Health policy making under information constraints: An evaluation of the policy responses to the economic crisis in Greece

- During 2005-2009, total and public health expenditure increased by 41.5% and 66% respectively.
- Health care became part of the fiscal adjustment.
- During 2009-2012, total and public health expenditure decreased by 24.1% and 25.5%.
- Policies were not targeted and were restricted to quick and easy fiscal adjustment.
- Structural reforms were ignored and the financial burden to individuals increased.

IntroductionCost consolidation in the highly fragmented and inefficient Greek health care system was necessary. However, policies introduced were partly formed in a context of insufficient information. Expenditure data from a consumption point of view were lacking and the depth of the political and structural problems was of unknown magnitude to the supervisory authorities.MethodsDrawing upon relevant literature and evidence from the newly implemented OECD System of Health Accounts, the paper evaluates the health policy responses to the economic crisis in Greece. The discussion and recommendations are also of interest to other countries where data sources are not reliable or decisions are based on preliminary data and projections.ResultsBetween 2009 and 2012, across-the-board cuts have resulted in a decline in public health expenditure for inpatient care by 8.6%, for pharmaceuticals by 42.3% and for outpatient care by 34.6%. Further cuts are expected from the ongoing reforms but more structural changes are needed.ConclusionCost-containment was not well targeted and expenditure cuts were not always addressed to the real reasons of the pre-crisis cost explosion. Policy responses were restricted to quick and easy fiscal adjustment, ignoring the need for substantial structural reforms or individuals' right to access health care irrespective of their financial capacity. Developing appropriate information infrastructure, restructuring and consolidating the hospital sector and moving toward a tax-based national health insurance could offer valuable benefits to the system.