5.2 Health care
The authorities have committed to further reforming the health care sector, with the aim of
universal, equal and effective care, controlling public expenditure, managing prices of
pharmaceuticals, improving hospital management, increasing centralized procurement of
hospital supplies, managing demand for pharmaceuticals and health care through
evidence-based e-prescription protocols, commissioning private sector health care
providers in a cost effective manner, modernizing IT systems, developing a new electronic
referral system for primary and secondary care that allows to formulate care pathways for
patients. As the full implementation of these objectives requires time, the authorities are
committed to implement necessary additional necessary measures also beyond the
deadlines referred to this document.
2.5.2.1 Rationalisation of health expenditure
The authorities will, in line with detailed targets and deadlines set out in the TMU (section
XX),
a.take structural measures focusing on improving efficiency as a means to contain
expenditure. By May 2018 these measures will address the remaining part of the recent
overspending on "other items" in the EOPYY budget for "Other Illness Benefits" which was
not inlcuded under the clawback (125 million), which will be eliminated by gradual
implementation of these measures and/or adoption of additional ones as necessary; to this
end EOPYY will contract and directly purchase optometrician services as a prior action and
by March 2018 special education services (key deliverable);
b.as a prior action, they will take further structural measures as needed to ensure that the
estimated gap between spending for 2018 and the claw back ceilings for pharmaceuticals,
diagnostics, private clinics , "other items" is reduced compared to the previous year;
c.by January 2018, they will develop a mapping of overall public sector capacity; by March
2018, based on this mapping, the authorities will develop an in-depth assessment to be
used in the future to commission private providers per region subject to insufficient public
capacity;
d.implement a new system of electronic referrals (e-referrals) to secondary care to be used
by family doctors. (March 2018);
e.develop, by January 2018, a c r i t i c a l m a s s o f prescription guidelines and
therapeutic protocols for patient care pathways (primary and secondary care)
for the pathways that have the greatest therapeuti c and cost implications, to
feed into the e-prescription system; as a key deliverable, at least additional 20 of
th e s e therapeutic protocols will be introduced in the e-prescription
system between December 2017 and May 2018.
f.develop an annual report on human resources for the whole health care sector (to be
used as a human resource planning instrument) with a focus on PHC (first report to
be published by February 2018);
g.closely monitor and fully implement universal coverage of health care and inform
citizens of their rights in that regard and proceed with the gradual implementation of
the new Primary Health Care System. To this end, the authorities h a v e adopted
all the necessary legislation to implement this new system in May 2017. Within
this framework, EOPYY will change the way it provides primary health care by
introducing compulsory patient registration with a family doctor, who will act as a
gatekeeper in charge of referrals to specialists. As a prior action EOPYY will
launch the procedure for contracting family doctors. Compulsory patient
registration shall be finalised and become fully operational by March 2018 (key
deliverable), with gatekeeping to be gradually implemented over 2018. In
parallel, the roll-out of Local Health Units will start by December 2017, as a first
step of the planned creation of a critical mass of Local Health Units (at least 100)
by May 2018, with full implementation to be achieved subsequently. As new Local
Health units become operational, the existing contractual arrangements of
EOPYY with private GPs will be correspondingly reduced so as to avoid
duplications in the local provision of primary care;
h.as a prior action, the authorities already have developed a plan in collaboration with the
Ministry of Education, the medical faculties, the Central Health Board and the Medical
Association to restructure academic curricula and specialty training in medicine in order to
increase the availability and enhance the training of general practitioners. First elements of
this plan will be implemented in the academic year 2017-2018.
2.5.2.2. Execution of claw backs and regular audit1
a.The authorities will execute the claw backs every six months and perform regular
audits.
b. The authorities will continue to collect relevant data from EOPYY, the
National Organisation for the Provision of Health Services, and regularly publish it.
c.The authorities will apply and collect outstanding claws backs, continuously until
they are cleared. As a prior action, EOPYY will finalise the legal procedure to offset
outstanding clawback amounts for past periods (2013-2015) with accumulated
arrears. As key deliverable, by March 2018, (i) any outstanding u n c o l l e c t e d
claw back amount related to 2016 will be offset and collected and (ii) the
authorities will extend the 2018 claw back ceilings for diagnostics, private clinics and
pharmaceuticals to the next three years; (iii) by May 2018 the clawbacks of 2017
will be collected/offset according to the timetable specified in the TMU ( section xx).
d.To assess and improve the performance of health care providers, EOPYY will carry
out systematic monthly auditing of private clinics.
2.5.2.3. Measures to improve the financial management and cost effectiveness of
hospitals
The authorities will:
a.take concrete steps to increase the proportion of centralised procurement by January
2018, following the adoption of the Law on centralised health procurement; for
details se e TMU (Section XX); in May 2018 present the plan to increase the
proportion further in 2019; the appointment procedures under the rules set by
Law 4369/2016 must be started by March 2018 at the latest and completed by
May 2018 at the latest (key deliverable).
b.by May 2018, reduce waiting times (including for elective surgery) with respect to the
previous year in line with the Social Pillar and reduce unwarranted variation in
waiting times across providers and patients (including across socio-economic and
other patient characteristics); for details see TMU (Section XX);
c.by March 2018, start the implementation of the DRGs system in pilot hospitals;
d.produce regular quarterly and yearly reports, based on financial data for hospitals and
hospital performance (benchmarking based on activity related indicators).
2.5.2.4. Reducing pharmaceuticals spending through generic penetration and price
reduction
a.The authorities will update and publish on a regular basis (for details see TMOU
Section XX), and at least every six months, the positive and the negative list.
b.As a prior action, the authorities will publish a revised price bulletin in November
2017. As a key deliverable, they will publish a revised price bulletin in May 2018.
1Details on specific targets by deadline contained in the TMU (Section M ¶57-59).
c.By February 2018, as a key deliverable, the authorities will adopt further measures to
improve cost-effectiveness of pharmaceutical spending with a view to reaching the
40% generics penetration target. These measures may target many relevant areas,
such as updating the set-up of reimbursed prices and of patients' participation to
ensure they promote the choice of cost-effective drugs and by further improving the
incentive structure of pharmacists to encourage the sale of less costly drugs for any
given active substance prescribed.
d.To further reduce prices, they will make use of the negotiating committee to develop
price volume and risk agreements, such as MEAs (Managed Entry Agreements), in
line with other EU countries standards and international expertise, especially for
innovative and high cost drugs and regularly report on the progress. The authorities
will set-up a Health Technology Assessment (HTA) centre to evaluate which
products to reimburse and under what conditions and agreements, in line with
existing guidelines and with evidence of best-practice in the EU, to become active
once fully operational after June 2018. As an intermediate step and prior action,
they have already set up an HTA committee.
Θέμα: 3 December 2017. Supplemental Memorandum of Understanding: Greece. (Αναγνώστηκε 3010 φορές)
29 Σεπτεμβρίου 2011, 12:57:38