Health system reforms

Three months after the sudden change of leadership at the Health Ministry and a fairly inactive summer, the endeavor to make the National Health System (ESY) more effective is still incomplete. So far, Health Minister Costas Stefanis and his colleagues have said they would follow the policy and priorities of his predecessor, Alekos Papadopoulos, which they have largely done. Action continues on improving health infrastructure, principally at the large hospitals in Athens and Thessaloniki being upgraded for the Olympics in 2004. The main innovation is the creation of new independent emergency departments that will eventually be open around the clock. Initially they will open 24 hours a day on a roster basis. For example, in the First Regional Health System of Attica, by the end of this year the new emergency department at Evangelismos will go into operation, followed by those at other hospitals such as the Ippokrateio and the Red Cross. As for patient admissions offices, a number of hospitals have such a service, but this requires a change in the thinking and outlook of both hospital staff and administrations, which in many cases make it ineffective. Afternoon clinics have been set up in nearly all the large hospitals and they are expected to stabilize, given that there is little demand for afternoon clinics in small regional hospitals. Health Ministry sources say the system works well at large hospitals; in fact, demand is increasing, and in some cases waiting lists – especially for examinations – have been shortened. The new health and welfare inspectors unit, SEYYP, officially came into being on September 16 and takes up duty as of today. Its task will be to document problems in the health system and report on ways of solving them. SEYYP has 134 inspectors at a head office in Athens and a branch office in Thessaloniki. Inspectors will receive training in seminars held at regular intervals. Inspections will start in October and SEYYP’s first reports will be ready for assessment. SEYYP will conduct health, pharmaceutical, administrative and economic inspections in all state and private health and welfare services in Greece. This includes hospitals, regional and prefectural administrations, insurance providers, medical and pharmaceutical materials producers and suppliers, and slimming and beauty institutes, as well as therapeutic springs. There will be both regular and extraordinary inspections decided by the chief inspector, on the order of the Health Ministry or in response to a request from the Ombudsman. Inspectors may request information, documents or other evidence from staff or management of the establishment undergoing inspection. They have the right of access to files, even to confidential material, unless it concerns matters of foreign policy, or national defense and security. After the inspection, the officer in charge prepares a documented report which includes a description of the case, conclusions and proposals, which is submitted to the chief inspector. If any omissions or infringements are noted, a regular internal investigation will be suggested, but if a punishable offense has been committed, the report will be forwarded to the public prosecutor. Sources say that evaluations of National Health System doctors will start within the next three weeks, and initially will be performed by clinic directors. The list of those who will staff the national evaluation commissions is complete. The draft legislation for the organization of welfare structures was submitted to the parliamentary committee for discussion in July. The bill includes provisions for decentralized welfare services brought under the control of the regional health systems; the development of a welfare map of Greece; the extension of programs like Home Help for the elderly and of daycare centers; new nursery schools and preschools; and creative activity centers for children and people with special needs. The Health Ministry deems the creation of legislation reorganizing primary health to be a priority, which should stop crowding at outpatients’ clinics by instituting family doctors and developing urban health centers. Draft legislation is currently under discussion by Health and Labor ministry committees. It includes provisions for the creation of an organization to manage health receipts collected from large insurance funds. Special committees at the Health Ministry are working on the draft bill for reorganization of the public health and hygiene sector, which is connected with the 2004 Olympic Games. The bill is based on a regional health system executive in each area, the institution of monitoring mechanisms and the development of public health personnel.