Introduction Cardiovascular risk management by primary care in Greece
In Greece, the orientation of the health system in primary care is poor. The primary care in Greece in urban areas is through contracted private physicians mainly. In rural areas, a few salaried physicians working in public health centers. There is no system in primary care. We do not have a gatekeeping referral system. We do not have patient lists. We have high private payments. We have care restricted to those that visit the practices. We lack the comprehensive national electronic medical records. There are no referral letters, no communication with specialists, and no clearly defined role of GPs in the chronic disease management.
Most of the private practices in urban areas are single handed. In rural areas they are public group practices. We have a fragmented healthcare system. Patients can access any service they wish to. They have numerous first point of contact. There is a big problem in the continuity of care and coordination. We fail to offer comprehensive care, but as you can see, we are doing quite well in cardiovascular risk factors. We check cholesterol, diabetes, and obesity, among other things. Overall, primary care is underfunded in Greece. This shows the hospital-centric orientation. Due to the high private payments, we have unmet care needs for those with low income. We have problems in access for patients.
Overall, there are too many physicians in Greece. We are first in the world in physicians per population. In urban areas we have the higher density of physicians. In Athens, where I practice, it is the highest density in the world. We have too many cardiologists. We do have a very strong cardiologist society, the Hellenic Cardiological Society, however. We have about 3,500 GPs in Greece now, while we have 60,000 doctors.
Currently, under the support of the European community and WHO, Greece is in the reform process. As of 1st January, of 2018, patients must be registered to a family doctor, and they must act as a gatekeeper. There are some new small public family health units in urban areas with multidisciplinary teams what is not good for this kind of structure is that GPs will be public servants with a fixed salary. We doubt about the quality such a system will have. Also, the freedom of choice of the patient will be restricted. Physicians, the income is not satisfying. It will be lower. We do not know why we do this, why we have, at the same time, the denser network of private physicians.
Data from a very recent study shows that we are doing quite well in ischemic heart disease mortality regarding to the money spent in healthcare. We have good heart mortality, but at the same time, we do not make the progress we want. The 25 last years, we had 1 of the poorer progress in Europe. That is explained partially by the risk factors and the health behaviors. We are first in smoking in Europe, adult smoking, and first in childhood obesity.
