By Eleni Androni, Legal Counselor of the Hellenic Private Hospitals Association (SEK)
The Greek health care system is a highly centralized mixed health system model that comprises elements from both the public and private sectors. Public insurance coexists with private insurance with the first being mandatory in Greece for all workers according to the social security system. From 2011 the public health insurer, namely the National Organization for the Provision of Health Services (EOPYY) manages a unified health insurance fund and purchases publicly funded health services delivered by the National Health System by contracting with both public and private providers with the later covering over 30% of all services.
However, there is still no unified budget for the provision of health services delivered by the National Health System. There is different allocation of funds between public and private hospitals. Public sector has an annual budget of above 5 billion and no VAT, while the private sector has a budget over 300 million euros that includes 24% VAT.
Because of EOPYY budgetary constraints, rebate and clawback mechanisms are imposed horizontally to all private providers, who at the same time cannot refuse to offer health services to patients with public insurance (EOPYY) even when the allocated budget is exceeded. Today Claw back and Rebate that is imposed for outpatient services is up to 60%, and for inpatient services over 40%.
Association’s 3 main priorities for 2024
A more efficient allocation of public resources is needed, in order to reflect the real needs of the national health care system (from pharmaceutical products to health care services) and which, for the provision of hospital services, would reflect the real flow of patients towards private hospitals (the “money follows the patient” principle) either with the increase of the budget allocated for the provision of hospital services by private hospitals or by adopting one unified budget for both public and private providers.
Rebate and claw back mechanisms shall be abolished since in any case are not the suitable tool for the control of public expenditure in hospital health care services.
Reduction of today VAT (24%) imposed only on private hospital health services and in any case VAT exemption of private hospital services provided to EOPYY insured patients in the context of national health system (EOPYY contracts).Further cooperation between public and private sector.
