Incoming Health Minister Thanos Plevris has hit the ground running in an effort to implement planned healthcare reforms that were long postponed due to the COVID-19 epidemic.

The government touted a list of reforms during the public health crisis, a number of which triggered a strong backlash from main opposition SYRIZA, particularly the determination to go ahead with public-private partnerships between hospitals, which the opposition views as a plan to downgrade the National Health System to the benefit of the private sector.

That cooperation has effectively already begun, however, as private hospitals were marshalled to treat non-COVID patients when public hospitals were hugely overburdened by the enormous weight of single-handedly managing the raging pandemic. Hospitals in northern Greece especially came to the brink of collapse.

Plevris, a lawyer who has a PhD in health law, is conducting an exhaustive review of public health finances.

As legal advisor to former health minister Adonis Georgiadis, Plevris drafted plans for radical reforms which included a broad cooperation between the National Health System and private sector health facilities, which are to play a supplementary but decisive role in the current overall reform plan. Both ministers are in the right wing of the ruling conservative party.

The government believes that the public-private cooperation necessitated by the pandemic has laid the groundwork and may be expanded without a serious public backlash.

Some private hospitals, such as the large Henry Dunant Hospital Centre, agreed to take on shifts of public hospitals by treating non-COVID patients, and some doctors from that hospital and others agreed to serve at public hospitals in northern Greece, which were at the brink of collapse.

By all accounts, making that cooperation permanent and making it an integral part of the National Health System, which is a key aim of the government, which is already stirring a major opposition backlash.

That is precisely why the government backed off from pushing the plan in the past.

Mergers, closure of hospitals

One of the main vehicles for the implementation of the planned reforms is the new-fangled Organisation for Ensuring Quality Healthcare S.A. Established in 2020, it is said to have played a decisive role in managing the public health crisis, providing contingents that visited regional hospitals.

The stated strategic goal of the organisation is to evaluate the performance of both private and public hospitals so as to ensure effectiveness and transparency.

National Health System at the core of reforms

The government insists that the National Health System will remain the core of healthcare in Greece.

Prime Minister Kyriakos Mitsotakis has declared that the epidemic highlighted both the strengths and the dysfunctions of the system, which barely withstood the pressure.

With the fourth wave of the pandemic having already arrived, the focus of the health ministry right now is on bolstering public healthcare facilities, drawing from the model implemented when the epidemic was raging, which relies on COVID-19 reference hospitals that treat the vast majority of serious cases.

These hospitals will operate as hubs, offering specialises care, with others playing a supplementary role.

Major report on NHS systemic dysfunctions

The government plans to unveil within the next ten days a comprehensive report – authored by professors Ioannis Yfantopoulos, Nikos Polyzos, Yannis Tountas, and Kyriakos Souliotis – that details the dysfunctions of the system and aims at the development of a flexible nexus of services, presumably including proposals for the structure of a public-private cooperation.

It is on the basis of this report that the government will proceed with the controversial merger of hospitals and clinics.

In the second phase, the government plans to either shut down or transform the role of specific healthcare units, while at the same time focusing on the development of rehabilitation centres, home care, and palliative care.

Digital reform and infrastructure

The government plans to use funding apportioned to Greece from the EU’s Pandemic Recovery Fund in order to implement the reforms and maintains that its plan is feasible.

In that framework, digital management of healthcare services and changes in the primary healthcare system are top priorities and the government believes that it can move more swiftly in this area as there is a political and social consensus on the need for reform.

Health, digital reform ministries to cooperate

As for the digital transformation of healthcare, the government intends to use the largely successful vaccine rollout as a model. It believes that the successful programmes for digital vaccination certificates and electronic prescriptions have laid the groundwork for a closer, sweeping cooperation of the ministries of health and of digital reform.

That includes a digital upgrading of state hospitals and the establishment of digital healthcare files for individual patients nationwide.

The role of EOPYY

The National Organisation for the Provision of Health Services (EOPYY) – the huge nationwide health insurance organisation – is slated to play a key role in implementing the national healthcare reform programme.

With the establishment of evaluations, EOPYY will have the authority to conclude contracts and pay for services provided based on their “true value”.

The objective here is to create a framework for healthy competition for the provision of healthcare services not provided by the state.

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