Citizen Preferences for Primary Health Care reform in Greece

The Greek National Health System is currently pursuing the strengthening of Primary Health Care (PHC). Citizen preferences for healthcare service utilization, their views on structural reform of the current system, and the profiling of those in favor of PHC are essential in planning a reform that respects citizens' needs. However, data on this topic in the country are scarce. The present study maps citizen preferences for health care reform in the primary care sector in Greece.

In March 2017, a sample of 1,002 citizens were surveyed by telephone. The survey was repeated with a different sample of 1,001 persons in October 2017. Both samples were defined via a random multistage selection process using a quota for the municipality of residence, sex, and age. Responders were asked to rate their satisfaction with the existing healthcare system and to rank their preferences as to the most important elements of future structural reform. Barriers to accessing healthcare services and in the implementation of structural reform as well as actual healthcare services utilization were also recorded. A logistic regression model was used to identify sample characteristics independently associated with the most requested reform.

Citizens preferred to visit physicians -as outpatients- in their private practices (50.5 % in March and 44 % in October) rather than in public health services (17.8 % and 18 %, respectively). For 86.9 % and 85.6 %, respectively, structural reform of the current health system was considered "very" or "extremely necessary". The introduction of family physicians in the system was the most requested reform (48 % and 49.4 %, respectively). Citizens in older age groups were more likely to request the implementation of family physicians (25-39 years old: OR: 2.14, 95 % CI: 1.36-3.37; 40-54 years old: OR: 2.89, 95 % CI: 1.85-4.52; 55-64 years old: OR: 3.62, 95 % CI: 2.27-5.78; and over 65 years old: OR: 3.32, 95 % CI: 2.10-5.26). Male responders were 23 % less likely (OR: 0.77, 95 % CI: 0.63-0.93) to be in favor of this reform, after controlling for the other variables in the model.

Both survey streams reveal the growing demand for structural reform in the current healthcare system. Strengthening PHC is the most requested reform. Older and female citizens were more likely to be in favor of this reform. Integrating the private sector in developing a comprehensive PHC system, enhancing existing public health services, and increasing public awareness of the advantages of PHC should be considered critical elements of a high-quality PHC system. HIPPOKRATIA 2019, 23(3): 111-117.