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Primary Healthcare Greek Market Overview

Primary health care is provided almost exclusively (over 90%) by private providers (physicians, diagnostic centers, physiotherapists etc.) who have contracted with the major health fund (EOPYY) thus creating a form of Private Public Partnerships (PPP) scheme.

• Diagnostics

Health Care provision in Greece is a highly regulated market. For many years, Primary Health Care has been burdened with red tape, which served as an entry barrier to the market. As an original Bailout precondition (2012 program) the procedures for creating a Primary Health Care Facility has been largely simplified. The establishment and operation of a private Diagnostic Center or a Multimodality (Primary Health Care Providers- PHCP) in Greece is regulated by a rather simple and unceremonious – in its conception – yet strict regulatory framework. A PHCP is not obliged to prior licensing, except in cases of ionizing radiation modalities. Moreover, advertising is prohibited.

As per Greek Primary Healthcare Legislation, Diagnostic Centers are distinguished between those that has less than three units/ infirmaries and those with three or more which are named as Multimodality or Multiinfirmaries (as per exact Greek translation). Despite the fact that the terminology used in the law (for political reasons) is confusing, the simple truth is that the market is divided into Diagnostic Centers (pure or Multimodalities, that provide diagnostic services through high tech medical equipment) and the physicians practices.

There are no shareholding limitations for the PHCP corporate entities. The strict restrictions provided by former legislation (13Presidential Decree 84/2001 that was amended by Law 3919/2011 concerning the shareholders structure), have been eliminated and therefore, the establishment of a medical company of Primary Healthcare is rather simple.

• Doctors

Greece ranks first among Organisation for Economic Co-operation and Development (OECD) countries in the number of doctors per capital (146,29 per 1.000 population, Source: OECD, link: http://snapshots.compareyourcountry.org/s-56d96d12a8780?yr=undefined&lc==en&template=sbardiamond), and also has the highest concentration of physicians among EU Member States. The vast majority of doctors are specialized, with the General Practitioners (GPs) being a very small minority. The population has long been trained to refer directly to the specialized doctor. Therefore no “demand filter” exists in the Greek Healthcare System. However, due to the inefficient doctor’s utilization in Greece, the numbers of specialized doctors leaving the country to offer their services abroad is staggering (15Approximately 1.800 doctors per year are certified to leave the country just by the Athens Medical Association.
Link: http://www.kathimerini.gr/825077/article/ygeia/h-megalh-fygh-twn-giatrwn). Due to the austerity measures, a very small number has been absorbed by the NHS, while most doctors have no alternative but to start their own private practice.

Studies suggest that the oversupply of physicians’ services has contributed to a higher annual per capital rate for medical expenditure compared with those in most EU countries. In addition, the oversupply of specialist physicians coexists with an undersupply of General Practitioners (GPs) and nurses.

• One Day Clinics

One Day Clinics (ODCs) and OCDs are the Primary health care clinics in which minor surgical outpatient operations that do not involve general anesthesia or epidural administration can be performed, provided that the patient is discharged on the same day of the operation.

Despite the surgical scope of the One Day Clinics, these are considered as primary healthcare facilities, thus enjoying exemption from VAT. This exemption makes them more attractive than the clinics (whose services are subject to 24% VAT). Effectively this means that One Day Clinics enjoy a 24% profit margin over the Clinics.

Effectively, several One Day Clinics (ODCs) were created in the first few months since the enactment of the legislation setting up the criteria for them, licensed by the local medical associations, but since then licensing came to a halt by the Prefectures which took the view that legislation was incomplete (no list of operations and linkage to Hospitals) and therefore licensing was not feasible. Pending the resolution of the difference / new licensing is extremely difficult.

Most units concern eye OCDs, where laser and cataract operations are performed. Dermatological OCDs also exist, involved mainly in cosmetic operations.

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