It is now more than 10 years that the World Health Organization (Regional Office for Europe) published its report on “Health Care Systems in Transition: Greece” (1996).
In the concluding remarks of this now rather historic report, it was recognized that “a key objective of the 1983 reforms in Greece was to increase equity in access to health care services. This was to be achieved through the establishment of an NHS guaranteeing universal coverage and access to health care services.”
The report accepts that this objective was to “some extent accomplished, particularly through the establishment of rural health centres and clinics, as well as by the establishment of large teaching hospitals in areas far from the major urban centres, where the larger and better equipped hospitals already in existence were concentrated. The network of rural health centres that was built during the mid-1980s in fact constitutes a solid structure upon which a patient-hospital system can be built. In addition, the primary care services offered free-of-charge at all NHS hospitals increased access, as entitlement by virtue of the NHS was on the basis of citizenship and not fund membership.”
On the other hand, it is openly confessed that “the objective of equity was partially compromised, however, by the inadequate staffing and facilities of health centres which did not allow them to o perate as effectively as originally planned, as well as by the development of the underground economy in more recent years.”
By that time nobody was talking about Service-oriented Architectures and Web services – and many of the efforts since that time focused on the development of efficiency-promoting measures, but in general the picture
There is a saying: ‘have hammers, will see only nails’, just because you have a hammer in your hand. According to some recent data of OECD Health Data for Greece, among European countries, Greecehas the lowest share of public spending on health (53% in 2004). By contrast, more than 80% of health spending is funded by public sources in several Nordic countries ( Denmark, Norway and Sweden) and the United Kingdom. The OECD average is 73%.
On the other hand, it is an interesting fact that there are more physicians per capita in Greecethan in any other OECD country. During the past decades, the number of doctors per capita increased markedly in Greeceto reach 4.9 practising physicians per 1.000 population in 2004, well above the OECD average of 3. On the other hand, there were only 3.8 nurses per 1.000 population in Greece in 2002, a figure much lower than the average of 8.3 in OECD countries.
Health sector in Europe had the luck to receive huge amounts of funding from different sources (direct funds from European Commission Programmes, Structural Funds, National Community Support Framework Programmes, etc.). However this plethora of resources did not necessarilly result into successful implementations. To let aside the difficult issue of sustainability. The treatment to this was also not the best: people simply increased the budgets in the various projects while similar or even bigger scale suboptimalities emerged.
As it seems, we cannot afford this type of trend, simply because there is a lack of viable funding resources. Therefore, there is a great interest in the adoption and deployment of low-cost solutions. Be them in the area of patient care, hospital management, or post-surgical care and home care, the common denominator seems to be: how can we achieve more (outcomes, results, impact, change, etc.) with less (resources, budgets, etc.).
This is not utopic - it only needs the existence of a strong political im perative and a critical mass of ex periences and skills of the people that shall implement this.
Know-how has not been treated as an important factor in many EU members - and especially for the public health sector organisations, employees were not empowered or motivated to increase their knowledge capital and foster the acquisition of new skills.
This era seems now to come to an end: more and more interest is attracted by public as well as private health care entities in supplying their employees with increased skills and capacities. For sure, this is treated as a new market, capable to supply various actors such as companies, academic or research institutions, etc. with 'new' money.
Drawing again our examples from the recent past, we can see that this does not necessarilly help at all: health sector employees and medical practitioners are exposed to a set of information and content sources, without necessarilly getting an idea of how can they employ them in their own environment. Innovation – even if it is developed as part of a research project – needs to be deployed. And last but not least, the deployment of the acquired skills is not regarded as a success indicator...
Low cost budgeting procedures, easy to plan, program and implement innovations created as part of research project and the direct linkage to adoption and deployment will be the leitmotiv for the next years.
GAZETTE 
