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Arch Hellen Med, 38(4), July-August 2021, 548-556


Primary Health Care in Greece: Lost in the labyrinth

A. Philalithis
Department of Social Medicine, School of Medicine, University of Crete, Herakleion, Crete, Greece

In most developed countries Primary Health Care (PHC) is the point of first contact with health care, usually at the premises of general practice/family medicine. In Greece, although the debate about PHC started at the time of the 1978 Declaration of Alma-Ata for PHC, the repeated efforts to create a unified, integrated PHC system, based on the services of general practice/family medicine, have failed. Examining the events, it is seen that when the National Health System (NHS, in Greece, ESY) reform was halted in 1987, three methods of organizing PHC prevailed: (a) The ESY health centers, staffed with specialists in general practice and other health professionals, provided care in rural areas, where, mutatis mutandis, access of patients to health care has similarities with the Beveridge model of the UK; (b) in urban areas, clinical and laboratory specialists who had contracts with the numerous professional health insurance funds continued to provide first contact care. In this case, access had similarities with the traditional Bismarck model of Germany, France, etc.; (c) the Institute for Social Security (IKA), operated its own polyclinics, staffed by clinical and laboratory specialists. Access of those insured with IKA to health care has similarities with the Semashko model of the former Union of Soviet Socialist Republics (USSR). The establishment of the National Organization for the Provision of Health Services (EOPYY) in 2011 unified all the health insurance funds, and everybody acquired the right to seek care wherever they deemed appropriate. A unified system was created, but it became more complex, the "Greek labyrinth" model. The transfer of the IKA polyclinics from EOPYY to the National Primary Health Network (PEDY) in 2014 achieved the incorporation of IKA into the ESY. Assignment of the responsibility for the PEDY to the Health Regions (YPE), together with the rural health centers, created a unified administration for PHC, but did not affect dayto-day access. In 2017, the Local Health Units (TOMY) were created, in an effort to provide family health services in towns, but they turned out to be just another service like all others. While the legislation for PHC describes perfectly organized services, the gap between words and deeds is evident. Numerous reports on PHC and relevant scientific publications show that the knowhow and evidence-based proposals for improving PHC are not lacking; the problem is the lack of political will to overcome the resistance that was (and continues to be) strong and insurmountable.

Key words: Accessibility, General practice/family medicine, Health care services, National Health System of Greece, Primary health care.

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