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31 January 2011; Column 2011 - 1
Primary Care in Greece
By Lionis Christos, MD, PhD, HonFRCGP
Professor of General Practice and Primary Health Care, Head of Clinic of Social and Family Medicine -Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
Primary care serves as a necessary pathway for an individual for the promotion of health, the prevention of debilitating disease and in the reduction of disability has been also recognized in Greece. The National Health System (ESY) established in 1983 provides primary and hospital healthcare and emergency pre-hospital care, it was the same year where primary health care has been recognized as a formal part of the Greek national health system since 1983 (Health Act No 1397) and it has been put into action with the main aim of improving the quality of care throughout the implementation of regional health systems .
Up to date, 200 national health care centers are operating in Greece, and all of them serve the rural and semi-urban areas, in addition 250 Social Security Institution (SSI) polyclinics are located in urban areas . The medical specialty of general practice was considered as a cornerstone for this system and a vocational system of three years has been established in 1986 (today, the vocational training in general practice requires a 4 years residency with 3 years and two months in the hospital setting).
The central government through state insurance funds and private insurance schemes finance health care, upon this there is universal coverage for pharmaceutical care and various social insurance organizations are available for the citizens. Although all those in favor, it has been reported that integrated primary health care needs extensive efforts .
A general impression is that the primary care system in Greece has failed in reaching its targets and especially continuity of care, integrated and coordinated care and patient-family focused care.
Amongst these hardships in Greece, many attempts have been made to surpass these roadblocks to improve the efficiency of primary care  yet it is still an issue of debate and remains as a difficult discussion among the policy makers, providers and primary care practitioners.
In addition, a national electronic patient record (EPR) system using the International Classification of Primary Care (ICPC-2) is still not available although an initial development of a such system with the purpose of improving disease management, increased patient control and quality of care has succeeded on the island of Crete  and a formal translation of the ICCP-2 has been accomplished two years ago.
However, the future of primary care in Greece has been discussed extensively and certain proposals have been submitted and among them is to increase the quality and efficiency in primary care by, introducing quality indicators, the distribution of practice guidelines and clinical protocol for the most common diseases and health problems, the development of an electronic file for recording data, establishing a specialist nurse in primary health care education and a separate budget to each health center recorded in each regional administration . Such proposals are a great first attempt to help shape the current system.
Today, in the middle of a financial crisis in Greece, the current government has decided to focus on primary care and develop a mechanism in controlling the high health care cost through the integration of the major insurances that lose their traditional role as purchasers and providers of primary care services.
1. Tountas Y, Karnaki P, Pavi E. Reforming the reform: the Greek National Health System in transition. Health Policy; 62, 2002.
2. Soulioutis K, Lionis C. Creating an Integrated Health Care System in Greece. Journal of Medical Systems; 28, 2004.
3. Lionis C, Symvoulakis E, Markaki A, et al. Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review. International Journal of Integrated Care; 9, 2009.
4. Zavras A, Tsakos G, Economou C, et al. Using DEA to evaluate efficiency and formulate policy with the Greek national primary health care network. Data Envelopment Analysis. Journal of Medical Systems; 26, 2002.
5. Kounalakis D, Lionis C, Okkes I, et al. Developing an appropriate EPR system for the Greek primary care setting. Journal of Medical Systems; 27, 2003.
6. Lionis C. Ten steps to immediately improve the quality of services offered by health centers today.