Health  Vol.6 No.9 , March 2014
The Newly Established Unified Healthcare Fund (EOPYY): Current Situation and Proposed Structural Changes, towards an Upgraded Model of Primary Health Care, in Greece
ABSTRACT
Background: The National Organization for Healthcare Provision (EOPYY) constitutes simultaneously the monopsonistic healthcare insurer and a main provider of PHC in Greece. Currently, EOPYY is threatened by financial distress hence emerging a critical discussion on structural issues, providers’ reimbursement and gatekeeping revision. Objectives: To conduct a detailed analysis of the Greek social health insurance and PHC in order to propose consolidation policies. Methods: Search for raw data domestically and best practices internationally. Results: In Greece, PHC provision is fragmented leading patients to more expensive hospital care. Family physicians are a small portion of total physicians which, in combination with the free choice policy, results in non-gate-keeping despite growing co-payments. This necessitates the creation of a PHC network between EOPYY’s and NHS’s units and contracted professionals. This first evaluation has also revealed an irrational use of consolidated resources, which we propose to normalize through a new global budget system. Conclusions: Greek health insurance needs an immediate reform through which EOPYY would become an efficient pool of public and social health inflows. Besides, we suggest gate-keeping to be activated, proclaiming new EOPYY contracts with general practitioners and family pediatricians, applying a stricter referral system and reforming the reimbursement system.

Cite this paper
Karakolias, S. and Polyzos, N. (2014) The Newly Established Unified Healthcare Fund (EOPYY): Current Situation and Proposed Structural Changes, towards an Upgraded Model of Primary Health Care, in Greece. Health, 6, 809-821. doi: 10.4236/health.2014.69103.
References
[1]   National Organization for Healthcare Provision (EOPYY) (2013) Official Website.
www.eopyy.gov.gr

[2]   Polyzos, N., Kastanioti, C., Theodorou, M., Karakolias, S., Mama, M., Thireos, E., Polizoidis, P., Skamnakis, C., Tsairidis, H. and Dikaios, C. (2013) Study on Reimbursement System of Public and Private Primary Health Care Units Contracted with EOPYY. Democritus University of Thrace, Komotini.

[3]   Porter, M., Pado, E. and Lee, T. (2013) Redesigning Primary Care: A Strategic Vision to Improve Value by Organizing around Patients’ Needs. Health Affairs, 32, 516-525.
http://dx.doi.org/10.1377/hlthaff.2012.0961

[4]   Law 3918/2011

[5]   Chevreul, K., Durand-Zaleski, I., Bahrami, S., Hernández-Quevedo, C. and Mladovsky, P. (2010) France: Health System Review. Health Systems in Transition, 12, 1-291.

[6]   Müller, J. and Maaz, W. (2010) Der Schätzerkreis in der Gesetzlichen Krankenversicherung. Gesundheits und Sozialpolitik, 64, 20-25.

[7]   Hofmarcher, M.M. and Rack, H.-M. (2006) Austria: Health System Review. Health Systems in Transition, 8, 1-247.

[8]   Law 3054/2012

[9]   Skroumpelos, A., Kapaki, V., Athanasakis, K., Souliotis, K. and Kiriopoulos, I. (2012) Reconstruction and Financing of Health Insurance: The National Organization for Healthcare Provision (EOPYY) Project. National School of Public Health (NSPH), Athens.

[10]   Hellenic Statistical Authority (EL.STAT.) (2012) Announcement of the Results of the 2011 Population Census for the Resident Population. EL.STAT, Piraeus.

[11]   Maarse, Η. and Bartholomée, Y. (2007) A Public-Private Analysis of the New Dutch Health Insurance System. European Journal of Health Economics, 8, 77-82.

[12]   Gerlinger, T. (2010) Health Care Reform in Germany. German Policy Studies, 6, 107-142.

[13]   National Organization for Healthcare Provision (EOPYY) (2013) Unpublished data.

[14]   Kontodimopoulos, N., Kastanioti, C., Thireos, E., Karanikas, H. and Polyzos, N. (2013) The Contribution of Generic Substitution to Rationalizing Pharmaceutical Expenditure in Greek Public Hospitals under Recent Economic Crisis. Journal of Pharmaceutical Health Services Research, 4, 211-216.
http://dx.doi.org/10.1111/jphs.12032

[15]   Anonymous (2013) Pharmacists Preparing for New Protests: Unions Condemn EOPYY for “Unacceptable, Illegal and Unconventional” Delays in Payment of Its Debts.
http://www.tovima.gr/en/article/?aid=511944

[16]   Athens-Macedonian News Agency (2013) Settle All Debts by End of the Year “or Else”, Samaras Warns EOPYY Fund Managers.
http://www.amna.gr/english/articleview.php?id=3554

[17]   Law 3235/2004

[18]   Ministry of Health and Social Solidarity (MoH) (2013) ESY.net Unpublished Data.

[19]   OECD (2012) Health at a Glance: Europe 2012. OECD Publishing.
http://dx.doi.org/10.1787/9789264183896-en

[20]   Kousoulis, A., Angelopoulou, K.-E. and Lionis, C. (2013) Exploring Health Care Reform in a Changing Europe: Lessons from Greece. European Journal of General Practice, Early Online, 1-6.

[21]   Pierrakos, G. and Yfantopoulos, J. (2007) Factors That Influence the Evaluation of Primary Health Care Services. Archives of Hellenic Medicine, 24, 578-582.

[22]   Oikonomidou, E., Anastasiou, F., Dervas, D., Patri, F., Karaklidis, D., Moustakas, P., Andreadou, N., Mantzanas, E. and Merkouris, B. (2010) Rural Primary Care in Greece: Working under Limited Resources. International Journal for Quality in Health Care, 22, 333-337.
http://dx.doi.org/10.1093/intqhc/mzq032

[23]   Markaki, A., Antonakis, N., Philalithis, A. and Lionis, C. (2006) Primary Health Care Nursing Staff in Crete: An Emerging Profile. International Nursing Review, 53, 16-18.
http://dx.doi.org/10.1111/j.1466-7657.2006.00456.x

[24]   Hellastat (2013) Sector Study: Private Diagnostic Centers. Hellastat, Athens.

[25]   Yfantopoulos, J. (2007) The Welfare State in Greece. In: Metaxas, A.J., Ed., About Greece, Ministry of Press and Mass Media, Athens, 328-342.

[26]   Reibling, N. and Wendt, C. (2012) Gatekeeping and Provider Choice in OECD Healthcare Systems. Current Sociology, 60, 489-505.
http://dx.doi.org/10.1177/0011392112438333

[27]   Greek Public Opinion (GPO) SA (2011) Nationwide Public Opinion Research: Research on Evaluation of Health Services. National School of Public Health (NSPH), Athens.

[28]   Mossialos, E., Allin, S. and Davaki, K. (2005) Analysing the Greek Health System: A Tale of Fragmentation and Inertia. Health Economics, 14, S151-S168.
http://dx.doi.org/10.1002/hec.1033

[29]   Polyzos, N., Economou, C. and Zilidis, C. (2008) National Health Policy in Greece: Regulations or Reforms? The Sisyphus Myth. European Research Studies, 11, 91-118.

[30]   Labour Institute of the Greek General Confederation of Greece (INE/GSEE) (2013) 2013 Annual Report: The Greek Economy and Employment.
http://www.inegsee.gr/sitefiles/files/ekthesh-15email.pdf

[31]   Polyzos, N., Karanikas, H., Thireos, E., Kastanioti, C. and Kontodimopoulos, N. (2013) Reforming Reimbursement of Public Hospitals in Greece during the Economic Crisis: Implementation of a DRG System. Health Policy, 109, 14-22. http://dx.doi.org/10.1016/j.healthpol.2012.09.011

[32]   Carr-Hill, R. (1989) Allocating Resources to Health Care: RAWP (Resources Allocation Working Party) Is Dead-Long Live RAWP. Health Policy, 13, 135-144.
http://dx.doi.org/10.1016/0168-8510(89)90068-7

[33]   Schäfer, W., Kroneman, M., Boerma, W., Van den Berg, M., Westert, G., Devillé, W. and Van Ginneken, E. (2010) The Netherlands: Health System Review. Health Systems in Transition, 12, 1-229.

[34]   Siskou, O., Kaitelidou, D., Economou, C., Kostagiolas, P. and Liaropoulos, L. (2009) Private Expenditure and the Role of Private Health Insurance in Greece: Status Quo and Future Trends. European Journal of Health Economics, 10, 467-474.
http://dx.doi.org/10.1007/s10198-009-0164-3

[35]   Mossialos, E. and Allin, S. (2005) Interest Groups and Health System Reform in Greece. West European Politics, 28, 420-444.
http://dx.doi.org/10.1080/01402380500060460

[36]   Poterba, J. (1994) A Skeptic’s View of Global Budget Caps. Journal of Economic Perspectives, 8, 67-73.
http://dx.doi.org/10.1257/jep.8.3.67

[37]   Mulligan, P. (2002) Capitation: The Wrong Direction for Primary Care Reform. Canadian Family Physician, 48, 233-235.

[38]   Fan, C., Chen, K. and Kan, K. (1998) The Design of Payment Systems for Physicians under Global Budget—An Experimental Study. Journal of Economic Behavior and Organization, 34, 295-311.
http://dx.doi.org/10.1016/S0167-2681(97)00052-8

[39]   Epstein, A., Lee, T. and Hamel, M. (2004) Paying Physicians for High-Quality Care. The New England Journal of Medicine, 350, 406-410.
http://dx.doi.org/10.1056/NEJMsb035374

[40]   Dervenis, C., Kastanioti, C. and Polyzos, N. (2013) Restructuring the Finances of the Greek Health Care System in the Era of Economic Crisis. World Journal of Surgery, 37, 707-709.
http://dx.doi.org/10.1007/s00268-012-1755-1

[41]   Lionis, C. and Petelos, E. (2013) The Impact of the Financial Crisis on the Quality of Care in Primary Care: An Issue that Requires a Prompt Attention. Quality in Primary Care, 21, 269-273.

[42]   Goldfield, N., Averill, R., Eisenhandler, J. and Grant, T. (2008) Ambulatory Patient Groups, Version 3.0—A Classification System for Payment of Ambulatory Visits. Journal of Ambulatory Care Management, 31, 2-16.
http://dx.doi.org/10.1097/01.JAC.0000304091.21087.08

[43]   Boyle, S. (2011) United Kingdom (England): Heath System Review. Health Systems in Transition, 13, 1-486.

[44]   Greener, Ι. (2009) Healthcare in the UK: Understanding Continuity and Change. Policy Press, Bristol.

[45]   Crisp, N. (2011) 24 Hours to Save the NHS. Oxford University Press, Oxford.

[46]   Busse, R. and Riesberg, A. (2004) Health Care Systems in Transition: Germany. WHO Regional Office for Europe on Behalf of the European Observatory on Health Systems and Policies, Copenhagen.

[47]   Göpffarth, D. and Henke, K.D. (2013) The German Central Health Fund-Recent Developments in Health Care Financing in Germany. Health Policy, 109, 246-252.
http://dx.doi.org/10.1016/j.healthpol.2012.11.001

[48]   Roos, A.F. and Schut, F. (2012) Spillover Effects of Supplementary on Basic Health Insurance: Evidence from the Netherlands. European Journal of Health Economics, 13, 51-62.
http://dx.doi.org/10.1007/s10198-010-0279-6

[49]   Van der Feltz-Cornelis, C., Knispel, A. and Elfeddali, I. (2009) Treatment of Mental Disorder in the Primary Care Setting in the Netherlands in the Light of the New Reimbursement System: A Challenge? International Journal of Integrated Care, 8, 1-14.

 
 
Top