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14 May 2025 | Country Update
Creation of national registries of patients with rare diseases -
21 March 2025 | Country Update
National Strategy for Quality of Care and Patient Safety 2025–2030 -
14 September 2020 | Country Update
Establishment of the National Organization for Quality Assurance in Health (ODIPY)
7.6. Health care quality and safety
Multiple Eurobarometer surveys show high levels of patient dissatisfaction with the quality of health care in Greece. In the 2014 survey, only 26% of respondents in Greece assessed the quality of hospital care in the country to be good, while 73% thought that it was worse than in other EU Member States. Moreover, 78% believed that patients could deteriorate in health while under hospital care. These responses put Greece in second-last place among the EU28 (European Commission, 2010, 2014b).
Furthermore, 71% of respondents assessed the quality of care outside hospitals as bad (the second worst behind Cyprus, where 75% of respondents felt that way). Surveys on quality of life in more than 75 European cities showed that respondents living in Athens and Heraklion (the capital of Crete) expressed some of the highest levels of dissatisfaction with health care services, hospitals and doctors, with inhabitants of Athens being the most dissatisfied (69%) and inhabitants of Heraklion showing the sixth highest level of dissatisfaction (63%) (European Commission, 2013). Greek respondents also show the lowest levels of satisfaction with health care among the EU Member States in a series of other Eurobarometer surveys studying the social climate. Within the 13 countries with negative perceptions of their health care system, Greece has the lowest satisfaction index, followed by Bulgaria, Poland, Romania, Latvia and Hungary. In addition, Greece shows the largest overall deterioration in assessment of the health care system between 2009 and 2014 (European Commission, 2014c).
Many barriers to the provision of high-quality primary care services have been identified, including staff and equipment shortages, inadequate GP and paramedic training and absence of clear job descriptions for GPs and other personnel (Sbarouni et al., 2012). Moreover, there are no mechanisms to supervise and evaluate medical practices, measure the use of health resources or assess the outcomes of care. Primary care in Greece has been weak in preventing avoidable hospitalization: studies have shown that a third of admissions to a general hospital for surgery, ophthalmology and gynaecology, and ear, nose and throat could have been managed by a GP, as could 40% of orthopaedic emergency admissions (Marinos et al., 2009; Vasileiou et al., 2009).
In relation to the clinical effectiveness of hospital care, Greece shows high rates of hospital-acquired infections. A study of Greek intensive care units showed that in 2009–2010, during 6004 combined days in intensive care, 152 of 294 patients acquired 205 device-associated infections, which was an overall rate of 52% of patients or 34 device-associated infections per 1000 days (Apostolopoulou et al., 2013). Data from 64 hospitals collected over six months in 2011 showed that cases of hospital infections ranged from 230 to 450 per month, with an overall crude case fatality rate within a 28-day period after the first positive culture being 36% (Dedoukou et al., 2011).
Over the past few years, an effort has been made by the Ministry of Health in collaboration with the medical societies to introduce and disseminate clinical guidelines. For example, in 2013 and 2014, 25 new guidelines on obstetrics and gynaecology were produced, endorsed and presented by the Hellenic Society of Obstetrics and Gynaecology, in collaboration with government agencies and other medical societies (Vrachnis, Loufopoulos & Tarlatzis, 2015). Nevertheless, awareness and use of guidelines and protocols remain weak, as demonstrated by a survey aimed at investigating knowledge and application of protocols and criteria according to WHO’s definition of quality of care in the operating room: of the 153 nurses participating in the survey, 55% were unaware of the safety checklist as defined by WHO, and of those who knew it, only 43% used it (Karathanasi, Malliarou & Zyga, 2013).
Medical errors pose another challenge to the effectiveness of the health care system. Greece has no central national authority to which medical errors can be reported; most adverse events are detected using ad hoc reporting, which identifies only a small number of adverse events. However, research confirms that medical malpractice is present in the Greek health system and that the invasive medical specialties show the highest rates of adverse events (Pollalis, Vozikis & Riga, 2012). An attempt to estimate the economic burden of medical errors in Greece based on the review of 128 compensation cases awarded by civil courts between 2000 and 2009 found that the mean compensation amounted to €292 613, representing 35% of claimed compensation (Riga, Vozikis & Pollalis, 2014). The debate raised among health policy-makers as to the appropriate response to the problem resulted in proposals ranging from implementation of nationwide mandatory reporting, with public release of performance data, to voluntary reporting and quality-assurance efforts that protect the confidentiality of error-related data.
In March 2025, the government issued decisions providing for the establishment of the National Registry of Patients with Rare Hematological Diseases and the National Registry for Rare Ophthalmological Diseases (Ministerial Decision No 11646/2025 and Joint Ministerial Decision No 11502/2025 respectively). It is expected that a Ministerial Decision will be signed soon for the creation of the National Registry for Rare Liver Diseases. The Ministry of Health intends to establish 21 more registries for rare diseases.
The registries will be implemented by the e-Government Center for Social Security in collaboration with the Ministry of Health. Their aim is to comprehensively record, manage and monitor all patients across Greece who have rare diseases. The expectation is that this detailed knowledge will provide the basis for the Ministry of Health to identify patients with rare diseases and develop specific health policies for them. Researchers will also have access to (anonymized) demographic data on patients, the type of disease, the characteristics of treatment as well as data of the medical unit or hospital department providing treatment and the treating physician. These data can be used in research to gather evidence on the prevalence of diseases, their distribution by age, the monitoring of outcomes, and on the effectiveness and safety of the treatments applied.
Authors
References
Government Gazette No 1387, issue B, 21-3-2025, Ministerial Decision 11646/2025, “Establishment of the National Registry of Patients with Rear Hematological Diseases”. (https://search.et.gr/el/fek/?fekId=779204)
Government Gazette No 1418, issue B, 27-3-2025, Joint Ministerial Decision 11502/2025, “Establishment of the National Registry of Patients with Rear Ophthalmological Diseases”. (https://search.et.gr/el/fek/?fekId=779243)
In January 2025, Greece launched its new National Strategy for Quality of Care and Patient Safety 2025–2030. The new strategy was developed through a co-creation exercise involving the Ministry of Health of Greece, the seven health regions, the Agency for Quality Assurance in Health (ODIPY), the World Health Organization Office on Quality of Care and Patient Safety, and the EU Directorate-General for Structural Reform Support as part of the project “Development of a National Strategy on Quality of Care, Patient Safety and Patient Engagement in Greece” (HQC-2-Greece project).
The strategy is structured around three strategic pillars:
- leadership and governance: building a solid foundation for the health system through effective leadership, transparent governance, and the integration of evidence-based practices;
- evidence and innovation: emphasizing the importance of continuous innovation and the integration of evidence-based practices to improve safety, effectiveness, and equity in healthcare; and
- behavioural insights, literacy and engagement: patient empowerment through improved use of behavioural insights, health literacy and engagement in care decisions, as ensuring that patients are involved in their care leads to better outcomes and strengthens the patient-provider relationship.
Its objectives are:
- To nurture an efficient, accountable and data-driven health system, fostering a culture of accountability and enabling timely, informed responses to healthcare challenges.
- To foster trust in an effective and safe health system, focusing on patient safety, clinical outcomes and reliability of healthcare services, by strengthening evidence-based practices and integrating innovative solutions.
- To create patient partnerships in healthcare provision by empowering patients to take an active role in managing their own healthcare and make informed decisions.
Authors
References
National Strategy for Quality of Care and Patient Safety for Greece 2025–2030, available at: https://www.moh.gov.gr/articles/ministry/grafeio-typoy/press-releases/13090-ethnikh-strathgikh-gia-thn-poiothta-ths-frontidas-kai-thn-asfaleia-twn-asthenwn-gia-thn-ellada-2025-2030
Law 4715 (published in August 2020) provides for the establishment of the National Organization for Quality Assurance in Health (ODIPY). ODIPY’s mission is to ensure that the health services provided to citizens are safe, efficient, and of high quality. It also aims to improve transparency through the sharing of information and incentivizing improvement (thereby increasing accountability), and to produce evidence-based strategic planning in order to address the health needs of the population. Driven by this mission, and to ensure universal health coverage and equal access, ODIPY aims to develop a national quality strategy for health services, quality standards, a quality assessment framework, a dashboard for the automated measurement of key performance indicators, the national health map, and data-driven strategic planning.