Archives of Hellenic Medicine

Last update:

30-May-2013

Arch Hellen Med, 30(2), March-April 2013, 233-240

SPECIAL ARTICLE

The regional organization of the National Health System (ESY) in Greece –
A brief overview of the legislative interventions to date

N. Kakaletsis,^1,2 A. Ioannidis,¹ I. Sigalas,¹ A. Hatzitolios^1,2
¹Programme of Postgraduate Studies "Medical Research Methodology", Medical School, Aristotle University of Thessaloniki, Thessaloniki,
²First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, "AHEPA" University Hospital, Thessaloniki, Greece

Since the establishment of the Greek National Health System (ESY), many efforts have been made to implement a decentralized system of organization and administration of the health services in Greece. The implementation of such efforts is undoubtedly of crucial importance for the effective management of various local issues and needs, particularly in relation to the Health Map and the workforce and financing. The Legislative Act No 1397/1983, with which the ESY was founded, provided for the establishment of Regional Health Boards (PESYs), which ultimately were not put into application. Subsequently, various different governments by successive laws established the Regional Health Authorities (PeSYs, Legislative Act No 2889/2001), which were renamed as Regional Health and Welfare Authorities (PeSYPs, Legislative Act No 3106/2003) and later as Health Region Administrations (DYPEs, Legislative Act No 3329/2005), with minor differences between them, and in some instances retractions, concerning their number, composition and responsibilities, revealing a slipshod approach and absence of long-range planning and true volition for decentralization. More recently, the number of Health Regions was reduced from 17 to 7 (Legislative Act No 3527/2007) and ultimately the introduction of the Kallikratis Plan makes provision for the competences of the DYPEs, which had been pared down to the advantage of the Central Government and the health services that it supervises, to be transferred to the regional and local authorities (Legislative Act No 3852/2010). Through this brief history of the evolution of the regional organization of the ESY, we conclude that in spite of the initial plans for health services decentralization, an organizational system that ensures absolute dependence on the Central Government in combination with the absence of autonomous financing renders the DYPEs into services with an indeterminate role which is only advisory and imperfectly supervisory, with no power of decision-making, throwing doubt, especially in view of the recent recession, on their survival as independent administrative organizations.

Key words: DYPE, ESY, Greece, PESY, PeSY, Regional organization.