Out-of-pocket payments lead to catastrophic health spending in nearly 10% of households in Greece, a new WHO study reveals. Households facing catastrophic health spending due to out-of-pocket payments may not be able to pay for other basic needs such as food, housing and utilities.
According to the report, catastrophic health spending is consistently and increasingly heavily concentrated in the poorest fifth of the population. It is mainly driven by spending on outpatient medicines and outpatient care in the poorest households and by inpatient care and dental care in households with higher incomes.
“Can people afford to pay for health care? New evidence on financial protection in Greece” shows that despite efforts to improve affordable access to health care in recent years, gaps in coverage and quality remain. In addition to financial hardship, unmet need for health care in general, for dental care and for prescribed medicines is above the European Union (EU) average in Greece and largely driven by cost. Income inequality in unmet need is also an issue.
“Although financial protection has improved in Greece, too many people – especially those with the lowest incomes – still face financial hardship and unmet need,” said Dr Natasha Azzopardi-Muscat, Director of the Division of Health Systems at WHO/Europe. “This new WHO/Europe report outlines policy options to increase equity in access, close key gaps in coverage and ensure that public spending better supports those least able to pay for health care.”
More detailed comparative data are featured on UHC Watch, an online platform tracking progress on affordable access to health care in Europe and central Asia.
Coverage requires resilience to shocks
The economic crisis that began in 2008 exposed the complexity and fragmentation of health-care coverage in Greece. Financial hardship and unmet need increased markedly due to underlying challenges in coverage policy and cuts to coverage and public spending on health. Stronger policy responses are now needed to support households with low incomes and reduce out-of-pocket payments for outpatient medicines and other types of care.
Two key challenges remain – coverage and quality
Financial protection has improved on average since the economic crisis, but less so for households with low incomes, reflecting 2 key challenges. First, although public spending on health has risen since the crisis, it remains below the EU average as a share of gross domestic product, reflecting the relatively low priority given to health in allocating the government budget. Second, there are gaps in all 3 dimensions of coverage policy – who is covered, what is covered and user charges (co-payments); these gaps widen inequalities in access to health care.
Improving affordable access to health care
Building on important steps already taken to improve access to health care, the Government can continue efforts to reduce financial hardship and unmet need in the following ways.
- Simplify co-payments and improve protection against co-payments for outpatient medicines and other forms of outpatient care by extending exemptions from all co-payments to more low-income households; introducing an income-based cap on all co-payments; replacing percentage co-payments with low, fixed co-payments; and applying protection mechanisms automatically, with the help of digital tools, to simplify access and maximize take-up.
- Improve financial protection for people who need outpatient medicines by ensuring appropriate prescribing and dispensing, encouraging greater use of generics, and lowering medicine prices.
- Expand access to publicly financed nonemergency dental care, going beyond the services provided at present, particularly for children and people with low incomes, who currently experience high levels of unmet need.
- Monitor and continue to address long waiting times and informal payments, ensuring that existing and new measures do not widen inequalities in access to health care.
- Find ways to ensure that all residents are entitled to the same set of health-care benefits. This could be done by changing the basis for entitlement to benefits provided by the National Organization for the Provision of Health Services (EOPYY) from payment of contributions to residence (which would not require a fundamental change in the way the EOPYY is financed).
- Strengthen the purchasing and governance of publicly financed health care, so that public resources are better able to meet equity and efficiency goals.
The report notes that these policy choices can be supported by increasing the priority given to health in allocating the government budget and using any additional investment to reduce financial hardship and unmet need for households with low incomes.
About the report
This review is part of a series of country-based studies generating new evidence on affordable access to health care (financial protection) in health systems in Europe. It assesses the extent to which people in Greece face financial barriers to access or experience financial hardship when they use health care.
It covers the period between 2008 and 2025, using data from household budget surveys carried out from 2008 to 2023 (the latest available year), data on unmet need for health care up to 2024 (the latest available year) and information on coverage policy (population coverage, service coverage and user charges) up to May 2025.
WHO/Europe monitors financial protection through the WHO Barcelona Office for Health Systems Financing, using regional indicators that are sensitive to equity. Financial protection is central to universal health coverage (UHC) and a key dimension of health system performance assessment. It is an indicator of the Sustainable Development Goals, part of the European Pillar of Social Rights and at the heart of the European Programme of Work, WHO/Europe’s strategic framework.
Explore country-level and comparative data and analysis on UHC Watch, an online platform tracking progress on affordable access to health care in Europe and central Asia.
The report and UHC Watch benefited from financial assistance from the EU through the EU4Health programme.