Author(s)

Stefanos E. Karakolias, Nikolaos M. Polyzos

Department of Social Administration and Political Science, Democritus University of Thrace, Komotini, Greece.

Background: The National Organization for Healthcare Provision (EOPYY) constitutes simultaneously the monopsonistic healthcare insurer and a main provider of PHC in Greece. Currently, EOPYY is threatened by financial distress hence emerging a critical discussion on structural issues, providers’ reimbursement and gatekeeping revision. Objectives: To conduct a detailed analysis of the Greek social health insurance and PHC in order to propose consolidation policies. Methods: Search for raw data domestically and best practices internationally. Results: In Greece, PHC provision is fragmented leading patients to more expensive hospital care. Family physicians are a small portion of total physicians which, in combination with the free choice policy, results in non-gate-keeping despite growing co-payments. This necessitates the creation of a PHC network between EOPYY’s and NHS’s units and contracted professionals. This first evaluation has also revealed an irrational use of consolidated resources, which we propose to normalize through a new global budget system. Conclusions: Greek health insurance needs an immediate reform through which EOPYY would become an efficient pool of public and social health inflows. Besides, we suggest gate-keeping to be activated, proclaiming new EOPYY contracts with general practitioners and family pediatricians, applying a stricter referral system and reforming the reimbursement system.

EOPYY; Healthcare Fund; Health Insurance; Primary Health Care; Reimbursement

Karakolias, S. and Polyzos, N. (2014) The Newly Established Unified Healthcare Fund (EOPYY): Current Situation and Proposed Structural Changes, towards an Upgraded Model of Primary Health Care, in Greece. Health, 6, 809-821. doi: 10.4236/health.2014.69103.