Resource Allocation and Outcomes in the Greek Health System: Convergence and Divergence Within the Mediterranean Healthcare Model

OBJECTIVES: The Mediterranean Healthcare Model (Greece, Italy Spain and Portugal) is based on architectural and historical similarities; however, important differences can be observed in their financing and expenditure structure. This study compares Greece’s healthcare funding allocation with the other mediterranean countries, and evaluates their justification and efficiency.

METHODS: Data on resource allocation and health outcomes were collected from the Eurostat and the OECD databases, covering the period 2009-2021 where available. Data include the financing sources of healthcare expenditure and its distribution in various functions of healthcare, expressed in PPS per capita and as a percentage of the total healthcare expenditure, in order to allow for comparisons. Moreover, data on unmet medical needs and preventable/treatable mortality have been used as indicators of health outcomes. Through descriptive statistics and correlations, the state of the Greek health system within the mediterranean healthcare model is assessed.

RESULTS: Greece has the lowest health expenditure per capita, while is the only country where total health expenditure (THE) per capita is lower than its 2009 level. Unlike the other countries, where government financing accounts for 60-75% of THE, in Greece social health insurance schemes and out-of-pocket payments are the main financing mechanisms, covering about 33% of THE each. Rehabilitative and long-term care appear significantly underfunded, while preventative and curative care also lag behind in terms of funding, compared to the other countries. At the same time, Greece presents the worst health outcomes in the region.

CONCLUSIONS: Despite adopting the Mediterranean model's foundations, Greece deviates in key aspects concerning the financing mechanisms and the allocation of the funds. The severe lack of investment on crucial aspects of healthcare raises questions on the decision-making framework, and whether it produces evidence-based policies. A multicriteria approach is needed for documenting priority setting and resource allocation in the Greek health system.