Patients could choose their practitioners from a yearly list at primary healthcare centers
The institution of the family doctor, which has not developed sufficiently in Greece, is vital for an organized health system. The present National Health System (ESY) does not meet the needs for a family doctor who keeps files on their patients, advises them and keeps an eye on them as they recover. As Bodossakis-Podromos Merkouris, president of the Greek Society of General Medicine and of the Health Ministry’s working group to draft legislation for primary healthcare, told Kathimerini: «The institution of the contemporary family doctor is not just an essential component of any advanced health system, but the basis on which the new system is to be built. Without family doctors and primary healthcare, it is like building the ESY on sand. Neither the IKA insurance fund’s polyclinics nor the hospitals’ outpatients departments can be primary healthcare points, since the former do not work night shifts and, therefore, cannot deal with people’s needs at any moment, while in the latter there is no continuity of care for the patients.» Merkouris believes that patients should choose their own family doctor from a list put up each year by the local primary healthcare center. Each family doctor would be responsible for providing healthcare to 1,200-1,800 people. Who could play such a role? «Family medicine is a vocation,» explained Merkouris, «and those who can exercise it are general practitioners.» At present, there are 1,350 GPs in Greece, working mainly at health centers and provincial clinics. To meet present needs, at least 4,000 GPs are needed, and they cannot be trained quickly because there are only 640 posts for GPs. Further training «If we want to get primary healthcare operating in the near future, we have to take steps quickly,» said Merkouris. «We have 72,000 doctors in Greece at a time when studies say we need 27,000, including all specialities. If doctors from other fields were given further training in general medicine, we would be in a position to start up the primary healthcare system in 2007.» Fees for family doctors are a major topic of discussion. As Merkouris points out, the way doctors’ fees are paid determines the way they work: «There are three basic methods of payment – a specific wage, which has the negative aspect of making doctors indifferent to their patients; a fee for each service, which may lead to the fictitious services; and payment by the patient on the doctor’s list. The last-mentioned method avoids the drawbacks of the other two and has the following advantage that if the doctor is no good, his or her list of patients will grow shorter as nobody will choose them the next year.» This method of payment applies at advanced health systems abroad and is also similar to the way that community doctors used to be paid in Greece, in a system that operated until 1955, where the community paid the doctor per patient, mainly in annual percentages. «What we want,» said Merkouris, «is for the family doctor to be the family’s adviser and friend. Who in Greece, in 2005, keeps a file on their patients, refers them to a hospital, looks after them following an operation and advises them as to when they can return to their normal pursuits?»
