Abstract
Over the past years, Greece has undergone several endeavors aimed at modernizing and improving national health care services with a focus on PHC. However, the extent to which integrated primary health care has been achieved is still questioned. This paper explores the extent to which integrated primary health care (PHC) is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country. A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care. Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care. Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development.
Highlights
Emerging demographic changes, mental health issues affecting individual and community well-being and global pressures of supply and demand present international challenges for any effort to reshape a health system, especially in countries with strained financial and human resources
Differences across the country between urban and rural primary care provision patterns [43, 50] as well as practice variations between National Health System (NHS) and major national Health Maintenance Organizations [10, 22] or private primary care providers have greatly contributed in the fragmentation and discontinuity of health care services [12, 14, 26, 39]
Our review identified some papers calling for integration of primary care services [14, 39], including those reporting on attempts towards clinical governance practices [13], and collaborative initiatives with local authorities in establishing community outreach programs [26, 42, 51, 52], Greece still operates under a conventional primary care management perspective
Summary
Mental health issues affecting individual and community well-being and global pressures of supply and demand present international challenges for any effort to reshape a health system, especially in countries with strained financial and human resources. ‘Community-based integrated care’ is a strategic vision that promotes more joined and consistent action of the health care workforce towards improved performance, maximizing population health In light of this definition, the focus is on multidisciplinary teams, rather than individuals, with partners recognizing, valuing and trusting each others’ rationales to meet shared endpoints [3] in the provision of qualitative and comprehensive health care services. Purpose: This paper explores the extent to which integrated primary health care (PHC) is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development
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