In 2008, Greece faced a severe financial crisis that led to drastic budget deficits and austerity measures imposed by international financial institutions. These measures aimed to stabilize the economy but had a profound impact on the country's public health care system. In this article, we examine the challenges and opportunities in Greece's health care system as it strives to achieve the United Nations Sustainable Development Goal (SDG) 3: Good Health and Well-being, drawing insights from interviews with Greek citizens and an overview of the broader context.

Public Health Challenges in Greece

The National Health System (ESY) was introduced in Greece in 1981 to provide free, equitable, and comprehensive health coverage for the public. However, the coexistence of both public and private health care systems created unequal outcomes and inefficiencies. According to OECD data, private health care spending in Greece increased from 46.6% of total health expenditure in 2009 to 51.5% in 2018, highlighting the growing reliance on private services. Many people, especially those from lower socioeconomic backgrounds, faced challenges in accessing quality health care.

The economic downturn exacerbated these issues, with public health expenditure decreasing significantly between 2010 and 2014. According to the World Bank, Greece's total health expenditure as a percentage of GDP declined from 9.9% in 2009 to 8.4% in 2014. This led to staff shortages, drug shortages, and long waiting times at public hospitals. Health care providers also faced poorer working conditions due to repeated reductions in salaries and rising emergency admissions. These factors contributed to a general lack of confidence in the public health care system among Greek citizens.

Insights from Interviews

In the course of conducting interviews with local residents throughout Athens, a deeper understanding emerged of the lived experiences and challenges within Greece's public healthcare system. Maria, a 32-year-old pharmacist, shared insights into the struggles faced by the general population in accessing medical facilities following the financial crisis. Despite the proficiency of medical professionals, Maria highlighted the enduring issues of long wait times and bureaucratic hurdles that hinder access to care.

Giorgia, a 45-year-old jeweler and mother of twins, voiced her discontent with the public healthcare system, characterizing it as "highly inefficient" and tainted by corruption. Recalling an incident where she urgently needed care after breaking her leg, Giorgia recounted the distressing three-month wait for an appointment at a public hospital. Faced with such delays, Giorgia, like many others, resorted to seeking private healthcare, shedding light on the pervasive issue of bribery within the system. She lamented the deterioration in access to public health services, particularly during the peak of austerity measures.

Similarly, Konstantina, a 53-year-old cosmetic shop owner in Pangrati, shared her firsthand experience accompanying a friend to a major hospital in Athens during a medical emergency. Despite arriving early in the morning, they endured a staggering wait until the following day to receive care. Konstantina's account underscores the formidable challenges of prolonged wait times and the limited accessibility of care, particularly for those lacking the financial means to pursue private alternatives. As Konstantina aptly remarked, "If you don’t have money to pay for health services and if you don’t have insurance then you’re in big trouble, my friend," reflecting the harsh realities faced by many individuals within the healthcare system.

Healthcare During the COVID-19 Pandemic

The COVID-19 pandemic placed additional strain on Greece's health care system, revealing existing gaps and challenges. While public health measures helped reduce the mortality rate from COVID-19 infections, access to medical care for non-COVID conditions suffered. Telemedicine was expanded to facilitate access, but regular services were disrupted, and many patients experienced delays in receiving care for other conditions.

The pandemic also exposed the long-standing deficiencies of the primary health care (PHC) system, which created significant challenges in meeting population needs. According to Eurostat data, Greece had the highest number of doctors per capita across OECD countries in 2019, yet Greek citizens were the least likely to visit a doctor among all EU countries. These challenges were compounded by underfunding and limited resources.

Opportunities for Improvement

Despite the challenges, there are opportunities for Greece to improve its health care system and work towards achieving SDG 3. Key approaches include:

• Enhanced Collaboration: Foster partnerships between public and private healthcare sectors to optimize resources and expand access. Joint initiatives can improve infrastructure and share expertise, enhancing the system's efficiency.
• Strategic Reforms: Implement targeted changes to reduce bureaucracy and enhance transparency. Streamlining processes and strengthening regulations will promote accountability and improve responsiveness.
• Community Empowerment: Engage local communities in healthcare delivery through grassroots programs. Training community health workers and promoting awareness campaigns can address access issues at the local level, improving overall well-being.
• Integration of Healthcare Technology: Strategic investment in healthcare technology, such as electronic health records and telemedicine, can improve access to care, especially in remote areas where traditional healthcare services may be limited. By utilizing telemedicine and other technological advancements, Greece can address gaps in care, enhance the continuity of care, and mitigate disparities in access to healthcare services.

Conclusion

While Greece's public healthcare system faces considerable challenges in achieving SDG 3, there are undeniable opportunities for improvement. By adopting a multifaceted strategy that includes public-private partnerships, strategic reforms, infrastructure investments, community empowerment, and technological integration, Greece can effectively tackle accessibility issues and progress towards establishing a more inclusive and integrated healthcare system. These initiatives not only resonate with the objectives of SDG 3 but also hold the potential to significantly enhance the overall well-being of the population. Through sustained commitment and collaborative efforts, Greece can chart a course towards a brighter and healthier future for all its citizens.