From the North Sea to the Mediterranean? Constraints to health reform in Greece

The report of an international experts' committee, recently invited by the Ministry of Health to review Greece's health care system, recommended the creation of a network of family doctors, reimbursed on a capitation basis. The committee also proposed that family doctors should manage a budget for the purchase, on behalf of their patients, of specialist and hospital services and drugs. The author examines the exportability of the fundholding experience from Britain to a country in which health care organization is very different, social health insurance is fragmented, private health care is large and growing, ambulatory health care services are provided by specialists, and behavioral-cultural factors cast doubt on the consequences of the proposed change. An attempt to implement fundholding in Greece is likely to have effects opposite to those intended. The more humble task of tackling the inequities and inefficiencies of the present system should be the starting point of all future reform projects.