Objectives and setting The 2008 financial crisis had a particularly severe impact on
Greece. To contain spending, the government capped public health expenditure and
introduced increased cost-sharing. The Greek case is important for studying the
impact of recessions on health systems. This study analysed changes in household
health expenditure in Greece over the economic crisis and explored whether the
impact differed across socioeconomic groups.
Participants We used data from the Greek Household Budget Survey for the years
2004 and 2008-2017. The dataset comprised 51,654 households, with a total of
128,111 members.
Design We compared pre- and post-crisis trends in Greek household out-of-pocket
payments for healthcare from 2004-2017 using an interrupted time series analysis.
This study explored spending in Euros and as a share of total household purchases.
Results Our results indicated that the population level trend in household health
spending was reversed after the crisis began (pre-crisis trend:
€0.040 decrease per
quarter (95% CI: -0.785 to -0.022), post-crisis trend:
€0.315 increase per quarter
(95% CI: -0.004 to 0.635)). We also found that spending on inpatient services and
pharmaceuticals has been increasing since the start of the crisis, whereas outpatient
services expenditure has been decreasing. Across all households, out-of-pocket
payments incurred a greater financial burden after the crisis relative to pre-existing
trends, but the poorest households incurred a disproportionately higher burden.
Conclusions This was the first study to use an interrupted time series analysis to
assess the impact of the economic crisis on household health expenditure in Greece.
Our findings suggest that there was an erosion of financial protection for Greek
households as a consequence of the economic crisis. This effect was particularly
pronounced amongst poorer households, which is indicative of a regressive
financing system.