3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
This epidemic has proven to expedite the need for swift reactions towards long lasting systematic deficiencies, endemic to the structure of the Greek Healthcare system. The rapid and focused response has in turn improved the overall system’s service capacity and potential: delivery to those most vulnerable, effectiveness in mobilisation and maintenance of essential services.
To date, there are 13 COVID-19 reference hospitals across the country, and 4 hospitals dedicated solely to COVID-19 patients. Isolation wards have also been designated, and in each Regional Health Authority (there are 7 in total which encompass both primary and secondary health services across the country) there is at least one reference hospital with a negative pressure isolation chamber.
Public-private partnerships to purchase ICU services from the private sector were established and can be utilized if necessary. Private hospitals will be reimbursed by the EOPYY (the national purchasing agency). The compensation cost amounts to €800 per existing bed and €1600 per bed, only for the additional ICU beds that private clinics have been asked to develop (40% capacity increase) to cater for possible future COVID-19 hospitalization needs. Patients who will be hospitalized in private hospitals will not be subjected to any co-payments.
A contingency plan is in place should the COVID-19 cases increase dramatically. Requisition of private clinics (facilities, personal protective equipment, pharmaceutical products and staff) is one of the scenarios being considered by the government. In this case, transfer of patients currently hospitalized in public hospitals with non-infectious diseases to private hospitals is envisaged, so that NHS hospitals may deal exclusively with the treatment of COVID-19 patients. Among other provisions, there is a plan to increase the number of reference hospitals across the country and the relocation of staff to dedicated COVID-19 hospitals.
Measures for Primary Health Care
In an effort to strengthen primary care contribution to the management of the epidemic, five health centres in Attiki (Capital Region) have dedicated their operation to COVID-19 patients, with potential expansion to rural health centers, if deemed necessary. Telemedicine services through Health Centres, will be established and made available within April, in order to monitor the symptoms of COVID-19 patients in home isolation and coordinate their care pathway (see below).
Despite the fact that primary health care in Greece has not yet been developed to its full potential, and problems of access, continuity of care and coordination are being reported, there is an aim to strengthen its role during the management of the pandemic through the following actions:
● Early detection and management of possible COVID-19 cases (with mild symptoms not requiring hospitalisation) in dedicated primary health care centres.
● Referral from primary to specialist care of those needing hospitalisation.
● Assistance to patients with chronic conditions or acute illnesses not related to COVID-19 in the remaining (non-COVID-19) primary care facilities.
● Risk minimization of exposure of patients and medical staff to SARS-CoV-2 in health care facilities.
Redesign of Primary Health Care Services
The Action Plan, announced on April 3rd, entails 2 main objectives:
1. The first objective pertains to the operation of designated COVID-19 health centres on a 24-hour basis exclusively for the screening and management of COVID-19 patients that do not require hospital referral. As of 10th April, five of these centres have completed preparations and are ready to strengthen and support the network of COVID-19 reference hospitals.
2. The second objective refers to the transformation of certain health centres to 24-hour health centres dedicated to care for non-COVD-19 patients with chronic diseases, management of emergencies and communication with registered patients who are in home isolation.
A primary health network for monitoring patients in home isolation is to be introduced within April. Designated medical co-ordinators will seek to undertake daily communications via telephone with patients, especially vulnerable and chronic pain patients, for the provision of counselling and support to them and their families, in accordance with the instructions provided by the National Public Health Organisation.
Furthermore, a telecounseling network for COVID-19 patients is underway. COVID-19 telehealth services will be available to self-isolated/ home-isolated patients (self and distance monitoring), patients with mild cases (distance monitoring and treatment) and patients after discharge (follow-ups) In this context, an electronic registry has been created to monitor patients diagnosed with COVID-19 and ensure continuity of care.
On April 7, a joint ministerial decision was issued by the Ministers of Finance and Health for the operation of 500 mobile units, by the end of April,which will collect testing samples from potential COVID-19 patients during community visits.