The social right for health protection, according to article 21 paragraph 3 of the Constitution, is defined as the right of individuals to receive healthcare services by the state. Furthermore the state is οbliged to take positive actions, so as to ensure preventively or therapeutically their best possible physical, psychological and mental wellbeing. After the National Health System (ESY) was founded, the state responsibility includes the assurance of the continuous provision of healthcare services, so as to ensure citizens’ right to health protection.
According to article 21, paragraph 3 of the Constitution, the right to health protection is explicitly enshrined only for Greek citizens. Foreign citizens are protected either according to international treaties which bind the country, or with provisions that refer to human value and dignity, the principle of equality, the prohibition of discriminations, the right to personality and the existence of the welfare state. Therefore each individual in the country is not allowed to be deprived of the minimum healthcare services which will ensure him the possibility to live with dignity, proper to every human being. However, while the Greek legislator foresees that the total population has the right to receive outpatient care, he offers to foreign citizens the hospitalization right, but only for minors, pregnant women and women who have recently given birth, for cases of emergencies and infectious diseases (provided that in their country they cannot receive proper treatment), until the stabilization of their medical condition. The problem remains intense for the illegal immigrants. An attempt is being made to lift the restrictions concerning them according to international treaties, so as to receive the minimum social protection. Greece, except prenatal tests for adult pregnant women, offers the minimum health protection provided by the Fundamental Rights Agency [FRA] of the EU, as summarized in the document titled “Fundamental rights of immigrants residing illegally in the EU”.
The National Health System
According to law 1397/1983 the National Health System (ESY) was founded and operates, assuring access to health services for citizens, regardless if they are employed or they fulfill certain requirements or not. The main characteristics of the National Health System, besides the state responsibility and funding, is the total, equal and proper health protection of the population and the founding of state services or legal entities of public law, controlled by the state. The total and equal provision of healthcare services means that they are offered under state assessment.
Medical treatment is distinguished into primary care (outpatient treatment), secondary care (hospitalization) and tertiary care (specialized hospitals). Hospitals are distinguished into general ones, which have medical departments of all or most of the specialties, and to specialized ones, which have medical departments only for certain specialties.
All public organizations that provide healthcare products and services are included in a unified organizational body (Ministry of Health, Health Region Administrations (DYPE), hospitals and primary care centres)
Hospitals have legal personality and are ruled by the Board of directors and their manager. Specific provisions apply for the hospitals of the Greek National Health System (ESY) which are social welfare institutions.
Cooperation between the public and private sector of healthcare services
The articles 33-35, paragraphs 3 and 4 of law 3370/2005, as applicable, allow the cooperation of ESY hospitals with non-profit private hospitals and especially the transfer of patients from ESY hospitals to the intensive care units of these institutions and the potential for further cooperation in other sectors by the order of the Minister of Health and Social Welfare. These provisions are part of the policy for joint-action between the public and private sector, as stated by law 3389/2005.
Health professionals (access to the profession, civil liability)
Health professionals include doctors, dentists, nurses, midwives, paramedical professionals, pharmacists. The access to any of these health professions is defined by special rules.
The Illegal actions and omissions or physical actions from health professionals of public hospitals (public entities) which took place while they carried out their duties are considered as actions of the public entity itself and are attributed to it. Therefore, the public hospital (public entity) is responsible for the property damage restoration as well as for monetary compensation for moral damages or pain and suffering that may have been caused. This responsibility of the public hospital (public entity) to provide compensation is called civil liability.
Civil liability of public hospitals (public entity) is objective, and thus independent of doctors’ responsibility. In fact, the injured party by resorting to the competent courts against the public hospital (public entity) does not need to state that the doctor acted fraudulently or negligently. It is sufficient that the party suffered damage as a result of the doctors’illegal actions or omissions during the performance of their duties in a public hospital (public entity) and that there is an adequate causal connection between the damage and their act or omission.
The responsibility of private hospitals regarding their doctors’ illegal actions or omissions is different than the responsibility of public entities in that it is subjective, meaning it is required additional deception or negligence on behalf of the doctors employed there.
Besides, the responsibility of health professionals, according to Law 2251/2004, regarding the protection of the consumers is objective liability, meaning that the doctors must prove that there was no deception or negligence in their actions.
Medicines and healthcare products
Access to pharmacy profession is ruled by specific provisions, (article 11, Law 2955/2001, and 1, paragraph 1, Law 1963/1991). Also, starting a pharmacy is subject to limitations such as population criteria (see article 13, paragraph 2, Law 3457/2006). Finally, the supply of medicines itself is subject to restrictions and specifically a medical product distribution license is required, while special regulations aim to achieve adequacy of medicines in Greece and set limitations to manufacturers and wholesalers.
Medical treatment is covered by the insurance through the National Organization for Health Care (EOPYY), while the uninsured individuals are covered by social welfare. The maximum medicine market prices are defined by the pharmaceutical industry based on the production cost through a rationally structured company, with an additional reasonable profit (indicatively, the Council of State 3633/2004 (plenary). After 2010, many adjustments occurred regarding the reduction of the medicine expenditure in Greece. In 2010 the average public and private expenditure in E.U. for pharmaceutical products came up to 1,6% of the GDP, while in Greece it was 2,1% of the GDP with small participation of the private sector in pharmaceutical expenditure, compared to most of the member-states. In fact, in 2010 Greece was the country with the highest outpatient pharmaceutical expenditure in E.U. Taking into account this economic framework, measures have been taken in order to achieve the supply reduction, especially measures on medicine pricing, mandatory discounts, automatic returns (see article 11, Law 4052/2012). Measures have been taken concerning the reduction of the demand as well as the substitution of original medicines by generic medicines, the change of doctors’ prescribing behavior, the determination of prescriptions expenditure per doctor, the patient’s participation in the expenditure etc.
Individual’s rights to healthcare services
The main right of the user regarding public healthcare services is to be provided proper preventive or therapeutic services, taking into account his health condition and Health System’s Capabilities. The main principles that apply to public services are equality, continuity, adjustment, economy, security and participation.
