The effectiveness of primary health care reforms in Greece towards achieving universal health coverage: a scoping review

Thanos Myloneros,Dikaios Sakellariou

doi:10.1186/s12913-021-06678-9

Thanos Myloneros, Dikaios Sakellariou

Open Access

https://doi.org/10.1186/s12913-021-06678-9

Copy DOI

Abstract

IntroductionBetween 2010 and 2018, Greece implemented an Economic Adjustment Programme and underwent a series of extensive reforms, including in the health sector. We conducted a scoping review to examine whether the Primary Health Care reforms during that period assisted the country in moving towards Universal Health Coverage.MethodsWe performed a review of the literature on the following databases: Scopus, PubMed, Epistemonikos, Web of Science, and Google Scholar, including published research articles and grey literature. Findings were synthesised thematically, using the World Health Organization Universal Health Coverage dimensions: population coverage, service coverage, and financial protection.ResultsForty-four documents were included in this review. Out of these, thirty-eight were research-based (thirty-three qualitative, two quantitative, and three mixed design studies), two grey literature, and four legislative bills. The evidence suggests that despite the systemic interventions addressing longstanding distortions, population coverage, service coverage and financial protection have not significantly improved.ConclusionsThis review suggests that Primary Health Care reforms in Greece have not managed to substantially improve Universal Health Coverage, although some positive steps towards that direction have taken place with the establishment of community-based multidisciplinary health teams. Before further interventions are implemented, an evidence-based monitoring and evaluation mechanism is necessary in order to clearly evaluate their effectiveness and progress.

Highlights

Between 2010 and 2018, Greece implemented an Economic Adjustment Programme and underwent a series of extensive reforms, including in the health sector
Guidance received by the World Health Organizatiom (WHO) made it clear to the Greek government that in order to improve Universal Health Coverage (UHC) [12] the establishment of a comprehensive Primary Health Care (PHC) network was necessary [13]
It is worth noting that even though disadvantaged groups like the uninsured, chronic patients, pensioners, and migrants find that healthcare is too expensive, they tend to prefer, where possible, the private sector over the free public one, with the perception of superior quality and timely access [40, 79]. The aim of this scoping review was to identify through available literature, in what extend the PHC reforms in Greece that were implemented during the period of the Economic Adjustment Programme, have impacted the three dimensions of UHC

Summary

Introduction

Between 2010 and 2018, Greece implemented an Economic Adjustment Programme and underwent a series of extensive reforms, including in the health sector. Health System (known as ESY) but failed to develop strategies for comprehensive country-wide PHC services [3] This allowed multiple distortions to thrive and accumulate, such as fragmentation of services and funding, excessive reliance on specialist care, lack of care pathways, and supply-induced demand with consequent high out-of-pocket payments (OOP) as percentage of total health spending, compared to the rest of the EU-27 countries [4]. In 2010, the country entered a bailout programme known as Economic Adjustment Programme [10], which lasted until 2018 and was implemented through three consecutive Memoranda of Understandings (MoU), signed between the Greek State and the International Monetary Fund, the European Commission, the European Central Bank and,at a later stage, the European Stability Mechanism These MoUs came with a prerequisite but negotiable package of reforms, comprised mainly by cost-containment policies. Guidance received by the World Health Organizatiom (WHO) made it clear to the Greek government that in order to improve Universal Health Coverage (UHC) [12] the establishment of a comprehensive PHC network was necessary [13]

Objectives

Methods

Results

Discussion

Conclusion