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Private for – profit health
sector in Greece. Development characteristics (1980
– 2002)
Kondilis Elias Thessaloniki, May 2005
National Health System’s foundation act (L. 1397/83)
Article 6, §1
“All hospitals are founded as Legal Entities of Public Law (LEPL) … the foundation of hospitals with a different Legal Entity is prohibited”
Article 6, §2
“all hospitals owned by sickness funds or function as Legal Entities of Private Law (LEPrL) and receiving public subsides must be
converted into LEPL, within a year after the law has being issued”
source: L. 1397/83. National Health System. Government’s Newspaper A’ n.143. Athens. 7/10/1983
Number of hospitals by legal status, Greece 1980 - 2004
0
50
100
150
200
250
300
350
400
450
500
1980 1985 1990 1995 2000 2004
PUBLIC
LEPrL
PRIVATE
sources: (a) National Statistical Service of Greece. Statistical Yearbook of Greece. Athens. 1981 – 2003 (b) Ministry of Health & Social Solidarity. Department of private clinics. 2004
Number of hospital beds by legal status,
Greece 1980 - 2004
sources: (a) National Statistical Service of Greece. Statistical Yearbook of Greece. Athens. 1981 – 2003 (b) Ministry of Health & Social Solidarity. Department of private clinics. 2004
0
5000
10000
15000
20000
25000
30000
35000
40000
1980 1985 1990 1995 2000 2004
PUBLIC
LEPrL
PRIVATE
COMMUNALHEALTHCENTERS
Number of hospital beds by legal status, % total hospital beds, Greece
1980 - 2000
44,40%
61,30%70,10% 70,30% 69,40%
41,70%32,60% 29,60% 29,20% 29,40%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1980 1985 1990 1995 2000
PRIVATELEPrLPUBLIC
sources: National Statistical Service of Greece. Statistical Yearbook of Greece. Athens. 1981 – 2003
Movement of hospitals by legal status,
Greece 1980 - 1996Patient discharged by hospital's legal status, % total patient discharged
48,0%
67,0%
80,8% 80,2% 80,0%
15,9%
35,9%24,8%
19,2% 19,3% 19,5%
0%10%20%30%40%50%60%70%80%90%
100%
1980 1985 1990 1995 1996
PRIVATELEPrLHealth CentersPUBLIC
sources: National Statistical Service of Greece. Social welfare and health statistics 1980-1996. Athens 1981 - 2000
Post – NHS development period of private for – profit health sector in
Greece (1983 - 2002)
Main features: high investment rate of private enterprises in
biomedical technology
selective development of private enterprises on the most profitable health care sectors
absence of governmental control on the quality, the quantity and the type of services provided by the PFP health sector
Private Diagnostic Centers’ foundation act
(P.D. 3/11/1934)
Article 1, §1“the permission of Microbiological and Biological Diagnostic
function Laboratories can be granted only to medical doctors”
Article 7, §1-2“Microbiological and Biological Diagnostic Laboratories can also be
set up within private clinics on the grounds that the clinic’s
proprietor leaves the laboratory’s supervision to a certified medical doctor”
source: Presidential Decree. Institution and inspection of Microbiological and Biological Diagnostic Laboratories. Government’s Newspaper A’ no 384. Athens. 3/11/1934
Private Diagnostic Centers, Greece 1980 - 2002
33
192
421 403 401
0
50
100
150
200
250
300
350
400
450
n. P
riva
te D
iagn
ostic
Cen
ters
1985 1991 1994 1996 2002
sources: (a) Besis N. Private Health Services. Institute of Economic and Industrial Research. Athens. 1993(b) ICAP. Private Health Services. ICAP AE. Athens. 1995 - 1997(c) Ministry of Health & Welfare. Health Map. Athens 2002 www.healthgis.ariadne-t.gr/healthmap/
Biomedical Technology in Public and Private Health Sector, Greece 1980 -
2002
0
20
40
60
80
100
120
140
160
180
1980 1985 1990 1992 1997 2002
n. C
ompu
ted
Tom
ogra
phy
Scan
ners
PUBLIC*
PRIVATE**
0
10
20
30
40
50
60
70
80
1985 1990 1992 2002
n. M
agne
tic R
eson
ance
Im
agin
g U
nits
PUBLIC*
PRIVATE**
* PUBLIC: included NHS, LEPrL, military hospitals**PRIVATE: included private clinics and diagnostics centers
Sources: (a) Besis N. Private Health Services. Institute of Economic and Industrial Research. Athens. 1993(b) Kyriopoulos G. Niakas D. Issues of Economics and Health Policy. Center of Social Health Studies. Athens. 1994(c) ICAP. Private Health Services. ICAP AE. Athens. 2001 – 2003(d) OECD. Health Data. A comparative analysis of 30 countries. 3rd edition. OECD. Paris. 2004(e) Ministry of Health & Welfare. Study of high technology equipment installation in NHS hospitals. EKEVYL AE. Athens. 2003
Biomedical Technology, Greece 2002
6,95
20
16,5
0
2
4
6
8
10
12
14
16
18
20
CT Scanners per millionpopulation, 2002
Public CTGreeceTotal CTGreeceCT EU-15
0,22
3,32
7,2
0
1
2
3
4
5
6
7
8
MRI Units per millionpopulation, 2002
Public MRIGreece
Total MRIGreece
MRI EU-15
Sources: (a) OECD. Health Data. A comparative analysis of 30 countries. 3rd edition. OECD. Paris. 2004(b) Ministry of Health & Welfare. Study of high technology equipment installation in NHS hospitals. EKEVYL AE. Athens. 2003
IKA’s Payments for medical examinations held in Private for – profit Diagnostic Centers, Greece
1998
Number of Patients
Payments
Athens 219.817 10.855.476 €
Province 363.823 24.973.666 €
Total 583.640 35.829.143 €
source: Fyntanidou E. IKA gives trillions to private health sector. ΤΟ ΒΗΜΑ, 9-7-2000, p.50
Private for profit Hospital Beds by geographic region, % total PFP hospital
beds, Greece 1980 - 2004
47% 50% 53% 53% 52% 56%
23% 25% 24% 24% 26% 24%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1980 1985 1990 1995 2000 2004
Kriti
Aegean Islands
Thraki
Macedonia
Thessalia
Ipiros
Ionian Islands
Peloponnissos
Rest of Central Greece & Evia
Greater Athens
sources: (a) National Statistical Service of Greece. Statistical Yearbook of Greece. Athens. 1981 – 2003 (b) Ministry of Health & Social Solidarity. Department of private clinics. 2004
Private for – profit Hospital Beds by specialty of clinics, % total (Public & Private) Hospital Beds, Greece 1996 All specialties 29.07%
Obstetrical - Gynecological 52.81%
Neuro - Psychiatric 38.31%
Otorhinolaryngological 33.47%
Nephrological 29.73%
Surgical 28.83%
Pathological 23.69%
Neonatology 12.54%
Paediatrics 8.73%
Heart Infract Units 6.33%
Oncological – Chemotherapy 5.04%
Radiotherapeutic
source: National Statistical Service of Greece. Social welfare and health statistics 1996. Athens. 2000
Movement & surgical procedures by legal status of hospitals, Greece 1995 -
1996
80,2
15,2
62,470
19,3
84,8
37,429,6
0%10%20%30%40%50%60%70%80%90%
100%
Total PatientDischarged*
ObstreticalGynecological
PatientDischarged*
NeuroPsychiatricPatient
Discharged*
SurgicalProcedures**
PRIVATELEPrLPUBLIC
source: National Statistical Service of Greece. Social welfare and health statistics 1995 - 1996. Athens. 1999 - 2000
* 1995** 1996
Legislation on Private for – profit clinics, Greece (1925 – 2004)
1925 Legislative Decree 18/7/25 (a) Allows the foundation of private Infectious Diseases and Tubercular
Clinics
1961
1963
Royal Decree 451/62(b)
Royal Decree 521/63(c)
Sets the technical and constructural specification frames of the operation of
private clinics
1983 Law 1397/83(d) Forbids the foundation, merger or relocation of private clinics
1991 Presidential Decree 247/91(e)
Presidential Decree 517/91(f)
Allows the foundation of private clinics.
Updates the private clinics’ operational requirements
2000 Presidential Decree 235/00(g) Sets the technical and constructural specification frames of the operation of
private clinics
sources: (a) Continual Legislation Code 1925 – 1994. Vol. 34 Sanitary Legislation. Subject: Private Clinics and Laboratories (b) Government’s Newspaper A’ 108. 21/7/1962 (c) Government’s Newspaper A’ 145. 17/9/1963 (d) Government’s Newspaper A’ 143. 7/10/1983
(e) Government’s Newspaper A’ 93. 21/6/1991 (f) Government’s Newspaper A’ 202. 24/12/1991 (g) Government’s Newspaper A’ 199. 14/9/2000
Legislation on Private for – profit clinics, Greece
95%
29%
66%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2002 2004
n. c
linic
s, %
tot
al c
linic
s
P.D. 235/ 00P.D. 247/ 91 & 517/ 91R.D. 451/ 62 & 521/ 63
source: Ministry of Health and Social Solidarity. Department of Private Clinics. Athens. 21/12/2004
Contemporary development characteristics of PFP health sector in
GreeceMain features:
High rate of revenue increase
Increase of private hospitals’ mergers and acquisitions
creation of oligopoly in PFP health sector
Creation of vertically integrated health systems - HMOs
Revenues of Private for – profit health sector, Greece 1993 – 2002
0 250.000.000 500.000.000 750.000.000 1.000.000.000
1993
1995
1997
1999
2001 General &NeuroPsychiatricClinics
Obstetrical -GynecologicalClinics
DiagnosticCenters
Sources: ICAP. Private Health Services. ICAP AE. Athens. 1995 – 2003
All amounts in €Private Medical Consultants’ Revenues not included
Median Bed Capacity of PFP hospitals, Greece 1980 - 2004
50
55
60
65
70
75
80
85
1985 1990 1995 2000 2004
n. in
patien
t ca
re b
eds pe
r pr
ivat
e cl
inic
sources: (a) National Statistical Service of Greece. Statistical Yearbook of Greece. Athens. 1981 – 2003 (b) Ministry of Health & Social Solidarity. Department of private clinics. 2004
Creation of oligopoly in PFP health sector,
Greece 2002
Revenues, % total revenues per sector
8 General Private Clinics 70.2%
3 Obstetrical Clinics 79%
12 Diagnostic Centers 45,4%
Sources: ICAP. Private Health Services. ICAP AE. Athens. 2003
PHP health sector’s development characteristics, Greece 1980–2002
The impact of NHS foundation on PHP health sector
private hospitals decreased by 60%
private inpatient care beds decreased by 40%
patient discharged from PFP hospitals decreased by 28% Post – NHS development period of PFP health sector
high investment rate in biomedical technology
selective development on the most profitable health care sectors
absence of governmental control Contemporary development characteristics of PFP Health Sector
high rate of revenue increase
increase of private hospitals’ mergers and acquisitions
creation of oligopoly
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