Quality in Primary Care 2013;21:369–78 # 2013 Radcliffe Publishing

International exchange A future for primary care for the Greek population Peter P Groenewegen PhD NIVEL – Netherlands Institute for Health Services Research, Utrecht, The Netherlands Arnoldas Jurgutis MD PhD Department of Public Health, Klaipeda University, Klaipeda, Lithuania

ABSTRACT Background is hit hard by the state debt Conclusions The authors recommend the devel- crisis. This calls for comprehensive reforms to restore opment of a clear vision and development strategy sustainable and balanced growth. Healthcare is one for strengthening primary care. Stepped access to of the public sectors needing reform. The European secondary care should be realised through the Union (EU) Task Force for Greece asked the authors introduction of mandatory referrals. Primary care to assess the situation of primary care and to make should be accessible through the lowest possible recommendations for reform. Primary healthcare is out-of-pocket payments. The roles of purchaser and especially relevant in that it might increase the provider of care should be split. Quality of care efficiency of the healthcare system, and improve should be improved through development of clini- access to good quality healthcare. cal guidelines and quality indicators. The education Approach Assessment of the state of primary care of health professionals should put more emphasis in Greece was made on the basis of existing on primary care and medical specialists working in literature, site visits in primary care and consul- primary care should be (re-)trained to acquire the tations with stakeholders. necessary competences to satisfy the job descrip- Results The governance of primary care (and health- tions to be developed for primary care pro- care in general) is fragmented. There is no system of fessionals. The advantages of strong primary care gatekeeping or patient lists. Private payments (for- should be communicated to patients and the wider mal and informal) are high. There are too many public. physicians, but too few general practitioners and nurses, and they are unevenly spread across the Keywords: economic crisis, Greece, health reform, country. As a consequence, there are problems of primary care access, continuity, co-ordination and comprehen- siveness of primary care.

How this fits in with quality in primary care? What do we know? Strong primary care is especially important in that it may to some extent buffer the negative effects of the economic crisis on vulnerable people. It contributes to better population health, less inequity in health and access to care, better opportunities to cost containment and lower healthcare costs. What does this paper add? Assessment shows that the current Greek healthcare system lacks key characteristics of strong primary care. Reform of primary care is therefore one of the priority areas for the Greek government. To increase the chances of successful reform, the strategy should be to combine local or regional pilots with national level policy development and implementation. 370 PP Groenewegen and A Jurgutis

Introduction the key objectives of Health in Action is the develop- ment of an integrated primary healthcare network with the aim of meeting population needs and ensur- The economic crisis that besets Europe is felt strongest ing the efficient use of public resources.8 in Greece. Its clearest symptom is the high state debt to At the background of this objective, is the policy gross domestic product (GDP) ratio. The Greek crisis theory that stronger primary care contributes to better became urgently visible from the moment the - population health, less inequity in health and access to pean Union (EU) had to intervene with loans and debt care, better opportunities to cost containment and 1 regulation from 2010 onwards. The economic crisis is lower healthcare costs.9 The current Greek healthcare doubly important for healthcare. Fir