Interest Groups and Health System Reform in Greece

Abstract

Despite the establishment of the National Health System in Greece in the early 1980s, the institutional framework remained largely unchanged due to opposition from interest groups and large set-up costs, thus allowing the powerful stakeholders to preserve their privileges. Not until almost two decades later was reform attempted in order to rationalise and modernise purchasing and delivery. The objective of this paper is to analyse the ambitious reform attempt of 2000 through the lens of rational choice institutionalism, identifying the initial goals of the reform, the reactions of the key stakeholders and the legislative outcome.

Notes

However, there is abundant evidence in the experimental economics and psychology literature that shows that individuals do not carry fixed preferences, but rather construct their preferences according to the way in which decision tasks are described or ‘framed’. See, for example, Kahneman and Tversky (2000).

Privileged insurance funds refer to funds that offer extended coverage to their members, and free choice of doctor.

The rigidity and political infiltration in the health sector was noted in a statement of the former IKA deputy governor, Hadziandreou: ‘I have to say that I met with a great deal of resistance when I tried to transfer people simply because I was absolutely convinced that they were not doing their job properly and were obstacles to improvement … It is a shame when you are trying to transfer a person to another position because he or she is proving to be a major obstacle when that person invokes party affiliation, claiming to be the victim of political persecution’ (Kathimerini 2003).

About 170 university doctors, representing only 20% of the medical school staff, ended up going to work in Haidari Hospital.

It is not clear whether this has been the case because of the high expectations for the reform plan implementation or because of the increasing coverage of health system issues in the media or for both reasons.

Deputy Finance Minister George Drys also made these claims in October 2000: ‘the 2001 budget is characterised as a health care, education and employment budget … (Our aim is) to achieve, for the first time, a budget surplus of 0.5% of GDP’ (Tsolis 2000).

The decrease is greater if expenditure is estimated at 2000 prices (€135.6 million or 3.87%).