Greek NHS fails to meet mission due to mismanagement, study shows

The Greek National Health System (NHS) has failed to meet its mission due to significant mismanagement, a new policy paper published by the influential Greek think tank diaNEOsis reveals.

The new policy paper by diaNEOsis is part of the organisation’s long-term research, analysis, and policy recommendations for the Greek NHS. It is signed by four academics in different fields of health: Prof. Yannis Tountas, Vassilis Kefis, Nikos Polyzos and Kyriakos Souliotis.

But now the need for a radical transformation of the NHS seems more urgent than before, as deep structural problems remain, and the expressed willingness of the current government for profound policy reforms is yet to take full form.

“The Greek NHS is unable to meet its mission due to significant problems of underfunding, understaffing, disorganised Primary Health Care, lack of planning and mismanagement”, the team leader & coordinator of this policy research, Professor Yannis Tountas, told Euractiv.

It is now “the only National Health System in the EU that is managed by the respective political leadership and by executives selected as a rule with party criteria”, he added.

The structure of the Greek NHS also seems to significantly limit the ability of the state’s own legislative or other interventions to succeed, according to the policy paper findings.

The Greek NHS has been the subject of many studies looking into lifting obstacles and filling the gaps.

Two years ago, diaNEOsis in cooperation with the team of academics, carried out another study named “New NHS”. In this study, the importance of having specialised administrative staff in key positions of the Greek NHS on all levels was highlighted to improve clinical effectiveness and financial efficiency.

A new model of organisation

The new policy paper also analysed other European health systems, proposing a new organisational model for the Greek NHS.

Speaking to Euractiv, Tountas said that this policy paper proposes an “integrated system of governance of the NHS” for it to be transformed “from a mismanaged state agency into a modern public organisation”, highlighting the new thing that this policy paper addressed to the Greek government comes to add.

It is the so-called “Hub-and-Spoke model” for the organisation of hospital care.

Specifically, a hub hospital would provide the most intensive medical services, having the highest investment of resources and the biggest concentration of advanced medical technology. Around it, there would be satellite hospital clusters offering more limited services distributed throughout the care network (at primary and secondary levels), the policy paper reports.

The institutional reforms

The study proposes several key reforms that have to be done for the Greek NHS to “be capable of adequately covering the health needs of the Greek population”, Tountas said.

First, “the re-establishment of the NHS as a Legal Entity under Public Law, i.e. as an independent public organisation” is necessary “with a Board of Directors and a President/General Manager”, Prof. Tountas added.

On the contrary,  a different reform is proposed for the hospitals themselves. The NHS hospitals should be transformed into non-profit Legal Entities under Private Law and operate as subsidiaries of the Ministry of Health. However, this reform  “does not mean a privatisation or a change of ownership”.

“A change of the institutional status of the NHS hospitals from Legal Entities of Public Law to Private Law” would contribute to “gaining managerial flexibility and efficiency without losing their public character”,  Prof. Tountas explains to Euractiv.

According to the proposed organisation model, 20 hospital networks throughout the country must be established “where each network will have a reference tertiary hospital and with which the secondary prefectural hospitals of its area of ​​responsibility will be functionally interconnected”, he added.

In the same context, the Greek Primary Health Care System must also be enhanced with 320  local networks and a central organisation.

The Primary Health Care System “will be headed by a Health Centre and will involve the rest of the primary healthcare units of the NHS, the newly established institution of Personal Physicians, primary health services of the Municipalities and the health units of the private sector contracted with the social insurance system”, Prof Tountas explained.

Next steps

The Greek government did not provide any public comment about this study.

The new Health Minister, Michalis Chrisochoidis, has previously shown an intense willingness to implement radical reforms in NHS management, while the new legislation established earlier in November regarding the selection criteria for the management of public bodies does not provide substantial reforms in hospital management selection process according to Greek media references.

The discussion about NHS reform and its management is currently open, while Mr Androulakis, the leader of PASOK, recently seized the opportunity to talk about that at a health event.

He announced his party’s reforms for the Greek NHS while asking for “merit-based selection of Governors in public hospitals through international competitions”. According to recent polls, the PASOK party is rising as a leading opposition party.

[By Marianthi Pelekanaki, Edited by Vasiliki Angouridi | Euractiv.com]

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