title: Health policy making under information constraints: an evaluation of the policy responses to the economic crisis in Greece.
abstract: BACKGROUND
  Cost consolidation in the highly fragmented and inefficient Greek health care system was necessary. However, policies introduced were partly formed in a context of insufficient information. Expenditure data from a consumption point of view were lacking and the depth of the political and structural problems was of unknown magnitude to the supervisory authorities.
  
  
  METHODS
  Drawing upon relevant literature and evidence from the newly implemented OECD System of Health Accounts, the paper evaluates the health policy responses to the economic crisis in Greece. The discussion and recommendations are also of interest to other countries where data sources are not reliable or decisions are based on preliminary data and projections.
  
  
  RESULTS
  Between 2009 and 2012, across-the-board cuts have resulted in a decline in public health expenditure for inpatient care by 8.6%, for pharmaceuticals by 42.3% and for outpatient care by 34.6%. Further cuts are expected from the ongoing reforms but more structural changes are needed.
  
  
  CONCLUSIONS
  Cost-containment was not well targeted and expenditure cuts were not always addressed to the real reasons of the pre-crisis cost explosion. Policy responses were restricted to quick and easy fiscal adjustment, ignoring the need for substantial structural reforms or individuals' right to access health care irrespective of their financial capacity. Developing appropriate information infrastructure, restructuring and consolidating the hospital sector and moving toward a tax-based national health insurance could offer valuable benefits to the system.
authors.affiliation: Health Economics Unit, University of Birmingham, Birmingham, United Kingdom. Electronic address: i.goranitis@bham.ac.uk.
authors.forename: Ilias
authors.initials: I
authors.lastname: Goranitis
authors.affiliation: Center for Health Services Management and Evaluation, Faculty of Nursing, University of Athens, Greece.
authors.forename: Olga
authors.initials: O
authors.lastname: Siskou
authors.affiliation: Center for Health Services Management and Evaluation, Faculty of Nursing, University of Athens, Greece.
authors.forename: Lycourgos
authors.initials: L
authors.lastname: Liaropoulos
mesh_terms: D003363:Cost Control / Q000191:economics; D003695:Delivery of Health Care / Q000592:standards; D057172:Economic Recession; D006115:Greece; D005102:Health Expenditures; D006291:Health Policy / Q000191:economics*; D009313:National Health Programs / Q000191:economics; D011050:Policy Making
keywords: Austerity; Economic crisis; Greece; Health reforms; System of health accounts (SHA)