GREECE - REIMBURSEMENT PROCESS
(Updated October 2008)
Description of Health Care System
The Greek health care system is a mixed system of public-private funding and provision of health care services. It constitutes of three subsystems, which operate almost independently, especially as far as primary health care is concerned:
- The National Health System (ESY), which comprises of public hospitals, Health Centers and the National Centre of Emergency Care (EKAB).
- The Social Security Institution (IKA) and other Social Insurance Funds, which provide their beneficiaries with different insurance coverage.
- The private sector, with numerous diagnostic centers, private clinics, laboratories, infirmaries etc.
Thus, health care in Greece is funded by the governmental budget (general taxation), the social insurance (insured premiums) and private expenditure.
Health Insurance in Greece is compulsory. Assignment to a Fund depends on the occupation of the insured and not on his/her income level. Insurance Funds are mainly funded through insured and their employers’ premiums as well as by the governmental budget, through social levies and subsidization of deficits.
Reimbursement and Pricing Approval Process
All medicinal products that require a prescription (apart from OTC) are reimbursed by Social Insurance. Reimbursement status is awarded on the basis of three categories according to disease severity and socioeconomic conditions of the beneficiary, as follows:
- The standard reimbursement rate is 75%, i.e. patients participate by 25% in their pharmaceutical expenditure.
- Treatments for chronic conditions (eg osteoporosis, Parkinson’s disease, coronary heart disease) attract 90% reimbursement.
- Treatments for severe, debilitating or life-threatening disease (such as cancer, multiple sclerosis, hormone deficiency) attract 100% reimbursement.
The average co-payment rate is estimated at 15%.
Public hospitals dispense medicinal products to the poor at no charge.
Pricing Approval Process
After it has been granted marketing authorization, and in order to be marketed, a pharmaceutical product must have a price. Prices are set by the Ministry of Development, based on the system of “2+1” (three lowest prices in European countries, two of which are selected from the 15 original member states plus Switzerland and one from the 10 countries joining the EU on 1/5/2004).
Once a price has been set, a 4-year monitoring period begins, during which the Department of the Ministry of Development which is responsible for the pricing of pharmaceuticals, investigates prices every year, and if the verification price has changed it will proceed to the necessary readjustments.
There is control for both prescription and Over-the-Counter pharmaceutical products and the latter get a price under the same criteria as the former. Generics are priced at 80% of the original brand in the retail market.
The retail price is uniform in the whole country, except for some districts where reduced VAT rates apply.
Over the last year, price bulletins were issued every 90 days. The price bulletin sets 3 prices for every drug:
- The wholesale price (or Pharmacy Purchase Price), which is the price at which the drug is purchased by the pharmacist. This price includes wholesaler’s profit.
- The retail price, which is calculated as the Pharmacy Purchase Price plus the pharmacist’s profit margin and the VAT.
- The hospital price, which derives from the Pharmacy Purchase Price reduced by 13%.
- ESY: National Health System
- EOF: National Organization for Medicines
- SFEE: Hellenic Association of Pharmaceutical Industries
- ΙΚΑ: Social Insurance Institute
Reimbursement Organizations/HTA Organizations
Reimbursement organizations are the social insurance funds:
There are no HTA Organizations in Greece – pharmacoeconomic studies are not required, neither for the pricing nor the reimbursement procedures.
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