Primary Healthcare Reform in Greece: Progress, System Challenges and Future Directions

Primary healthcare (PHC) is fundamental to equitable healthcare access, disease prevention, early diagnosis, chronic disease management and coordination across levels of care. In Greece, the development of a comprehensive and integrated PHC system has been constrained by longstanding organizational fragmentation, parallel public and private delivery arrangements; incomplete implementation of successive reforms; and the absence of consistently standardized patient pathways. This narrative review presents a structured analysis of Greek PHC based on the published literature, official policy documents and administrative evidence, organized around accessibility; adequacy; affordability; appropriateness; availability; and additional domains of continuity, digital integration, patient experience and quality assurance. Greece has developed an extensive network of public, publicly financed private and exclusively private providers, while the Personal Doctor reform provides an institutional basis for population registration, first-contact care and longitudinal monitoring. However, the evidence indicates implementation gaps, geographical variation in physician availability and continued reliance on uncoordinated access to multiple providers. Appointment delays, limited access to contracted physicians and private consultation costs remain important barriers, while gaps persist in home-based care; rehabilitation; palliative care; and integration with public health, mental health and social services. Fragmented clinical information further restricts continuity, accountability and performance assessment. Strengthening Greek PHC requires a transition from administrative registration and fragmented provision towards accessible, multidisciplinary and coordinated care. Proposed priorities include standardized patient pathways, interoperable electronic records, systematic assessment of patient experience, strengthened community-based services, expansion of the nursing workforce and a feasible national quality-monitoring system. Population-based capacity planning is proposed conditionally on secured financing, workforce availability and phased verification of operational services; Italy’s incomplete implementation illustrates the risk of equating planning standards with delivered care. Sustainable reform will depend on workforce capacity, institutional continuity, professional and patient participation, and the translation of policy commitments into measurable improvements in routine care.