Presentation (CTI)

OBJECTIVES: Greece bears one of the highest out-of-pocket health spending shares in the OECD (34% vs 15% EU average), while 21.9% of Greeks report not using health care service despite unmet medical needs, with cost as the primary barrier. This study examines the impact of Greece's co-payment structure — rates of 10-25% with no annual cap — on multimorbid patients evaluating GDP-adjusted metrics in a 13 European-country comparison.
METHODS: A cross-national analysis compared co-payment rates and cap mechanisms, net income and GDP per capita among 13-EU countries. Two vignettes with three chronic conditions were modelled and compared with identical total drug cost among countries (1,980€/yr). Vignette A: HTA, COPD and dyslipidemia medicines (in Greece all at 25% copay) and Vignette B: HTA, T2D and dyslipidemia; (T2D at 10% chronic rate, rest 25%).
RESULTS: Of 13 countries, 11 enforce an annual spending cap; Greece and Portugal are the only two exceptions. Greek patients pay on average 495€/yr for Vignette A and 360€/yr for Vignette B. Among countries comparable annual copayment rates range from 0€ (Scotland, Wales, Netherlands) to 493€ (Denmark). Greece absolute copayment burden reaches 2.73-3.75% of average net income and 1.85-2.54% of per capita GDP. Among the capped countries, the respective figures range from 0.00% to 0.88% of net income and 0.00% to 0.96% of per capita GDP. Only Portugal (2.45%,1.97%) approaches Greece. Under Vignette A, Greece's burden (3.75% of net income, 2.54% of GDP) is 4.2× the EU-13 average for income (0.90%) and 3.3× for GDP (0.77%). Even under Vignette B (2.73%,1.85%), it remains 3.0×and 2.4× the respective EU-13 averages.
CONCLUSIONS: Greece lacking a spending cap and co-payment rates ranging between 10-25%, shows the highest copayment burden among the EU-13 countries, partially explaining the large percentage of Greek patients reporting missing health care services due to financial reasons.