The Reform That Was Never Completed: Why Greece Must Redesign Its Health Financing Architecture

Health financing is a core determinant of the resilience and equity of health systems. Using WHO's three-pillar framework as an orienting reference-rather than a prescriptive template-this article analyzes the evolution, structural shortcomings, and policy dilemmas of the Greek health financing model, within a comparative European context. While many EU countries have strengthened public financing to ensure universal access, Greece maintains a hybrid, fragmented model in which out-of-pocket payments play a disproportionately large role. Despite recurrent reform attempts, Greece has not developed a cohesive public system with a clear commitment to social solidarity. Instead, the system has silently shifted into a de facto semi-privatized two-tier model that exacerbates social inequities, limits access and undermines efficiency. Drawing on international experience and documented policy lessons, the article proposes a strategic redesign of the health financing architecture. The proposal is conceptual and does not enter implementation specifics. Its central axis is the establishment of two national single purchasers of health services by level of care, with a clear allocation of responsibilities and authority, the Ministry of Health for hospital care, and the National Organization for Healthcare Services Provision (EOPYY) for primary, outpatient, and post-acute/rehabilitation care, to strengthen prevention, equitable access, and chronic care management while easing pressure on hospitals. The proposed model includes targeted investments in human resources and infrastructure, the enhancement of prospective payment mechanisms, the strengthening of primary care networks, and the leveraging of innovation. At the same time, it provides for reforms in governance, digital transformation of the system, and reallocation of resources based on principles of equity and efficiency. The proposed overall restructuring aims to strengthen financial protection, reduce inequities in access, and improve health outcomes through a publicly oriented, socially responsive, and strategically governed system.