3.2.2.1 Health insurance coverage and user charges ..................................................................... 51 3.2.2.2. Provisions for unemployed and uninsured people .......................................................... 55 3.2.2.3. OOP payments, black economy and catastrophic health expenditures ................... 58 3.3. Acceptability coverage ........................................................................................................................................ 67 3.3.1. Patient satisfaction with health services provided ......................................................................... 67 3.3.2. Health system responsiveness ............................................................................................................... 71 3.3.3. Vulnerable groups, social exclusion and discrimination ............................................................... 72 3.3.3.1. Migrants ......................................................................................................................................... 73 3.3.3.2. Roma population ........................................................................................................................ 76 3.3.3.3. Patients with chronic illness ...................................................................................................
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