In 1983, Greece established a national health system (ESY) in which the Government must, under the Constitution, “guarantee that all citizens enjoy the benefits of a complete range of services of high quality, free at the point of service” (The Greek Constitution, 1975). The Greek health system is characterized as a dual system. The supply side is organized largely along Beveridge lines, with state-provided hospital care and a network of rural health centers covering almost one-third of the population. On the demand side, the system functions mainly along Bismarck lines, with health insurance provided traditionally by 39 health funds, up until 2012 when the various funds merged into one fund, called EOPYY (National Organization for Healthcare Services Provision), covering the entire population [5].

Health services for inpatients are systematically provided by hospitals that are placed all over the country—there are over 130 secondary and tertiary hospitals—which are state run (there are seven public university medical schools). Primary healthcare (PHC) is provided by health centers run by the National Health System (ESY) and social insurance funds. In these centers, physicians often have a very small role, limited to prescribing and referring. In addition to the ESY, there are also healthcare services provided by the private sector, both at PHC level and hospitals.

In 2010 the first step was taken toward the unification of the social health insurance funds, and a year later, Law 3918/2011 introduced a major restructuring of the health system. More specifically, the health sectors of all major social insurance funds (IKA, covering employees and workers in the private sector; OGA, farmers; OAEE, self-employed professionals; and OPAD, public sector employees) formed a single healthcare insurance organization (the National Organization for Healthcare Services Provision (EOPYY) which henceforth acted as a unique buyer of medicines and healthcare services for all those insured. EOPYY also became the country’s main new body tasked with managing and providing primary healthcare (PHC), which also undertakes the operational coordination and the cooperation between (public and private) healthcare units and health professionals constituting the PHC network [6].

In terms of rationalizing the hospital payment system, the former reimbursement method based on a fixed per diem charge was abandoned in 2012, and a new payment system (called KEN-DRGs), based on the German version of diagnosis-related-groups (DRGs), was developed [7].