The new national health system (GeSY) has introduced a number of new methods of financing. There has been a shift from a predominantly tax-funded system that financed public sector health services together with high direct private payments from citizens to the private sector to a system of proportional contributions from beneficiaries based on their income and with a concomitant matching contribution from the government for each beneficiary. This adopts a more progressive approach to financing and coverage that includes all levels and strata of society such as dependents of beneficiaries, the unemployed and other low-income and socially disadvantaged persons.
Income contributions in the new scheme are as follows:
- employees, pensioners, government officials and income earners: 2.65% of gross income;
- employers for each employee: 2.90%;
- self-employed: 4.00%; and
- state/government for each employee, self-employed, government officials and pensioners: 4.70%.
All of the above groups are required to pay contributions levied on their gross income if they have any income. The maximum amount of gross annual income on which contributions are paid is €180 000.
The funds collected form the Health Insurance Fund, which is administered by the Health Insurance Organisation (HIO). The HIO is a public, independent organisation whose role is to manage the Fund, ensure access to and provision of health services to beneficiaries without adverse discrimination, and to contract with health care providers.
In addition to the Health Insurance Fund, there are combined cost-sharing arrangements comprised of low co-payments and personal contributions with annual caps; these aim to create a net of high financial protection without creating serious financial barriers to access by contributing to reduce unnecessary use of health services. So far, out-of-pocket payments, which were the third highest in the EU under the old system, have declined by 68%, from 2018 to 2020.
Examples of user charges are copayments of €15 if the maximum number of annual visits to the personal doctor/paediatrician is exceeded, co-payments of €6 for outpatient specialist visits with referral from a personal doctor/paediatrician, and €25 personal contributions without referral, which is accompanied with a €150 per year cap reduced to €75 for certain vulnerable groups such as guaranteed minimum income recipients and low-income pensioners.