State still calls the shots
Around the world, the state’s involvement in healthcare policy is still high, even in countries in which there is no such tradition, such as in the USA, where state expenditure through the federal Medicare and Medicaid programs is in the order of 50 percent. The state also plays a large part in setting the rules for the way the rest of the health sector is organized. These days, the distinction between state and private sectors is not based so much on who owns the businesses or the technologies, but on who pays for the use of those services. For example, in many high-technology departments in the state sector, there are many under-the-table payments by patients. Yet many small independent clinics are much more patient-friendly due to contracts with insurance companies. In Greece, the State and the social security funds subsidize 57 percent (30 and 27 percent respectively) of health services, compared to 75-80 percent in the European Union as a whole. All the quality-related problems in Greece’s health sector (such as physical surroundings and communication) require more money, money that isn’t there because of the lack of public funds. Social security has the same problems, due to the lack of subsidies from the State and other factors such as unemployment, underemployment and the avoidance of paying contributions. The small private sector and the substitution of hospital services by pharmaceutical treatment, which is cheaper and more accessible, acts as a shock absorber for the imbalances in the healthcare market. Is there a trend toward enlarging the already large private healthcare sector?
