title: A future for primary care for the Greek population.
abstract: BACKGROUND
  Greece is hit hard by the state debt crisis. This calls for comprehensive reforms to restore sustainable and balanced growth. Healthcare is one of the public sectors needing reform. The European Union (EU) Task Force for Greece asked the authors to assess the situation of primary care and to make recommendations for reform. Primary healthcare is especially relevant in that it might increase the efficiency of the healthcare system, and improve access to good quality healthcare.
  
  
  METHODS
  Assessment of the state of primary care in Greece was made on the basis of existing literature, site visits in primary care and consultations with stakeholders.
  
  
  RESULTS
  The governance of primary care (and healthcare in general) is fragmented. There is no system of gatekeeping or patient lists. Private payments (formal and informal) are high. There are too many physicians, but too few general practitioners and nurses, and they are unevenly spread across the country. As a consequence, there are problems of access, continuity, co-ordination and comprehensiveness of primary care.
  
  
  CONCLUSIONS
  The authors recommend the development of a clear vision and development strategy for strengthening primary care. Stepped access to secondary care should be realised through the introduction of mandatory referrals. Primary care should be accessible through the lowest possible out-of-pocket payments. The roles of purchaser and provider of care should be split. Quality of care should be improved through development of clinical guidelines and quality indicators. The education of health professionals should put more emphasis on primary care and medical specialists working in primary care should be (re-)trained to acquire the necessary competences to satisfy the job descriptions to be developed for primary care professionals. The advantages of strong primary care should be communicated to patients and the wider public.
authors: NIVEL - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands. P.Groenewegen@nivel.nl.
authors: Peter P
authors: PP
authors: Groenewegen
authors: Department of Public Health, Klaipeda University, Klaipeda, Lithuania.
authors: Arnoldas
authors: A
authors: Jurgutis
mesh_terms: D057172:Economic Recession; D005544:Forecasting; D006115:Greece; D018166:Health Care Reform; D006801:Humans; D011320:Primary Health Care / Q000639:trends*; D011785:Quality Assurance, Health Care