Health Policy and Politics

Abstract

This chapter critically examines the health policy trajectory and reform dynamics since the restoration of democracy in Greece in 1974. After a brief Introduction, the second section highlights the distinctive features of the Greek health-care system that make it a ‘sui generis’ case in comparative studies. It uses analytical tools from the available literature on policy formation (such as, the concepts of ‘institutional layering’ and ‘windows of opportunity’ for policy breakthroughs), and sets out an explanatory framework for understanding the prolonged ‘halfway transformation’ from a deeply fragmented social health insurance system to universal health care. The third section provides a short historical account of the origins and development of social health insurance up to the late-1970s. Section 4 scrutinizes the (incomplete) establishment of a National Health System (ESY, Εθνικό Σύστημα Υγείας), in 1983, the policy stalemate during the 1990s, and the failed attempt to tackle persistent fragmentation and inequalities in coverage and funding, in the early 2000s. Section 5 unravels the confluence of factors during the crisis years, and under the three bailout programmes, which catalysed significant changes in light of the 1983 ‘path shift’, though in a way that greatly weakened the scope and quality of public provision. The concluding section stresses the need for systematic research on the complex issue of equity, comprehensiveness, and fiscal sustainability under conditions of strained public resources.