Gaining health : analysis of policy development in European ...

substantial increases to hospital physicians’ salaries in the
early 1980s (6) and is exacerbated by the fact that, at the
present time, remuneration in the ESY is relatively low. The
Code of Medical Deontology, updated in 2005, strengthens
the severity of action to be taken against medical staff accepting
(or even soliciting) such payments.
The Ministry of Health and Social Solidarity (MHSS), renamed
from the Ministry of Health and Welfare following
the 2004 elections, decides on overall health policy issues.
Until 2007, 17 regional health authorities had responsibility
for implementing national priorities at the regional level,
coordinating regional activities and organizing and managing
the delivery of health and welfare services. Legislation
passed in 2007 provided for a reduction in the number of
health regions, to cut down on expense but also to bring
them more in line with the general administrative regions of
the country. The MHSS validates all financial transaction in
the health regions.
The annual budget of the ESY is set by the Ministry of
Economy and Finance, based on historical data. Taxes provide
about 70% of all hospital funding, the remainder being
covered by social security and out-of-pocket payments.
Fixed per diem or per-case fees are set by the state but tax
revenue is often used to fill the gap between these levels
and the actual costs of services provided.
PHC centres were originally financed through the budget of
the public hospital to which they belonged administratively,
although from 2004 they gradually achieved financial and
administrative autonomy. Historically, the rural population
was provided with PHC in rural surgeries and health centres.
Later, health centres were developed for urban workers
insured under IKA. A draft Law for PHC (7) is available
on the Internet for comments. Through this proposed legislation,
all public PHC units, and those of the private sector
that wish to join, are to be brought under one system following
common guidelines and levels of payment.
Apart from a few exceptions, the concept of health promotion
is not yet strongly on the agenda. The Code of Medical
Deontology mentioned above states that medical action
includes prevention, diagnosis, therapy and rehabilitation
and that physicians are responsible for the maintenance and
improvement of health, rehabilitation and tackling pain.
In 2004, there was a high concentration of physicians (4.9 per
1000 population, compared to an average of 3.4 per 1000
in EU15 countries), whereas the supply of nurses was only
about half that in Europe as a whole (3.5 per 1000 population
compared to 7.5 per 1000 for the EU15 average).
2. Greece’s approach to developing policies
to tackle NCD
2.1. History
Some years ago, when Greece regularly formulated
five-year socioeconomic development plans, these plans
included health and social welfare. They were based on evidence
and on proposals set out in reports made by working
groups with a broad participation. They were published
by the Centre of Planning and Economic Research (KEPE),
which acted as the secretariat for the planning process
under the supervision of the then Ministry of Coordination.
In the framework of the 1976–1980 development plan, for
example, the extensive report on health (8) examined the
health status of the population, highlighting inequalities in
mortality between geographical regions and the urban and
rural populations, and proposing policy measures dealing
with health risks for NCD, preventive measures, improvements
in environmental health, and the health care system.
Also during this period, Professor Spiros Doxiades, the then
Minister for Health in the Conservative Government, gathered
a team of young scientists to further explore available
health data with the aim of proposing the establishment
of a national health system. This initially created considerable
opposition, mainly from the medical profession, and in
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Case studies: policy development in countries for tackling noncommunicable diseases