1. Looking Ahead It is a pity to waste a good crisis TACD, Athens, 31 May, 2013 Lycurgus Liaropoulos Prof. Emeritus, University of Athens

2. Comparison with € Countries 2003-2011

3. The Crisis in Health: € SHA, Greece

4. Access to Medicines = Access to Care Greece: A country where access to care depends on employment. No job = No care, for 1,5 million unemployed Aspirin to Cancer: 50.000 people “covered”: – For how long?? – For what services?? – What happens afterwards??

5. A “Fragmented” Health Non-System A system full of holes, where the continuum of care dos not exist. No beginning (Primary) Care and no end (Long-Term) care. A fully commercialized system, offering mainly acute care services with immediate cash value, often paid by the user directly, and under-the counter. A total of €2 billion in “black health economy” in 2005)

6. Example 1: Health Insurance instead of Health Security In a country with 1.4 million unemployed, health insurance is financed (?) partly though employer – employee contributions Insurance runs out if unemployed for more than a year and a half Even when partly employed, one needs 100 days of officially registered and paid work to be covered

7. Example 2: not one Fully autonomous 24/7 Emergency Care Department EKAB = A huge system simply to carry patients facing an emergency to what??? Different hospitals and different departments “on duty” each day. Total chaos!!!!! The ER is simply a “conduit” to securing: – a hospital bed, often “at a price” – Additional income for hospital doctors Total disconnect between PHC and Hospital

8. Example 3: A system lost in “paperwork” Providers wait for months to be paid because their paper claims need …”processing” Insured persons wait for months to be get back money they spent for services “covered” Thousands of employees simply for “pushing papers around” Graft and small-scale corruption are rife Paper work makes claims management and control impossible and inefficient

9. Conclusion: Repair the system “in motion” Make the crisis an opportunity Eliminate and/or merge unnecessary services (i.e small and non-performing hospitals With the funds released, create value e.g. Emergency units in 8 major Athens Hospitals Copy French payment e-card system for claims management Eliminate all contributions for health insurance. Embed the notion of “Health Security” for all citizens, instead of “Health Insurance” only for the employed.

10. The Solution-1: National Health Insurance - Now Abolish social security contributions, thus boosting personal disposable income and competitiveness of the economy Cover expenses through EOPYY based on: – A standard benefit package (similar to the one used today) – Taxes collected on a progressive scale Absolutely no user payment on the point of service. e-card for user charge and provider reimbursement (no medical information) Private Health Insurance as supplementary cover

11. The Solution now-2: e-charge for all health goods & services: e-card copy of the French SESAME-Vitale EOPYY reimburses providers periodically on agreed- upon schedule Patients – users are “charged” at point of use or sale. Actual payment through tax system on a progressive scale Patients are “responsible” for the use of services. Providers are fully accountable for the quantity of services provided. Electronic utilization review Savings from wasted paper handling, billing, salaries

12. Health and the Troika The Troika should not micro-manage the health system. The Health Ministry should. Across-the-board cuts are the responsibility of the Government, not the Troika. By 2011 the fiscal targets were met H-System sustainability now depends on deriving more value from money spent Save money by scrapping unnecessary work