Expat guide to health care in Greece

A comprehensive guide to health care in Greece from its public and private systems as well as medications, mental health and vaccination advice.

From a distance it is easy to see the appeal of Greece: great climate, deep history and access to that famous Mediterranean diet. However, Greece consistently comes in the bottom few places of the best expat destinations survey by Inter Nations. It scores poorly for many aspects of expat life (health and well-being, transport, quality of life, safety) but does well for leisure options (ninth in 2016) and climate (fifth in 2016).

This article will give you the background on the Greek health care system and how expats can ensure they have access to quality care.

An introduction to health care in Greece

The health care system in Greece is a mixed one which has been hit hard by the recent economic crisis. The National Healthcare Service (ESY; in Greek, Εθνικό Σύστημα Υγείας, ΕΣΥ), public insurance funds and the private sector all play a role in the funding and provision of health care services.

The World Health Organisation (WHO) state: “A weak primary care system is a major challenge for the delivery of services… Public health services have taken a back seat in favour of the development of secondary care services. The services delivered rarely engage in prevention, health promotion, social care and rehabilitation.”

Efforts to reform the failing health care system into the 2000s often failed outright or stagnated at the implementation phase. This included attempts to reduce public sector spending and rectify inequities and inefficiencies. Since 2010, these reforms have included:

• The establishment of a single purchaser for the National Health System
• Standardising the benefits package
• Re-establishing universal coverage and access to health care
• Reducing pharmaceutical expenditure
• Changes to procurement and hospital payment systems

The priority for 2018-2021 is a major overhaul of the primary care as well as addressing adequate health system funding and maintaining universal health coverage.

Inside a Greek hospital

While health and well-being in Greece doesn’t fare well in expat surveys for factors including job security, family life and work/life balance, it came in at number 10 for quality of medical care. This is at odds with the claims of one expat site that says: “Greece is notorious for having one of the worst health care systems in Europe”; while another says: “For decades, hospitals in Greece have been praised for their quality of care. However, the health care system is notorious for corruption, lack of funding and mismanagement.” 

Expats in Greece can be covered by national health care services if they pay taxes and belong to one of the national health care organisations which are often based on the type of employment you’re in. For example, IKA is the largest Social Security Organisation in Greece. It covers those in dependent employment in Greece or abroad for an employer who is based in Greece, as well as those who offer full-time or part-time personal labour on commissioned work agreements and are not insured with any other main insurance agency. OAEE is the social security fund for the self-employed.

Many expats choose to use international private medical insurance (iPMI) to ensure access to care — in particular to reduce waiting times. In fact, many expat websites agree that it is essential if you are relocating to Greece.

Zakynthos, one of the many dozens of Greek islands

Public health care in Greece

The public health system in Greece is responsible for:

• Public health surveillance
• Infectious disease control
• Environmental health control
• Health promotion.

It provides free, or low-cost, health care services to residents who are contributing to the social security system. For example, IKA is a public insurance company that oversees Greece’s social security which includes health care. This includes medical exams done by IKA-accredited health practitioners, health and laboratory examinations in IKA-accredited laboratories and other related expenses based on standard government rates.

Medical care by IKA-approved practitioners is usually free, but patients must pay for prescribed medicines.

The Greek health care system has no referral system¹ and patients can directly access specialists by visiting ESY urban facilities, rural health centres or hospital outpatient departments. This often leads to long waiting lists for some specialties.

Most medical staff in Greece will speak some level of English, although this may vary depending on the location and size of the hospital — for example, big teaching hospitals vs small facilities; big city vs small town.

Expats who work in Greece and pay regular contributions to social security may be entitled to full or subsidised health care benefits.

Expats from within the EU can access the public health care system if you have an E111 card — the free European Health Insurance Card (EHIC). You should also apply for your health care certificate via the E106 or E109 forms (the European Health Card). The E106 can be acquired by expats in their own country if they have paid two full years of social security/national insurance but only offers expats access to public health cover for a limited period. This does not cover the cost of private care.

Social health care, especially within the bureaucracy of the Greek system, can be complicated and confusing for expats and in-depth research is advised if you intend to rely on the public system.

Private health care in Greece

Private health care in Greece is normally considered to be superior to the public alternative and many Greek residents use private health services. Private facilities tend to have newer equipment and shorter waiting times, but are not covered by the public insurance schemes. The private sector includes profit-making hospitals, diagnostic centres and independent practices.

The private sector extensively provides primary health care services including physicians in private practice who are under contract with one or more insurance funds, including ambulatory care.

Many patients prefer to visit hospitals in Athens or large university hospitals to access higher quality care and services because district hospitals are often understaffed and lack the latest technology. Expats seeking to use a private hospital in Greece may choose to have private health care insurance as they will be responsible for the full cost of their treatment in a private facility.

Health care costs in Greece

Below are some average 2019 health care costs:

• Family doctor check-up £35 (USD$45)
• Cold medicine for six days £2.40 (USD$3)
• Antibiotic prescription £6.20 (USD$8)

Private health insurance in Greece

Private health insurance is popular among Greek nationals and expats alike and there are numerous national companies offering cover. In such cases, private health insurance can cover the portion of the bill that the government doesn’t or — depending on the level of cover — completely cover costs.

If you already have private health insurance in another country, you may be able to extend it to cover you in Greece. Most hospitals and clinics included under international private medical insurance (iPMI) schemes are situated in Athens or Thessaloniki².

Aerial photo of famous Hatzikiriakio area with the well-known child-care institution Piraeus in Attica, Greece 

Hospitals

Generally, the more remote the hospital, the lower the standard of care will be — for example on small islands. The best public hospitals — usually concentrated in the major cities — offer higher quality care while the country’s medical schools will offer complex and technologically sophisticated services. As such, expats who require more sophisticated care than island hospitals can provide are taken to Athens or Thessaloniki.

According to the type of services they offer, Greek hospitals are categorised as either general or specialised. While general hospitals include multi-specialty departments covering many disciplines, specialised hospitals usually deal with a specific area of medicine.

Public hospitals in Greece are generally adequate though there are often long waiting periods in order to receive care. One expat blogger reported that: “you may face challenges while trying to use this National Healthcare system as it is not uncommon for you to show up to a National Hospital and find the medical staff is on strike or understaffed. There may not be a bed or a room to accommodate you and the lines are long in order to be seen by a physician.”³

Emergencies

Emergency care is free in Greece because it is state-funded. A person with a life-threatening injury or illness can choose to go directly to an emergency department of a public hospital or call the National Center for Emergency Care (EKAV).

It is recommended to research all of the important telephone numbers to call in case of an emergency. Greece uses the European emergency service number: 112 and all phones of all types can be used to call it for free.

Pharmacies

Pharmacies are ubiquitous and usually signposted by a green cross — similar to many European countries. Many Greek pharmacists speak English and are able to advise on some conditions, saving you a trip to the doctor.

Medication

In cities such as Athens and Thessaloniki, medication is easily accessible though you may have to go to hospitals for some, more specialised drugs.

International medication best-practise is to bring your prescribed medication in its original containers. When possible, bring a signed physician’s letter outlining your condition and the medication required for it, including generic names. It is always advisable to check that all of your medication is legal in Greece.

Vaccinations

Some vaccinations are recommended or required for Greece:

• Hepatitis A
• Hepatitis B
• Rabies
• Measles Mumps Rubella (MMR)
• Tetanus, Diphtheria & Pertussis (TDAP)
• Chickenpox
• Shingles
• Pneumonia
• Influenza
• Meningitis
• Polio

Health hazards

2019: There is an outbreak of measles in Greece and travellers should be vaccinated against it. Greece has been the worst affected country in a Europe-wide measles outbreak.

Mental health

One of the many reforms to the Greek health care system from 2010-2019 includes mental health. The WHO reported on progress made and areas for further work.

The positive:

• Increase in new mental health services
• Positive changes in public attitudes towards mental illness.

The negative:

• Significant shortages of staff and services in several parts of the country
• Lack of coordination between mental health services and central government, local authorities and social services
• Absence of quality assurance
• Gaps in specialist mental health services (for example children, adolescents, autism, intellectual disabilities and eating disorders)
• Lack of information about locally available services

Many international health insurers cover mental health services within the plan benefits. For example Aetna International’s Employee Assistance Services include support for stress and anxiety via help finding solutions to everyday issues or easy-to-access mindfulness training or behavioural counselling.  

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