The Greek Government decided to abandon the agreed structural reforms in the healthcare system — such as the reform of the primary-care sector, the introduction of therapeutic protocols, patient registries, health technology assessment, etc. — which would have made the healthcare system sustainable and generated revenues within the existing budget. Instead, it decided to go on with the horizontal cut in spending that cumulatively added up to a 61% reduction.

Also, in order to deal with a generally inelastic demand for medicines, the government preferred to impose two different claw-back mechanisms and multiple rebates on the country’s pharmaceutical industry, not only hampering the competitive advantages of Greek pharmaceuticals, which constitute the country’s second largest export product, but also harming the prospects of the industry’s viability, putting thousands of jobs at risk.

1. Does this double claw-back, accompanied by multiple rebates, exist in any other pharmaceutical industry within the EU?

2. Is the double claw-back imposed compatible with internal market competition regulations?

3. Was the decision to abandon the healthcare system reforms and instead impose the harmful double claw-back mechanism a Greek Government decision, or was it a measure imposed by the Troika?

Answer given by Mr Moscovici on behalf of the Commission

According to Article 168, paragraph 7 of the Treaty on the Functioning of the European Union (TFEU), the Union action shall respect the responsibilities of the Member States for the definition of their health policy and for the organisation and delivery of health services and medical care. Hence, it is foremost for Member States to decide on how to ensure access to healthcare for their populations.

The Commission supports the intention of the Greek Ministry of Health to enhance the cost-efficiency and effectiveness of the Greek National Health System as well as the quality and accessibility of public healthcare in order to fully meet the health needs of the population but also to ensure sustainability.

The capping target and claw-back for the pharmaceutical budget were legislated by Greece in the context of the Memorandums of Understanding (MoU) agreed with the Greek authorities under the successive Assistance Programmes. This type of mechanism is used widely throughout Europe(1) and can be an effective way of controlling pharmaceutical expenditures without endangering access to pharmaceuticals.

In Greece it has been paired with structural measures to ensure high quality care is sustainable for Greece and accessible for the citizens, The Greek authorities have, under the latest MoU, committed to continue these efforts(2) by, amongst others, developing additional prescription protocols, improving the incentive structure of pharmacists, setting up a new Health Technology Assessment institute to inform reimbursement and rolling out a new Primary Health Care system. In order for conducting some of these reforms, they benefit from technical support provided by the Structural Reform Support Service of the Commission.

(1) Economic Papers 461 | September 2012 ‘Cost-containment policies in public pharmaceutical spending in the EU’ Carone, Schwierz, Xavier
(2) Memorandum of Understanding, 2015