Health technology assessment in Greece

In 1983 a health reform aimed to assure universal coverage and equity in th e distribution of services in Greece. The reform implied state responsibili ty for the financing and delivery of services and a reduction of the privat e sector. The model was a Bismarckian scheme for social insurance. However, healthcare delivery remains fragmented and uncoordinated and the private s ector is getting stronger. The dominant payment system is fee-for-service f or the private sector and administered prices and salaries for public hospi tals and social insurance funds. The many insurers have their own eligibili ty requirements, validation procedures, etc. Coverage of services by social security funds, probably among the most comprehensive in Europe, is determ ined more on historical and political grounds than on efficiency or cost-ef fectiveness. The system is plagued by problems, including geographical ineq ualities, overcentralization, bureaucratic management, poor incentives in t he public sector, open-ended financing, inefficient use of hospital beds, a nd lack of cost-effectiveness. There are no specific legal provisions for t he control of health technology. Technologies are introduced without standa rds or formal consideration of needs. There are no current efforts to contr ol hearth technology in Greece. However, health technology assessment (HTA) has gained increasing visibility. In 1997 a law provided for a new governm ent agency responsible for quality control, economic evaluation of hearth s ervices, and HTA. The hope is that the new law may introduce evaluation and assessment elements into health policy formulation and assure that cost ef fectiveness, quality, and appropriate use of health technology will receive more attention.