ΣYNΔEΣMOΣ ΦAPMAKEYTIKΩN
EΠIXEIPHΣEΩN EΛΛAΔOΣ
2014
HELLENIC ASSOCIATION OF PHARMACEUTICAL COMPANIES
THE PHARMACEUTICAL
MARKET IN GREECE
FACTS AND FIGURES
f o u n D At I o n f o r
eConoMIC & InDustrIAL
reseArCH
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Contents
Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
FOREWORD BY SFEE’S PRESIDENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2. Key statistics of Greek pharmaceutical market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
3.Economic environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.1 Macroeconomic indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
4. Demographic trends and health profile of the national population . . . . . . . . . . . . .
4.1 Demographic trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.2 Dependency Ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.3 Causes of death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
16
19
21
5. Demand side: Health and pharmaceutical expenditure in Greece . . . . . . . . . . . . . .
5.1 Pharmaceutical Expenditure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.2 Health Expenditure & Pharmaceutical Expenditure . . . . . . . . . . . . . . . . . . . . .
5.2.1 Comparison with other countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.3 Welfare Spending and Public Pharmaceutical Expenditure . . . . . . . . . . . . . . .
5.4 Health Expenditure and Pharmaceutical Expenditure of Households . . . . . .
23
25
28
34
37
40
6.The Supply side: Pharmaceutical Industry and Economy . . . . . . . . . . . . . . . . . . . . . .
6.1Sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.2Production . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.3Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.4 External trade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.4 Research and development (R&D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
42
46
50
53
55
56
7. Pricing of Pharmaceutical Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7.1 Pharmaceutical products price structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7.2 Pharmaceutical Price Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7.3 Reimbursement of pharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
57
59
61
62
8. State’s debt towards pharmaceutical firms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
9. Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
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List of Figures
Figure1: GDP (%change) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 2: Unemployment and Inflation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 3: GDP determinants change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 4: Projection of population, Greece, 2015-2050* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 5: Projected shares of the population aged 65+ and 80+ 2015-2050,
in Greece, EU-28 and OECD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 6: Evolution of life expectancy at birth in Greece, 1960-2010 . . . . . . . . . . . . . . . . . . .
Figure 7: Life expectancy at birth in Greece and in the OECD countries, 2013 . . . . . . . . . .
Figure 8: Dependency population ratio EU-27, 2014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 9: Dependency population ratio in Greece 2010-2050 . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 10: Causes of deaths in Greece, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 11: Health Expenditure & Public Health Expenditure (in mil. €) . . . . . . . . . . . . . . . .
Figure 12: Health Expenditure & Public Health Expenditure as a% of GDP,
Greece, Eurozone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 13: Public Pharmaceutical Expenditure 2009-2014 (mil. €) . . . . . . . . . . . . . . . . . . . .
Figure 14: Per capita Public Pharmaceutical expenditure in Greece,
EU and EZ-15, (€) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 15: Total Health Expenditure Components (mil.€) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 16: Total Health Expenditure Components (% GDP) . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 17: Public Health Expenditure Components (bln€) . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 18: Public Health Expenditure Components (% GDP) . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 19: Breakdown of NHS hospitals expenditure, 2012-2014( in mil.€) . . . . . . . . . . . .
Figure 20: Hospital expenditure evolution, 2012-2014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 21: Health Expenditure as a percentage of GDP (OECD countries), 2013 . . . . . . . .
Figure 22: Average per capita health expenditure evolution, OECD . . . . . . . . . . . . . . . . . . .
Figure 23: Health expenditure per capita, $ ΡΡΡ (Purchasing Power Parity) 2013 . . . . . . .
Figure 24: Expenditure on health by type of financing (2013) . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 25: Distribution of social security expenditures in Greece & EU-28 . . . . . . . . . . . . .
Figure 26: Change in Social protection expenditure (2007-2013) . . . . . . . . . . . . . . . . . . . . . .
Figure 27: Average health expenditure of households, 2008-2014 . . . . . . . . . . . . . . . . . . . .
Figure 28: Breakdown of monthly average household health expenditure, 2008-2014 . .
Figure 29: Number of Pharmacies per 100,000 inhabitants, EU 27, 2013 . . . . . . . . . . . . . .
Figure 30: Number of Wholesalers, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 31: Pharmaceutical Sales in values, Greece, 2008-2014 (bln€) . . . . . . . . . . . . . . . . .
Figure 32: Pharmaceutical Sales in volume, Greece, 2008-2014, (mil. of packages) . . . .
Figure 33: Penetration of pharmaceuticals in European countries (in volume)
based on patent status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 34: Pricing in European Countries, 2014 (price per unit, €) . . . . . . . . . . . . . . . . . . . .
Figure 35: OTC sales, 2012-2014 (in mil. €) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 36: OTC total sales in various countries, 2014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
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Figure 37: Domestic Production of pharmaceutical products, 2000-2014 (mil. €) . . . . . . .
Figure 38: Industrial Production Index for Pharmaceutical goods (2010=100) . . . . . . . . . .
Figure 39: Turnover Index in Pharmaceutical Industry (2010=100) . . . . . . . . . . . . . . . . . . .
Figure 40: Added Value Pharmaceutical Sector Production . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 41: Employment in the production of pharmaceuticals . . . . . . . . . . . . . . . . . . . . . . .
Figure 42: Share of employment in the production of pharmaceuticals
in the EU (2014) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 43: Pharmaceutical Trade Balance (mil.€) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 44: Number of Clinical Trials, all phases and stages. 2014 . . . . . . . . . . . . . . . . . . . .
Figure 45: Drugs Price Index vs Price Index of other Basic Goods (2005=100) . . . . . . . . . .
Figure 46: Total State debts evolution towards SfEE member
companies’ until 31.12.2014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 47: State debts evolution towards SfEE member companies’
until 31.12.2014 (Invoices for 2014 only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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List of Tables
Table 1: The Greek pharmaceutical market in figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Table 2: Births-Deaths 1931 – 2014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Table 3: Insured and Uninsured 2014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Table 4: Causes of Death 2009-2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Table 5: Evolution of % contribution of the pharmaceutical industry in public
pharmaceutical expenditure (target), 2012-2014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Table 6: Social Protection Expenditure, ESSPROS system - Greece - EU28 . . . . . . . . . . . . 37
Table 7: Social Protection Expenditure (Helios Program) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Table 8: Pharmacies and Wholesalers in Greece and Europe, 2013-2014 . . . . . . . . . . . . . . 44
Table 9: OTC sales by group in Greece, in mil.€ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Table 10: Share of added value in Manufacturing 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Table 11: Educational employment structure in pharmaceutical production (2014) . . . . . 54
Table 12: Mark-up in the pharmaceutical supply chain. 2014 . . . . . . . . . . . . . . . . . . . . . . . . 59
Table 13: Mark-up for pharmacies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Table 14: Legislative changes re pricing, reimbursement & rebates, 2014 . . . . . . . . . . . . . 63
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FOREWORD BY SFEE’S PRESIDENT
“The Pharmaceutical Market in Greece: Facts & Figures 2014”
It is with great pleasure to preface the renewed annual edition ‘The Pharmaceutical
Market in Greece: Facts & Figures 2014’, conducted by SFEE’s Data Monitoring Committee
in collaboration with the Health Economics Observatory of IOBE.
As it has been established during the past years from our association, this report intends
to be the most comprehensive overview of key facts and data of the pharmaceutical
market in Greece and the wider economic environment in which we are operating, trying
to inform both our members and all other stakeholders in the broader health sector.
This year’s edition includes not only updates of main data contained in previous editions,
but also new information relative to the health sector, while intending to objectively provide
an explanation of key trends of last year (2014), compared to the current year.
More specifically this year’s edition covers trends regarding the evolution of public and
private healthcare expenditure, the shaping of the overall pharmaceutical market, including
OTC, the key factors that will affect future trends such as ageing population or dependency
ratios and a brief summary of key macroeconomic data that affect the entrepreneurship of
the pharmaceutical industry.
In an era dominated by Big Data, the need for decision-making and the shaping of a national
health policy based on evidence should be the primary focus of all stakeholders, so as to
demonstrate and exploit the added value of pharmaceuticals and not simply focus on the
costing side while undertaking short term tax-based solutions.
We hope you find it useful
For the Data Μonitoring Committee For SFEE
Konstantinos Kofinas
Pascal Apostolides
General Secretary
President
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THE PHARMACEUTICAL MARKET IN GREECE:
FACTS & FIGURES 2014
This edition was composed and reviewed by the research staff of the Health Economics
Observatory at IOBE with the active participation of SFEE’s correspondent working group.
The Data Monitoring Committee would like to thank Mr. Aggelos Tsakanikas, Assistant
Professor at the National Technical University of Athens and Scientific Associate of IOBE,
who along with the following IOBE researchers have undertaken the study for this year.
Athanasios Athanasiadis, Research Officer of Health Economics Observatory, IOBE
Grigoris Pavlou, Research Associate, IOBE
We would like also to thank the members of SFEE’s Data Monitoring Committee
Pinelopi Karabela, Market Access Specialist, GlaxoSmithKline
Markos Katsoulakis, Director, Commercial Operations, MSD
Christos Martakos, Corporate Affairs Manager, Pharmaserve Lilly
Makis Mpokaris, Business Excellence Director, Sanofi
Spyros Bokias, Business Excellence Manager, Menarini Hellas
Chrysa Panagopoulou , Market Access Manager, Alcon Laboratories Ελλάς
Ioanna Roubou, Head Market Access & Public Affairs Novartis (Hellas) S.A.C.I.
Responsible for the general edition was Zefi Vostitsanou, SfEE Scientific & Corporate Affairs
Director and for the coordination and processing was Dorina Theodoratou, SfEE, Health
Economics & Market Access Officer.
Konstantinos Kofinas
General Secretary of BoD SFEE and Chairman of the Strategic Planning – Monitoring of
Healthcare Expenditure – Data Monitoring Committee
Chairman of the Board & Managing Director, Merck, Greece & Cyprus
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1 Executive Summary
The Greek economy in 2014 showed positive growth of 0.8% for the first time after a sixyear recession period (2007-2013) which had resulted in the fall of GDP by 26.3% or by €66
bln. At the same time, the major decline in revenues led to a significant decline in prices,
thereby intensifying the recorded deflation, while the unemployment rate was reduced to
26.5% from 27.3% in 2013.
With respect to demographic trends, the negative trend in the natural change of the
population highlighted by a difference between births and deaths of -21.592 persons for
2014 is expected to continue steadily for the next decades, resulting in an overall reduction
of the Greek population until 2050, while significantly changing its age-group composition.
In particular, it is expected that people aged over 65 years in Greece in 2050 will almost
account for 1/2 of the total population (46.6%), thus deteriorating the dependency ratio and
resulting in even greater pressures on the social security system.
Public pharmaceutical expenditure followed a downward trend for fifth consecutive year,
as the target was reduced at €2 bln from €2.37 bln the previous year, thus, resulting in an
overall decrease of 60.8% during the period 2009-2014. As expected, a similar trend has
been observed re public pharmaceutical expenditure per capita, as it has been reduced
from €456 in 2009 to €183 in 2014 ranking Greece in the bottom among EU countries.
At this point, it should be noted that the aforementioned has been proven insufficient as
proven by the great contribution of the industry through the mechanisms of rebates and
clawback. Specifically, the pharmaceutical industry in 2014, paid €226,4 mil in rebates
and €201,8 mil in clawback to cover patient needs, thus contributing with 21.6% of the
actual pharmaceutical expenditure compared to 13.9% in 2013 and 9.4% in 2012.
Based on the latest available data, health expenditure in Greece reached €15.7 bil in 2013
(8.6% of GDP), out of which €10 bln (5.5% of GDP) accounted for public health expenditure.
Expenditure for curative & rehabilitative care services amounting to €9.5 bln followed by
pharmaceutical expenditure with €4.6 bln were the main expenditure components, in
contrast to ancillary health care services (€833 mil) and health administration (€582.6 mil).
Hospital pharmaceutical expenditure amounted to €1.6 bln demonstrating a decline of
9.4% compared to the previous year. The greater reduction in the individual categories
comprising hospital expenditure was observed in expenditure for services (-18.2%) and the
respective pharmaceutical expenditure (-13.7%).
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Total sales of pharmaceutical products in terms of value to wholesalers/pharmacies
amounted to €3.88 bln, indicating a fall by 2% compared to 2013, whereas sales to hospitals/
EOPYY demonstrated an increase of 4.5% respectively. On the contrary, in terms of volume
(number of packages sold) the latter presented a reduction of 3.6%, whereas sales to
pharmacies/wholesalers showed an increase of 2.8%.
Penetration rate of patent protected medicinal products in 2014 reached 11.2%, percentage
higher than in other European markets (EU average 7%), which can be, however, explained
by the significantly lower prices in Greece (52% lower than EU average). Respectively, the
share of non-protected medicinal products amounted to 64.2% (off patent 35% and generics
28.7%) higher than the previous years. According to latest available data, over the counter
medicinal products (OTC) market size in 2014 amounted to €331 mil., showing an increasing
trend compared to previous years, which is in line with the increased self-medication of
patients prevailing this period.
Production of pharmaceutical products in Greece in value terms was estimated at €857
mil. in 2014, decreased by 2.8% compared to previous year. Overall, when compared to
other national manufacturing sectors (24 in total), pharmaceutical industry is ranked 10th,
showing a steady contribution in the domestic industrial production for the country.
Employment in the manufacturing of pharmaceutical products in Greece was estimated
at 13.3 thousand people in 2014, showing an increase of 0.8% compared to 2013. In total,
the workforce in the pharmaceutical industry represents 0.4% of total employment in the
Greek economy and 3.6% of the respective labor force of the industrial sector, which is
higher than the average of EE28 (2.1%).
Imports and exports of medicinal products amounted to €2.7 bln and €1.0 bln, respectively
in 2014. Compared to last year, imports fell by 2.2% and exports by 0.7%, thus, lowering the
pharmaceutical trade deficit at 3.1% or in absolute numbers - €1.6 bln compared to - €1.7
bln in 2013.
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2 Key statistics of Greek pharmaceutical market
Table 1: The Greek pharmaceutical market in figures
Number of
companies(1)
Production (2)
Employment of
pharmaceutical
production (3)
External trade(4)
Parallel Exports (5)
Pharmaceutical
Sales (6)
Public
Pharmaceutical
Expenditure (7)
Public Health
Expenditure (8)
Price Structure (9)
Demographic
data(10)
Price Change (11)
Generics (12)
Manufacturers and Importers (2014)
Wholesalers (2014)
Pharmacists Associations (2014)
Domestic Production at ex-factory prices (2014)
% change 2013/2014
Value added (2014)
Share of value added/Total of manufacturing (2013)
Number of employees (production) (2014)
Number of employees (production) (2013)
% change 2013/2014
Share of employment in production/total of manufacturing (2014)
Exports Value (2014)
% change 2013/2014
Imports Value (2014)
% change 2013/2014
Value terms (2014)
To wholesalers / pharmacies (at retail prices)
To hospital (at hospital prices)
% change sales pharmacies/wholesalers 2013/2014
% change sales hospitals 2013/2014
Expenditure 2009
Expenditure 2014
Clawback 2014
Rebate 2014
Change public pharmaceutical expenditure 2009/2014
Per capita public pharmaceutical expenditure (2014)
Public Pharmaceutical Expenditure / Sales of medicinal products
(2014)
Private pharmaceutical expenditure (2013)
Greece (value) (2013)
Greece (% of GDP) (2013)
European Union (% of GDP) (2013)
Ratio of ex-factory price to retail price
Life expectancy (2013)
Dependency ratio (% population 0-14 years & 65+/ 15-64 years) (2014)
% of Uninsured
Medicines Price Index 2009/2014
% of total sales (in value terms PPPs)
% of total sales (in volume terms)
% of total sales (in volume terms)
Generics and
off-patent (13)
Value (2014)
OTC (14)
Επενδύσεις R&D (14) Estimations (2014)
~106
100
27
€ 857 mil.
-2.8%
€533 mil.
3.1%
13.3 thous.
13.2 thous.
0.8%
3.6%
€1,049 mil.
-0.7%
€2,698 mil.
-2.2%
€306.7 mil.
€3,877 mil.
€1,399 mil.
-2%
4.5%
€5,108 mil.
€2,000 mil.
€201.8 mil.
€226.4 mil.
-60.8%
€183
37.9%
€1,700 mil.
€10.021 mil.
5.5%
7.7%
67.4%
81.4 years
51.7%
25.2%
-26.5%
15.2%
28.6%
64.2%
€331 mil.
€100-120 mil.
(1) EL.STAT, EOPYY, Panhellenic Association of Pharmaceutical Wholesalers
(2) Eurostat 2015, PRODCOM
(3) Eurostat, Labour Force Survey, SBS, 2015
(4) Eurostat, International trade, EU Trade Since 1988 By CN8, 2015
(5) EOF, 2015
(6) System of Health Accounts (SHA) 2013, EOPYY 2012-2014, State Budget 20132014, data processing ΙΟΒΕ, SFEE, OECD Health Data 2015, Eurostat 2015
(7) SHA, 2013
(8) M.D 1907/Β/15.7.2014, estimations ΙΟΒΕ & EFPIA 2014
(9) OECD Health Data 2015, Ministry of Labour, Atlas, 2014
(10) Eurostat, Harmonised Indices of Consumer Prices (HICP), 2015
(11) IMS 2014, Midas
(12) IMS 2014, Midas
(13) AESGP, IMS Hellas Data 2015
(14) EOF,2014
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3 eConoMIC envIronMent
3 .1 MACROECONOMIC INDICATORS
The Greek economy in 2014 exhibited positive growth of 0 .8% after a six-year recession
period (2007-2013), which had resulted in a fall of GDP by 26 .3%, that is a loss of €66 bln of
national income (from €251 bln to €187 bln), causing significant changes in the production
of the economy with a significant number of businesses terminating their function . During
the same period, unemployment recorded continuous escalation, reaching its highest
levels historically at 27 .5% in 2013 . The major decline in revenues led to a significant decline
in prices, thereby intensifying the recorded deflation until 2013 .
The recovery in 2014 was fragile due to the exposure of the economy to high uncertainty,
with the pre-election period heightening it and suspending the dynamic trend that had
been created, primarily due to the strengthening of tourism .
figure1: GDP (%change)
% change
6.0
4.0
3.5
2.0
0.8
-0.4
0.0
-2.0
-3.9
-4.4
-4.0
-5.4
-6.6
-6.0
-8.9
-8.0
-10.0
2007
2008
2009
2010
201 1
2012
2013
2014
Source: Eurostat, 2015, GDP Chain linked volumes 2010
Source : Eurostat, 2015, GDP Chain linked volumes 2010
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figure 2: unemployment and Inflation
Unemployment
30 (%)
Inflation (%)
6.0
26.5
5.0
27.5
24.5
4.7
25
4.2
20
4.0
17.9
3.0
15
3.1
3.0
2.0
12.7
8.4
10
9.6
1.3
1.0
1.0
7.8
0.0
5
-0.9
-1.4
0
-1.0
-2.0
2007
2008
2009
2010
Unemployment
201 1
2012
Inflation
2013
2014
Source: Eurostat, 2015 GDP Chain linked volumes
The Greek recession period was signified not only by a reduction in GDP by ¼ but also by
a restructuring in its components . In particular, until 2007 the Greek economy was mostly
based on consumption (public and private), while investments were limited to cyclical
fluctuations . Net Exports (exports-imports) usually worked negatively in GDP because
of wide trade deficits . From 2008 onwards, the environment is reversed and public and
private consumption fell significantly due to the decline in income, thus limiting the growth
rate of GDP .
8.0
6.0
4.0
2.0
0.0
-2.0
2.6
2.4
1.0
-2.6
2.0
-0.4
-1.8
-0.1
-4.0
2.9
0.3
-0.7
2.6
-0.9
-6.6
-5.1
-6.0
2.8
3.1
-1.4
-1.1
-7.4
-2.0
-8.0
-5.4
0.2
1.1
-1.5
-1.3
-2.2
-0.2
-0.2
2013
2014
0.9
-3.2
-10.0
-2.8
-12.0
-14.0
2007
2008
Government Consumption
2009
2010
201 1
Private consumption
2012
Investments
Net exports
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figure 3: GDP determinants change
8.0
6.0
2.6
4.0
2.4
1.0
2.0
0.0
-2.6
-2.0
2.0
-0.4
-1.8
-0.1
-4.0
2.9
0.3
-0.7
2.6
-0.9
-6.6
-5.1
-6.0
2.8
3.1
-1.4
-1.1
-7.4
-2.0
-8.0
-5.4
0.2
1.1
-1.5
-1.3
-2.2
-0.2
-0.2
2013
2014
0.9
-3.2
-10.0
-2.8
-12.0
-14.0
2007
2008
Government Consumption
2009
2010
201 1
Private consumption
2012
Investments
Net exports
Source: Eurostat, 2015, The numbers show the effective influence of each component in the GDP growth rate
In particular, during the period 2010–2012, private consumption declined on average
by ~5 .9% which was counterbalanced by the restriction of imports and thus, the
strengthening of net exports . From then on and especially in 2014, all GDP components
were normalized and in combination with the correction of imbalances in the financial
and commercial sectors, there was return to a positive rate of GDP growth (0 .8%) and
the turnaround of the primary fiscal deficit and current account deficit into surpluses .
As a result, private consumption in 2014 was increased by 0 .9% verifying the positive
climate around the Greek economy .
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4 DeMoGrAPHIC trenDs AnD HeALtH ProfILe
of tHe nAtIonAL PoPuLAtIon
4 .1 DEMOGRAPHIC TRENDS
The number of births in Greece in 2014 amounted to 92,148 persons recording a 2 .1% drop
from previous year, while the number of deaths recorded an increase of 1 .17% amounting
to 113,740 persons respectively . As such, the natural population change (difference of
births - deaths except migration) was negatively affected, resulting in an overall reduction
of 21,592 people in the national population .
Table 2: Births-Deaths 1931 – 2014
Year
1931
1950
1960
1970
1980
1990
2000
2010
2011
2012
2013
2014
births
199,243
151,134
157,239
144,928
148,134
102,229
103,274
114,766
106,428
100,371
94,134
92,148
Deaths
114,369
53,755
60,563
74,009
87,282
94,152
105,170
109,084
111,099
116,668
111,794
113,740
natural change
84,874
97,379
96,676
70,919
60,852
8,077
-1,896
5,682
-4,671
-16,297
-17,660
-21,592
Source: EL . STAT, 2015
Based on the latest revision from Eurostat, this negative trend in the change of the
population is expected to continue until 2050, thus, resulting in both an overall reduction of
the population in Greece and a change in its composition, as reflected in Figure 4 .
12
11
10
9
8
7
6
5
4
3
2
1
0
11.0
10.7
40%
10.1
9.6
33.9%
9.1
30.5%
30%
25%
25.6%
20.7%
35%
% population
mil.people
figure 4: Projection of population, Greece, 2015-2050*
20%
21.9%
15%
10%
5%
0%
2015
2020
2030
Total population
2040
2050
Population aged 65 years and over
Source: Eurostat, Population Projections, 2014, data processing ΙΟΒΕ
*Not included the possible legalization of migration from 2015 onwards
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Explicitly, while in 2015 the percentage of people aged 65+ years in Greece is estimated
at 20 .7% of the total population, it is expected to cover 1/3 in 2050 . Simultaneously, the
proportion of over 80 years of age is estimated to double to 12 .7%, in contrast to EU and
OECD averages .
figure 5: Projected shares of the population aged 65+ and 80+ 2015-2050, in Greece,
% of total
eu-28
andpopulation
oeCD
40.0%
% of total population
33.9%
35.0%
40.0%
30.0%
33.9%
35.0%
25.0%
20.7%
30.0%
20.0%
25.0%
20.7%
15.0%
20.0%
10.0%
15.0%
5.0%
10.0%
0.0%
5.0%
Greece
28.1%
18.9%
25.3%
28.1%
16.4%
25.3%
12.7%
18.9%
16.4%
6.1%
10.9%
12.7%
5.3%
6.1%
EU28
OECD
+65
EU28
0.0%
Greece
+80
EU28
Greece
+65
9.5%
4.4%
OECD
EU28
2015
OECD
10.9% 4.4%
5.3%
Greece
9.5%
OECD
+80
2015
Source: OECD, Historical Population Data and Projections Database, 2015, processing data IOBE
Life expectancy in Greece has increased considerably over the last 50 years, as it can be
proven from the respective increase from 72 years in 1960 to 79 .8 years in 2010 (Figure
6), due to technological advances, improvement in the provision of healthcare services,
contribution of R&D and innovation of new drugs and therapies .
figure 6: evolution of life expectancy at birth in Greece, 1960-2010
85.0
81.6
80.7
85.0
80.0
80.0
75.0
75.0
70.0
65.0
70.0
60.0
65.0
77.1
73.8
72.0
73.8
72.0
68
68
1960
78.2
75.3
75.3
77.1
74.8
72.6
78.2
77.1
81.6
79.8
77.1
69.9
74.8
72.6
69.9
1970
1980
1990
2000
60.0
Source: OECD, Health
1960Data 2015, *United
1970 Nations estimation
1980
1990
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facts and figures agg.indd 17
80.7
79.8
2000
2010
Greece
2010
Greece
2015-2020*
OECD
2015-2020*
OECD
28/3/16 1:28 PM
According to OECD data, life expectancy in Greece reached 81 .4 years in 2013, which is
higher than the respective average of 80 .4 years . The highest life expectancy was recorded
in Japan, Spain, Switzerland and France (Figure 7) .
figure 7: Life expectancy at birth in Greece and in the oeCD countries, 2013
Japan
Spain
Switzerland
Italy
France
Australia
Israel
Iceland
Sweden
Luxemburg
Norway
Korea
New Zealand
The Netherlands
Greece
Austria
U.K.
Ireland
Finland
Germany
Portugal
Belgium
avg OECD
Slovenia
Denmark
USA
Chile
Chezh Rep.
Estonia
Poland
Turkey
Slovakia
Hungary
Mexico
83.4
83.2
82.9
82.8
82.3
82.2
82.1
82.1
82.0
81.9
81.8
81.8
81.4
81.4
81.4
81.2
81.1
81.1
81.1
80.9
80.8
80.7
80.4
80.4
80.4
78.8
78.8
78.3
77.3
77.1
76.6
76.5
75.7
74.6
70.0
72.0
74.0
76.0
78.0
80.0
82.0
84.0
86.0
Source: OECD, Health Data 2015
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44 .2 DEPENDENCY RATIO
The demographic changes directly affect population’s dependency ratio . In Greece, nearly
half of the population is dependent on the other half, and this proportion is expected to
grow, signaling deterioration and increased pressure on social security systems, following
the general tendency that currently exists in the developed countries1 . In particular, in 2014
Greece’s dependency ratio reaches 51 .7 and is close to the EU-27 average (51 .8) and the
average of OECD countries (51 .9) (Figure 8) .
figure 8: Dependency population ratio eu-27, 2014
57.9
57.9
56.5
55.5
54.4
54.4
54.2
53.3
52.6
52.1
51.9
51.9
51.8
51.7
51.1
51.0
50.7
49.5
48.8
48.6
48.2
47.3
46.4
45.8
45.2
44.9
44.2
43.3
Sweden
France
Finland
Denmark
U.K.
Italy
Belgium
Ireland
Netherlands
Estonia
Germany
avg OECD
EU-27
Greece
Portugal
Latvia
Spain
Bulgaria
Austria
Czech Republic
Luxembourg
Hungary
Slovenia
Malta
Lithuania
Cyprus
Romania
Poland
Slovakia
40.5
35
40
45
50
55
60
65
70
Source: OECD, Health Data 2015
1 . Dependency population ratio shows the number of dependents (aged 0-14 and over the age of 65) to the total active population (aged
15-64) . A high ratio means that the overall economy faces a greater burden in supporting the ageing population . This indicator is on an
upward trend in advanced economies, reflecting rising life expectancy and declining birth rates .
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According to United Nations estimations it is expected to amount 81 .8% by 2050, as only in
the age group 65+ the dependency ratio is expected to increase to 30% compared to 19 .5%
in 2015 .
figure 9: Dependency population ratio in Greece 2010-2050
35
81.8
30
80
70.9
30
25
20
15
49.7
18.6
59.2
55.0
52.2
27.3
70
60
23.3
50
20.5
19.5
90
40
30
10
20
5
10
0
0
2010
2015
2020
2030
Dependency ratio %
2040
2050
Dependency ratio % (65+)
Source: United Nations, Population projections
Additionally, the uninsured consisted 25 .2% of the total population in 2014 . One can observe
significant differences depending on the social security fund they belong to . The highest
percentage of uninsured was found in IKA with 37 .3% of the total uninsured population,
followed by ETAA with 20 .4%, whereas OGA and the Civil Servants’ Sickness Insurance
Fund (OPAD) had the lowest percentage, with 9 .8% and 5 .3% respectively .
table 3: Insured and uninsured 2014
social security
funds
IKA
uninsured
Insured
total
% uninsured/total
1,989.749
3,340.740
5,330.489
37.3%
oGA
161,326
1,484.014
1,645.340
9.8%
oAee
160,537
855,159
1,015.696
15.8%
oPAD
68,882
1,238.558
1,307.440
5.3%
etAA
36,479
142,187
178,666
20.4%
esAA
29,150
120,125
149,275
19.5%
oikos nautou
28,823
132,521
161,344
17.9%
ote.
19,220
108,267
127,487
15.1%
rest
30,077
243,850
273,927
11.0%
total
2,494.166
7,421.571
9,951.737
25.2%
Source: Ministry of Labour, Atlas, 2014
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4.3 Causes of death
During the period 2009-2013, an increase in the number of deaths by 3.25% is recorded with
cancer being the cause of death with the most significant increase (1,512 patients more,
5.5% vs. last year). According to Table 4 “other causes” recorded the greatest increase by
26.3% and in particular, deaths due to diseases of the digestive system and diseases of the
genitourinary system which were the most frequent.
Table 4: Causes of Death 2009-2013
1 Diseases of the circulatory system (of which)
2009
48,453
2013
46,342
Heart disease
31,976
30,212
Cerebrovascular diseases
15,493
14,996
Other circulatory system diseases
984
1,134
2 Neoplasms
27,345
28,857
3 Diseases of the respiratory system
10,770
10,924
4 Violent deaths (of which)
3,868
3,473
Accidents related to transport
1,647
1096
Other accidents
1663
1624
Suicides
391
533
Homicides
167
158
Other violence *
0
62
5 Infectious and parasitic diseases
6 Other Causes
1,183
1,105
16,697
21,093
1,404
1,759
Endocrine and metabolic diseases, nutrional deficiencies
and immonity
Diseases of blood and blood-forming organs
211
481
Mental disorders
109
137
Diseases of the nervous system and sense organs
1,517
1,830
Diseases of the digestive system
2,585
3,049
Diseases of the genitourinary system
1,859
2,106
Complications of pregnancy, childbirh and the puerperium
4
0
Diseases of the skin and subcutaneous tissue
35
28
Diseases of the musculoskeletal system and connective tissue
426
371
Congenital anomalies
214
195
Certain conditions originating in the perinatal period
172
158
Symptoms, signs and indefinable conditions
8,161
10,979
108,316
111,794
TOTAL DEATHS
Source: EL.STAT., 2015, data processing IOBE
*Pursuant to the 9th Revision of the International Statistical Classification of Diseases, Injuries and Causes of Death (ICD-9) the following
are included: cases when it is stated that an investigation by a medical or legal authority has not determined whether the injuries are
accidental, suicidal or homicidal; deaths caused by injuries inflicted by law-enforcing agents (including military) on duty in the course of
attempting to enforce the Law; deaths caused by injuries during war operations.
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The basic cause of death were diseases of the circulatory system with 41 .5% (heart diseases
with 65%) followed by neoplasms with 25 .8% and diseases of the respiratory system with
9 .8%, as shown in Figure 10 .
figure 10: Causes of deaths in Greece, 2013
18,9%
3,1%
41,5%
1,0%
9,8%
25,8%
Diseases of the circulatory system
Diseases of the respiratory system
Violent deaths
Neoplasms
Infectious and parasitic diseases
Other causes
Source: EL .STAT, 2015 data processing IOBE
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5 DeMAnD sIDe: HeALtH AnD PHArMACeutICAL
exPenDIture In GreeCe
In 2013 total health expenditure2 in Greece amounted to €15 .8 bln from which public
expenditure amounted to €10 bln . During the period 2009-2013, the reduction in total health
expenditure and subsequently in public health expenditure accounted for 31 .9% and 37 .8%
respectively following the downward trend of GDP .
figure 11: Health expenditure & Public Health expenditure (in mil. €)
health exp.
mil.euro
25,000
23,177
20,000
22,269
19,599
15,000
16,098
17,106
15,777
15,582
13,188
10,000
11,408
10,021
5,000
0
2009
2010
201 1
Current health expenditure
2012
2013
Current public health expenditure
Source: System of Health Accounts (SHA) 2013, data processing IOBE
More precisely, total health expenditure as a percentage of GDP in 2009 accounted for
9 .8%, whereas in 2013 for 8 .6%3, proportion lower than both the EU average (9 .8%) and the
respective Eurozone average (available data for 17 countries, 10 .2%) . What is important
to note is that the percentage of health expenditure in countries with similar economic
problems is higher than in Greece and specifically, in Portugal and Italy it accounts for 9%
and 8 .8% respectively . Correspondingly, public health expenditure in Greece accounted for
2 . The Hellenic Statistical Authority (ELSTAT) publishes statistical data for the Funding on Health Expenditures at national level based on
the new System of Health Accounts manual SHA 2011 of the OECD, against SHA 1 .0 that used for earlier data . The data have been revised
based on the new methodology for the period 2009-2013 .
3 . It should be noted that according to OECD data the percentage of health expenditure is 9 .2%, and has calculated with the old
methodology SHA 1 .0, while 8 .6% correspond to the new SHA methodology 2011
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5 .5% of GDP in 2013 compared to 7 .8% in the EU and 8 .0% in the Eurozone, with Portugal
and Italy standing at 6% and 6 .8% respectively .
figure 12: Health expenditure & Public Health expenditure as a% of GDP, Greece,
eurozone
12%
10%
9.8%
9.6%
9.8%
9.8%
9.6%
9.4%
9.6%
8.8%
9.8%
8.6%
8%
7.7%
6%
6.8%
7.6%
7.5%
6.9%
6.3%
7.5%
5.9%
7.7%
5.5%
4%
2%
0%
2009
2010
201 1
2012
2013
Current Health Expenditure (%GDP)-Greece
Current Public Expenditure (%GDP)-Greece
Current Health Expenditure (%GDP)-EU
Current Public Expenditure (%GDP)-EU
Source: System of Health Accounts (SHA) 2013, EL .STAT, 2015, data processing IOBE
The pharmaceutical market is only a subset of the total health expenditure . However,
due to the fact that the fiscal adjustment program has focused on the contraction of the
pharmaceutical expenditure alone, its analysis is of significance . For a more complete
understanding of the individual costs of pharmaceutical spending, it is necessary to clarify
certain components, as presented below .
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5 .1 PHARMACEUTICAL ExPENDITURE
Data on “pharmaceutical expenditure” are often confused with data on “total
pharmaceutical sales” released by the National Organization for Medicines (EOF).
EOF records sales of medicinal products from pharmaceutical companies to hospitals, wholesalers and pharmacies, on a monthly basis . On the other hand, according
to the OECD’s International Classification of Health Accounts, with which Greek statistics have been harmonized, pharmaceutical spending is the total expenditure for
medicinal products prescribed for outpatient care (non-hospital treatment) . Therefore, pharmaceutical expenditure is only a fraction of total pharmaceutical sales.
More precisely, pharmaceutical sales are composed of:
(a) Public pharmaceutical expenditure which is incurred by social insurance funds
(part is reimbursed to public funds, as it is inclusive of VAT 6 .5% and mandatory
discounts/ rebates/ clawbacks from pharmacists and pharmaceutical companies);
(b) Hospital sales from pharmaceutical products (invoiced at hospital price = wholesaler price minus 8 .74% - rebates);
(c) Sales of pharmaceutical products that are re-exported (parallel exports);
(d) Sales of pharmaceutical products to Greek citizens or tourists at their own cost;
(e) Patient’s copayment, which does not put burden on social security funds .
Regarding point (b), it should be noted that pharmaceutical sales to hospitals are
included in hospital expenditure, so they should be excluded from the analysis to
avoid double-counting .
Regarding points (c) and (d), it should be noted that these sales are not part of public
pharmaceutical expenditure; on the contrary, they generate revenue to the government, in the form of VAT, income tax, payroll tax, social security contributions, etc .
Public pharmaceutical expenditure is the final amount Social Security Funds have to
spend to cover population needs, after deduction of rebates and clawback . In 2014, the
respective target was set at €2 billion compared to €5 .1 bln in 2009, resulting in an
overall decrease of 60 .8% the period 2009-2014 .
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figure 13: Public Pharmaceutical expenditure 2009-2014 (mil. €)
mil.euro
70%
6,000
92
78
4,000
250
5,108
2,000
4,522
50%
78
193
153
177
3,750
2,880
2,371
204
226
2,000
30%
10%
0
-10%
-11.5%
-2,000
-26.6%
-30%
-43.6%
-4,000
-50%
-53.6%
-60.8%
-6,000
-70%
2009
2010
Net Public Pharmaceutical Expenditure
2011
Rebates
2012
clawback
2013
2014
% Cumulative change since 2009
Source: System of Health Accounts (SHA) 2013, EOPYY 2012, State Budget 2014: Executive Summary, data processing IOBE .
* Midterm Fiscal Strategy forecasts, ** forecasts
Note: Data for refunds / rebates (rebates) from pharmaceutical companies are only available for the years 2009-2013
The reduction in public pharmaceutical expenditure from 2012 onwards has been proven
greater than appropriate, leaving the state unable to meet patients’ needs and thus,
transposing a significant part of the economic burden to the private sector and specifically
to the pharmaceutical industry . In particular, as shown in Table 5, the proportion with which
pharmaceutical companies participate in the coverage of the actual public pharmaceutical
expenditure, through clawback & rebates, is growing exponentially year by year, reaching
21 .5% in 2014 from 9 .4% in 2012 .
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table 5: evolution of % contribution of the pharmaceutical industry in public
pharmaceutical expenditure (target), 2012-2014
Pharmaceutical % participation of
expenditure
industry in pharma
(b)
expenditure
Year
Industry
Rebates
Industry
Clawback
Total
(a)
2012
€193 mil .
€78 mil .
€271 mil .
€2,880 mil .
9 .4%
2013
€177 mil .
€153 mil .
€330 mil .
€2,371 mil .
13 .9%
2014
€226 mil .
€ 204 mil .
€430 mil .
€2,000 mil .
21 .5%
* Mandatory discounts such as simulation hospital price (8 .74%), mandatory hospital discounts (5%) etc, are not included here .
As expected, similar downward trend was observed for public pharmaceutical expenditure per capita, where spending has been reduced from €456 per capita in 2009 to €183
in 2014 (Figure 14) . This is compared with both the Eurozone (17 countries data available)
and the EU averages (22 countries data available) evolution of the respective per capita
expenditure that also follow a declining trend but at a smoother rate . Specifically, in 2013
the average public pharmaceutical spending per capita the EU average was reduced to
€260 from € 284 originally in 2009 and respectively the Eurozone average to €295 in 2013
from €323 in 2009 .
figure 14: Per capita Public Pharmaceutical expenditure in Greece,
eu and eZ-15, (€)
500
456
450
404
400
350
300
250
337
300
323
323
311
284
286
276
295
265
260
257
200
216
150
183
100
50
2009
2010
201 1
2012
Greece
EU (22)
2013
2014
EZ (17)
Source: System of Health Accounts (SHA) 2013, EOPYY 2014, State Budget 2014: Executive Summary, OECD Health Data 2015, Eurostat,
data processing IOBE .
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5.2 Health Expenditure & Pharmaceutical Expenditure
Health expenditure, according to the new SHA methodology 2011 is comprised of the respective expenditure for:
Care Services, Rehabilitation
• HC.1 Hospitals (public and private)
•H
C.2 Residential. Long-term care facilities
• HC.3 Providers of ambulatory health care
Ancillary Health Care Services
• HC.4 Providers of ancillary services (eg. clinical diagnostic imaging and laboratory
services, patient transport and emergency rescue services)
Products Supply for Outpatient Patients
• HC.5 Retailers and other providers of medical goods (pharmaceuticals, vision
glasses, hearing aids, orthopedic belts and accessories
Other Medical Products, Healthcare Management etc
• HC.6 Preventive Care Services & Public Health
• HC.7 Healthcare Management & Social Security Funds
•H
C.9 Non-specialized services by type
Note that in the present analysis, the category “Retailers and other providers of medical
goods (HC.5)” has been separated to “Pharmaceuticals” (HC.5.1)4 and “Other Medical
Products” (HC.5.2), so as to have a deeper description of the pharmaceutical spending.
In 2013, expenditure for Curative, Rehabilitative & Long-term care services amounted to €
9.5 bln accounting for the greater proportion of total healthcare spending, followed by total
pharmaceutical expenditure with €4.6 bln, ancillary health care services with € 833 million
and expenditure for healthcare management (€ 582,6 million.).
4. This category contains OTC and high-cost products (L.3816/2010).
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figure 15: total Health expenditure Components (mil.€)
mil.
16,000.0
13,950.2
14,000.0
13,468.0
Curative,Rehabilitative and Long
term care (HC.1, HC.2, HC.3)
12,000.0
10,783.3
10,157.8
10,000.0
8,000.0
Medical Goods (HC.5.1) Pharmaceuticals
9,485.7
Ancillary Services (HC.4)
Healthcare Management
(HC.6-HC.0)
6,880.1
Medical Goods (HC.5.2) Other medical products
6,000.0
4,619.6
4,000.0
2,000.0
-
1,081.7
833.1
715.5
549.5
2009
2010
2011
2012
582.6
255.6
2013
Source: System of Health Accounts (SHA) 2013, EL .STAT ., 2015, data processing IOBE
The categories refer to the HP classification of individual categories according to the SHA
The following figure depicts health expenditure components as a percentage of GDP (note
that during 2009-2013 national income has significantly decreased (-23 .2% or €55 bln)) .
Expenditure for Curative, Rehabilitative and Long Term care services correspond to 5 .2% of
% total
GDP in 2013, while pharmaceutical expenditure to 2 .5% in 2013 .
7.0%
5.9%
6.0%
6.0%
5.2%
5.2%
5.2%
Curative,Rehabilitative and Long
term care (HC.1, HC.2, HC.3)
5.0%
Medical Goods (HC.5.1) Pharmaceuticals
4.0%
3.0%
Ancillary Services (HC.4)
2.9%
Healthcare Management
(HC.6-HC.0)
2.5%
Medical Goods (HC.5.2) Other medical products
2.0%
1.0%
0.5%
0.4%
0.4%
0.5%
0.5%
2009
2010
2011
2012
2013
0.3%
0.0%
0.3%
0.1%
0.2%
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2009
2010
2011
2012
2013
figure 16: total Health expenditure Components (% GDP)
% total
7.0%
5.9%
6.0%
6.0%
5.2%
5.2%
5.2%
Curative,Rehabilitative and Long
term care (HC.1, HC.2, HC.3)
5.0%
Medical Goods (HC.5.1) Pharmaceuticals
4.0%
3.0%
Ancillary Services (HC.4)
2.9%
Healthcare Management
(HC.6-HC.0)
2.5%
Medical Goods (HC.5.2) Other medical products
2.0%
1.0%
0.5%
0.4%
0.4%
0.5%
0.5%
2009
2010
2011
2012
2013
0.3%
0.0%
0.3%
0.1%
0.2%
Source: System of Health Accounts (SHA) 2014, EL .STAT, 2015, data processing IOBE
Figures 17 and 18 depict the respective components as part of public health expenditure
alone . Public expenditure for Curative, Rehabilitative and Long Term care services and
public pharmaceutical care remain the most significant fragments, although they have
been reduced from €8 .9 bln in 2009 to €5 .9 in 2013 and from €5 .5 bln to €2 .9 bln in 2013
respectively .
As a percentage of GDP, long-term care faced a small reduction from 3 .7% in 2009 to 3 .3%
in 2013, in contrast to public pharmaceutical expenditure which fell significantly to 1 .6% of
GDP compared to 2 .3% in 2009 . Other components of public health expenditure as % of GDP
remained stable during the respective period .
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figure 17: Public Health expenditure Components (bln€)
mil.
10,000.0
8,887.8
9,000.0
mil.
10,000.0
8,000.0
8,887.8
8,807.4
8,807.4
9,000.0
7,000.0
5,944.4
5,543.8
7,000.0
5,000.0
6,000.0
4,000.0
6,432.2
6,351.5
8,000.0
6,000.0
6,432.2
6,351.5
5,944.4
5,543.8
2,919.1
5,000.0
3,000.0
497.1
647.8
634.4
384.5
-
489.1
171.1
2009
647.8
634.4
384.5
-
Ancillary Services (HC.4)
2,919.1
3,000.0
1,000.0
1,000.0
Medical Goods (HC.5.1) Pharmaceuticals
Curative,Rehabilitative and Long
termHealthcare
care (HC.1,
HC.2, HC.3)
Management
(HC.6-HC.0)
Medical Goods (HC.5.1) Pharmaceuticals
Ancillary Services (HC.4)
Healthcare
MedicalManagement
Goods (HC.5.2) (HC.6-HC.0)
Other medical products
4,000.0
2,000.0
2,000.0
Curative,Rehabilitative and Long
term care (HC.1, HC.2, HC.3)
2010
2011
2012
Source: System
of Health Accounts
(SHA) 2013, EL .STAT,
2015
2009
2010
2011
2012
Medical Goods (HC.5.2) Other medical products
2013
497.1
489.1
171.1
2013
%
figure
4.5%18: Public Health expenditure Components (% GDP)
%
4.0%
3.7%
Curative,Rehabilitative and Long
term care (HC.1, HC.2, HC.3)
3.9%
4.5%
3.5%
4.0%
3.7%
3.9%
3.3%
3.3%
3.1%
3.0%
3.5%
3.3%
2.3%
2.5%
3.3%
3.1%
2.5%
Healthcare
MedicalManagement
Goods (HC.5.2) (HC.6-HC.0)
Other medical products
Ancillary Services (HC.4)
3.0%
2.0%
Medical Goods (HC.5.1) Pharmaceuticals
Curative,Rehabilitative and Long
Management
termHealthcare
care (HC.1,
HC.2, HC.3)
(HC.6-HC.0)
Medical Goods (HC.5.1) Ancillary Services (HC.4)
Pharmaceuticals
1.6%
2.3%
Medical Goods (HC.5.2) Other medical products
1.5%
2.0%
1.6%
1.0%
1.5%
0.5%
1.0%
0.0%
0.5%
0.0%
0.3%
0.3%
0.1%
0.3%
0.3%
0.2%
2009
0.3%
0.3%
0.2%
2009
2010
2010
2011
2012
2011
2012
2013
0.3%
0.3%
0.1%
2013
Source: System of Health Accounts (SHA) 2013, EL .STAT, 2015
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Reduction in public health expenditure in Greece can also be reflected in the evolution of
hospital expenditure . It is noteworthy that during the period 2012-2014, hospital pharmaceutical expenditure was reduced by 20 .6%, thus reaching in €1 .6 bln from €2 .04 bln .
figure 19: breakdown of nHs hospitals expenditure, 2012-2014( in mil.€)
2500
2,500
2,038
2000
1500
1000
500
200
505
163
62
368
740
2,000
1,786
185
440
154
61
331
1,618
215
1,500
360
134
62
316
1,000
500
615
531
0
2012
Medicines
Orthopedical materials
Services
Total
2013
2014
Medical Supplies
Chemical Reactors
Outsourcing/ other expenses
Source: Ministry of Health
This reduction was not allocated equally among the different cost-centers of hospital
spending . Specifically, during 2012-2014, the greatest reduction was marked in expenditure
for services and medicines reaching 28% followed by the reduction in expenditure for
chemical reactors (18%) and expenditure of medical supplies (14%) .
According to Figure 20, medicines currently represent 32 .8% from 36 .3% in 2012 while
services represent 22 .2% from 24 .8% respectively of the hospital expenditure budget . On
the contrary, medical supplies and outsourcing exhibited an upward trend to 19 .5% and
13 .3% respectively .
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figure 20: Hospital expenditure evolution, 2012-2014
100%
32.8%
36.3%
Medicines
90%
80%
Services
70%
60%
50%
22.3%
24.8%
Medical Supplies
19.5%
18.1%
Consumables
40%
30%
13.3%
20%
9.8%
10%
8.0%
8.3%
3.0%
3.8%
0%
2012
2013
Reagents
Orthopedics
2014
Source: Ministry of Health, data processing IOBE-SFEE
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5 .2 .1 COMPARISON WITH OTHER COUNTRIES
Health expenditure as a percentage of GDP in Greece in 2013 accounted for 8 .6% which is
lower than the average of OECD countries (8 .9%) but also from countries with economic
crisis like Portugal (9%), Spain (8 .9%) and Italy (8 .8%) . It should be noted here that 8 .6%
corresponds to the new SHA methodology 2011 (see Appendix) . According to data from
the OECD, appreciated with the old methodology SHA 1 .0, health expenditure rate is 9 .2% .
figure 21: Health expenditure as a percentage of GDP (oeCD countries), 2013
USA
USA
TheThe
Switzerland
Switzerland
Germany
Germany
Sweden
Sweden
France
France
Denmark
Denmark
Canada
Canada
(1)(1)
Belgium
Belgium
Japan
Japan
Austria
Austria
New
New
Zealand
Zealand
Portugal
Portugal
(1)(1)
Spain
Spain
(2)(2)
Norway
Norway
AvgAvg
OECD
OECD
ItalyItaly
Australia
Australia
(2)(2)
Slovenia
Slovenia
Iceland
Iceland
Greece
Greece
Finland
Finland
UKUK
Ireland
Ireland
(2)(2)
Slovakia
Slovakia
Israel
Israel
(1)(1)
Hungary
Hungary
Chile
Chile
Chezh
Chezh
Rep.
Rep.
Korea
Korea
Luxemburg
Luxemburg
Poland
Poland
Mexico
Mexico
Estonia
Estonia
Turkey
Turkey
% GDP
%
18GDP
18
16
16
14
14
12
12
10
10
8
8
6
6
4
4
2
2
0
0
Source: OECD, Health Data 2015, SHA, 2013, (1) Preliminary estimations, (2) Data 2012
Additionally, during the period 2009-2013 per capita health expenditure in Greece decreased
by 7 .2%, which accounted for the greater reduction among OECD countries, as shown in
the figure below .
8.48.4
0.80.8
0.90.9
1.51.5
1 1
2.22.2
1 1
1.71.7
1.31.3
1.71.7
1.71.7
3.33.3
2 2
2.82.8
2.32.3
-2.3
-2.3
5.45.4
3.23.2
3.43.4
0.50.5
3.63.6
0.30.3
6.76.7
0.50.5
3.23.2
0.50.5
3.43.4
0.60.6
11.3
11.3
-0.1
-0.1
-0.2
-0.2
-0.3
-0.3
-0.8
-0.8
1.31.3
5.35.3
3.53.5
-1.6
-1.6
-1.6
-1.6
-3.3
-3.3
-4.3
-4.3
-0.4
-0.4
-4 -4
-7.2
-7.2
15
15
10
10
5
5
0
0
-5
-5
-10
-10
5.45.4
figure 22: Average per capita health expenditure evolution, oeCD
2005-2009
2005-2009
2009-2013
2009-2013
Source: OECD, Health Statistics 2015
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Total health expenditure per capita (Figure 23), expressed in $ PPP5, in Greece was
28% lower than the EU average . This was mainly due to the reduction in public health
expenditure per capita which was 39 .4% lower than EU countries, in contrast to private
health expenditure per capita which was the 3rd highest among EU countries and 8th
among OECD countries (33 .7% Greece 22 .6%, 26 .6% EU & OECD) .
Figure 23: Health expenditure per capita, $ ΡΡΡ (Purchasing Power Parity) 2013
USA
Switzerland
Norway
Netherlands
Sweden
Germany
Denmark
Austria
Luxembourg 2012
Canada
Belgium
France
Australia 2012
Japan
Iceland
Ireland 2012
OECD
Finland
New Zealand
EU*
UK
Italy
Spain 2012
Slovenia
Portugal
Israel
Greece
Korea
Czech Republic
Slovakia
Hungary
Chile
Estonia
Poland
Mexico
Turkey
8,713
4,197
6,325
4,178
2,084
5,862
4,981
882
5,131
4,495
636
4,904
4,126
779
4,819
3,677
1,141
4,553
3,841
713
4,553
3,469
1,084
4,371
3,608
763
4,351
3,074
1,277
4,256
3,31 1
944
4,124
3,247
877
3,866
2,614 1,251
3,713
3,090
623
3,677
2,968
709
3,663
2,509 1,154
3,453
2,536
918
3,442
2,583
859
3,328
2,656 672
3,298
2,558 745
3,235
2,802 561
3,077
2,381 696
2,928
2,099 829
2,51 1
1,783 728
2,482
1,639 843
2,428 1,444 950
1,551 798
2,366
2,366
1,551
2,275 1,2721,003
2,040 1,716 324
2,010 1,492 519
1,719 1, 111 608
1,623 749 874
1,542 1,198 344
1,530 1,081 447
1,048536 513
941 737 204
-
2,000
4,000
6,000
Total
8,000
Public
10,000
12,000
4,516
14,000
16,000
18,000
Private
Source: OECD Health Statistics 2015
* The EU refers to the average of 21 EU countries, due to unavailability of data for other countries
5 . Purchasing Power Parity
|35|
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The following figure demonstrates the breakdown of health expenditure by type of financing
in each country . In Greece, 25% of expenditure is financed by the general government,
while adding social security funds contribution increases the proportion of state funding to
approximately 65 .5% .
Figure 24: Expenditure on health by type of financing (2013
figure 24: expenditure
on health by type of financing (2013)
UK
Denmark
Sweden
Italy
Norway
New Zealand
Canada
Australia
Ireland
Spain
Portugal
Finland
Iceland
Chile
Austria
Greece
Mexico
T urkey
Switzerland
Belgium
Korea
Esthonia
Japan
Poland
Hungary
Luxembourg
Netherlands
Slovakia
Germany
Czech Republic
France
Slovenia
USA
86.6
84.3
84.1
77.0
74.1
72.0
69.2
67.6
67.4
67.0
64.8
60.8
52.5
41.8
4.3
31.3
25.0
22.4
20.5
18.8
11.4
11.1
11.0
10.5
9.6
8.8
8.6
7.2
6.7
6.6
6.0
4.0
3.2
34.9
0
10
General Government
20
3.5 9.9
1.9 13.7 0.1
0.6 14.8 0.5
0.4
1.0
21.7
0.4
10.8
14.6
2.6
7.8 4.9
12.6
1.9
1.5 13.2
14.3
3.6
8.9
19.9
2.1
0.1 13.4
16.9
0.4
4.7 5.8
22.1
0.4
1.25.6
28.0
3.6
14.2
2.1
19.3
1.5
28.2
17.8
20.9
44.9
40.5
28.7
33.0
5.0
3.0
6.5
66.7
72.7
61.0
55.8
74.0
80.4
67.6
69.7
78.2
74.7
67.8
Social Security
12.3
4.6
40
50
Private insurance
-
44.7
7.2
44.8
1.5
0.1
17.4
30.7
4.2
57.9
47.2
66.4
30
)
4.0
2.7
4.7
16.9
25.8
4.1
17.9
36.9
0.2
21.8
0.2
0.7
0.2
1.7
23.6
4.5
28.1
1.2
4.6 11.6
5.9 5.3 1.2
2.5
23.3
0.9
9.3
13.5
1.0
0.2 14.7
13.9
15.2
60
70
80
Private out-of pocket
12.6
90
6.7 0.6
1.2
100
Other
Source: OECD Health Statistics 2015
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5.3 Welfare Spending and Public Pharmaceutical Expenditure
Table 6 represents welfare spending6 in Greece comparative to EE-28 average for the
period 2008 -2012 (latest available data). Pension and sickness benefits cover the highest
share with 72.7% of total spending in Greece and 67.2% respectively in EE-28. It should be
noted though that pension benefits in EE-28 represent a significantly smaller proportion
of 40.6% of total spending compared to 51.3% in Greece. Differences are noted in other
categories as well with disability costs and family allowances exhibiting the greatest
differences (7.4% vs. 4.5% (GRE) and 7.8% vs 5.5% respectively) (Figure 25).
Table 6: Social Protection Expenditure, ESSPROS system - Greece - EU28
GREECE
Categories
(%of total)
Sickness/ Health care
Disability
Old age
Survivors
Family/Children
Unemployment
Housing
Social exclusion
Total expenditure (mil.€)
ΕΕ-28
Categories
(%of total)
Sickness/ Health care
Disability
Old age
Survivors
Family/Children
Unemployment
Housing
Social exclusion
Total expenditure (mil.€)
2008
2009
2010
2011
2012
Change
%11/12
29.0
4.7
42.4
8.3
6.3
5.1
2.0
2.2
59,204
29.1
4.7
41.4
8.2
6.7
5.9
1.8
2.1
63,249
29.2
4.7
42.3
7.8
6.4
6.1
1.4
2.2
62,550
25.9
4.9
44.0
8.1
6.2
7.4
1.3
2.3
60,165
21.4
4.5
51.3
8.0
5.5
6.3
0.8
2.1
57,954
-20.2%
-11.1%
12.3%
-4.9%
-14.8%
-18.0%
-36.4%
-9.1%
-3.7%
2008
2009
2010
2011
2012
Change
%11/12
29.6
29.6
29.5
29.6
29.6
7.8
7.6
7.5
7.5
7.4
40.0
39.4
39.7
40.1
40.6
6.1
5.9
5.8
5.7
5.6
8.2
8.1
8.1
8.0
7.8
4.9
6.0
5.8
5.5
5.4
2.0
2.0
2.1
2.1
2.1
1.4
1.5
1.5
1.5
1.5
3,212,438 3,345,567 3,474,912 3,550,706 3,673,484
3.4%
2.3%
4.8%
1.7%
1.4%
1.3%
3.4%
1.7%
3.5%
Source: Eurostat, 2015, EL.STAT, 2015, processing data IOBE
6. According to the classification system ESSPROS developed by Eurostat, expenditure, which is mainly incurred by social security funds,
is broken down into the following categories: Sickness, Disability, Old age, Survivors, Family/Children, Unemployment, Housing and
Social exclusion. In Greece, recording of public spending in these categories was done by EL.STAT.
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figure 25: Distribution of social security expenditures in Greece & eu-28
%
60
51.3
50
40.6
40
29.6
30
21.4
20
10
4.5
8
7.4
5.6
5.5
7.8
6.3 5.4
0.8 2.1
2.1 1.5
0
Greece
EU-28
Source: Eurostat, 2015, EL .STAT, 2015, processing data IOBE
In 2014, welfare spending according to data from the Ministry of Labor (Helios program)
amounted to €27 .7 bln of which €22 .5 bln corresponded to pensions, €3 .2 bln for death
benefits and €1 .7 bln for disability benefits .
table 7: social Protection expenditure (Helios Program)
€billion
Old age
22 .573 .138 .582
Death
3 .295 .325 .605
Disability
1 .721 .633 .199
Uninsured old age (OGA)
133 .267 .854
Without category
12 .904 .583
total
27.736.269.822
Source: Ministry of Labor (Helios program)
During the period 2007-2008 & 2009-2010 an increase in social spending by 2% on average
was recorded in both Greece and OECD countries, which was then followed during the
periods 2009-2010 & 2012-2013 by a reduction of 0 .8% vs . 25% respectively . In the figure
below, data for 34 OECD countries, during the same study periods are shown .
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figure 26: ChangeBetween
in social
protection expenditure
(2007-2013)
2007-08 and 2009-10
Between 2009-10 and 2012-13
-0.7
-0.1
-0.9
Mexico
Korea
Chile
T urkey
Israel
Iceland
Estonia
Slovak Republic
Canada
Switzerland
Australia
United States
Poland
Czech Republic
Hungary
OECD-34
Ireland
New Zealand
Japan
Norway
Greece
Luxembourg
United Kingdom
Slovenia
Netherlands
Portugal
Germany
Spain
Austria
Italy
Sweden
Finland
Belgium
Denmark
France
1.0
1.4
1.5
2.2 0.0
-0.20.4
-0.8
2.7
-2.4
5.8
-0.8
-0.9
-0.9
3.2
1.7
2.1
1.5
0.5
0.3
2.9
-0.9
1.7
0.7
2.5
-1.9
0.4
-0.2
2.5
-1.6
5.2
0.6
2.9 0.0
2.8
2.3
-0.3
-0.8
-0.6
-0.1
2.0
2.7
2.9
0.8
3.3
2.2
-1.3
0.9
2.6 0.2
2.2
0.7
4.3
-0.8
2.4
2.4
-0.6
0.3
1.6
4.6
1.1
3.8
2.9
2.5
-2.0
-1.0
0.0
1.0
2.0
0.7
0.4
0.5
3.0
4.0
5.0
6.0
Source: OECD, Society at a Glance, 2014
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5 .4 HEALTH ExPENDITURE AND PHARMACEUTICAL ExPENDITURE OF HOUSEHOLDS
In absolute terms, average monthly healthcare spending7 was reduced by 21% from €134 .4
in 2009 to €105 .8 in 2014 . However, this accounted for 7 .2% of total household spending
compared to 6 .5% in 2009, indicating the reduced purchasing power of households and the
increased participation of patients in healthcare spending .
figure 27: Average health expenditure of households, 2008-2014
euro
% Total
Expenditure
7.5
7.2
160
140
142.1
120
100
134.3
6.7
6.5
80
6.9
124.4
6.4
114.6
6.3
104.7
104.4
7
105.8
6.5
6.4
60
40
6
20
5.5
0
2008
2009
2010
Health Expenditure ( )
2011
2012
2013
2014
Health Expenditure as a % of Total Expenditures
Source: EL .STAT . 2015, data processing IOBE
As shown in Figure 28 during the economic crisis period there was a shift of household
expenditure mainly to pharmaceutical and hospital care . Specifically, from the €105 .8
monthly health expenditure per household 33 .3% refers to pharmaceuticals, 29 .3% to
hospital services, 15% to dental services and 10 .8% to other medical services .
7 . Household Budget Survey, which is conducted annually by the ELSTAT, provides information for the composition of total household
spending, according to various socioeconomic characteristics of each household .
|40|
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figure 28: breakdown of monthly average household health expenditure, 2008-2014
100%
1,5%
2,6%
1,5%
2,3%
1,5%
3,3%
1,4%
2,3%
1,5%
1,7%
90%
9,7%
9,3%
9,2%
8,5%
8,7%
2,3%
1,5%
7,8%
14,3%
11,7%
10,8%
20,1%
18,0%
16,1%
15,0%
80%
17,3%
70%
18,8%
60%
26,7%
50%
23,3%
29,4%
27,9%
27,4%
40%
30%
29,3%
20,0%
23,3%
17,5%
20%
10%
19,2%
22,1%
22,1%
2009
2010
2011
27,4%
32,4%
33,3%
2012
2013
2014
0%
Pharmaceutical products
Dental services
Paramedical services
Other medical products
Hospital services
Medical services
Therapeutic appliances and equipment
Source: EL .STAT . 2015, data processing IOBE
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6 The Supply side: Pharmaceutical Industry
and Economy
Production and distribution of pharmaceuticals is one of the most dynamic sectors of the
Greek economy. In 2014, according to Eurostat, approximately 13.3 thousand people were
employed in the manufacturing of medicinal products (employees of the wholesale sector
are not included), making the pharmaceutical industry a vital factor for growth in Greece.
The supply chain for pharmaceutical products is comprised of pharmaceutical companies
(both manufacturers and importers), wholesalers (both storage and distribution) and
pharmacies. All medicinal products are distributed through wholesalers to pharmacies,
except products for hospital use only which are provided through sales to hospitals. Direct
sales to pharmacies are permitted, as long as pharmacies accept the respective payment
policies of the companies. In some occasions, doctors or pharmaceutical companies are
allowed to supply patients directly upon approval by the Social Insurance Fund.
~ 56 Multinational &
~ 50 National Pharma companies
100 Wholesalers
27 Pharmacist cooperations
Pharmacies of Hospitals
28 EOPYY pharmacies
11.000 pharmacies
Source: ΕL.STAT. EOPYY, PanHellenic Association of Pharmaceutical Wholesalers
The wholesale segment of the market is comprised by private wholesalers and pharmacist
cooperatives. 100 wholesalers and 27 pharmacist cooperatives operated in the domestic
market, based on data from the PanHellenic Association of Pharmaceutical Wholesalers
in 2014.
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Based on the number of licenses, there are more than 11 .000 pharmacies . With a pharmacy
density of 99 pharmacies per 100,000 inhabitants, Greece comes first among the EU-28
average of 31 pharmacies per 100,000 inhabitants .
figure 29: number of Pharmacies per 100,000 inhabitants, eu 27, 2013
99
Greece
Bulgaria
Cyprus
Malta
Spain
Lithuania
Belgium
Ireland
Latvia
Slovakia
Estonia
France
Romania
EU-Average
Poland
Italy
Portugal
Germany
Hungary
Chezh Rep.
Croatia
UK
Luxemburg
Finland
Austria
Slovenia
Sweden
Netherlands
Denmark
56
54
51
46
45
45
40
37
36
36
35
32
31
30
30
28
26
25
25
24
22
18
15
15
15
13
12
6
0
20
40
60
80
100
120
Source: ABDA, German Pharmacies, Figures Data Facts 2013-2014
In 2013, (latest data available), the number of wholesalers in Greece reached 100, which is
rather high in contrast to other European countries . It is worth noting that every full-line
wholesaler in Greece is a separate entity in contrast to European practices, where full-line
wholesalers can operate warehouses with many branches (Table 8) .
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figure 30: number of Wholesalers, 2013
200
180
180
160
150
140
120
141
113
100
100
80
54
60
42
27 26 23 21
40
20
13 13 13 12 11
8
6
5
5
3
3
3
2
0
Source: GIRP, 2013-2014
table 8: Pharmacies and Wholesalers in Greece and europe, 2013-2014
Country
Austria
Belgium
Bulgaria
France
Germany
Denmark
Switzerland**
Greece
Estonia
UK
Ireland
Spain
Italy
Croatia
Cyprus
Latvia**
Lithuania**
Luxembourg
Hungary
Netherlands
Poland
Portugal
Romania
Slovakia
Slovenia
Sweden
Czech Rep .
Finland
Pharmacies* 2014
1,303
4,998
3,652
22,655
20,921
314
1,744
11,000
469
14,186
1,701
21,458
18,102
1,111
477
783
1,383
91
2,334
1,981
11,297
2,885
7,932
1,935
321
1,303
2,450
818
full-line
wholesalers**
7
8
3
17
13
2
4
100
4
9
2
42
52
Μ/Δ
Μ/Δ
3
3
3
7
5
10
46
7
2
9
3
4
2
Wholesalers** 2013
23
27
21
180
113
6
8
100
2
54
11
150
N/A
13
N/A
3
42
3
12
13
141
26
13
N/A
3
5
N/A
5
ratio Warehouses per
Wholesaler
3 .3
3 .8
7 .0
10 .6
8 .7
3 .0
2 .0
1 .0
0 .5
6 .0
3 .5
3 .6
1 .0
14 .0
1 .0
1 .7
2 .6
13 .0
0 .6
1 .9
0 .3
1 .7
5 .3
2 .5
ΠSource: *PGEU, 2014 **GIRP, 2013 (Data refer to EU-27 countries, except Cyprus and Malta) . N/A: Not Available
|44|
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EOPYY Pharmacies
The majority of high cost drugs belonging in L .3816 / 2010 list are provided
exclusively by EOPYY pharmacies or hospital pharmacies . Based on the
ministerial decree published in Government Gazette 64/Β΄/16-01-2014, the
list of high-cost, serious diseases pharmaceutical products that fall under
the provisions of L .3816/2010 was split into two distinct lists . The first list
relates to pharmaceutical products that are only available for hospital use
(1A), while the second list includes those pharmaceuticals, which their
use begins in the hospital and can be continued externally . EOPYY initially
operated five pharmacies in Attica and one in Thessaloniki . Currently, 28
EOPYY pharmacies are in operation . In areas where EOPYY pharmacies
do not exist, the insured can obtain the respective medicines from EOPYY’s
local health units, after placing an order . Products that are exclusively
available for hospital use are sold from EOPYY at hospital price, reduced
by 5%, while those in the second list are subject to the prices as regulated
by the Ministry of Health .
|45|
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6 .1 SALES8
Sales of medicinal products to pharmacies/wholesalers amounted to €3 .88 bln in 2014,
exhibiting a reduction of 2% compared to previous year . On the contrary, sales to hospitals
presented an increase of 4 .5% respectively . Approximately, 73 .5% of total sales were
supplied to wholesalers and private pharmacies9, while the remaining 26 .5% of sales to
hospitals & EOPYY pharmacies . It is worth noting that the market has recorded an overall
decrease of 44 .6% in sales compared to 2009 .
figure 31: Pharmaceutical sales in values, Greece, 2008-2014 (bln€)
bil. euro
8
7
6
7.00
6.55
6.03
5
5.56
4.61
4
3.96
3
3.88
2
1
1.47
1.47
1.31
1.36
1.20
1.34
1.40
0
2008
2009
2010
201 1
2012
2013
2014
Pharmacies/Wholesalers
Source: EOF 2015 (Pharmacies/Wholesalers at retail prices and Hospitals at hospital prices)
figure 32: Pharmaceutical sales in volume, Greece, 2008-2014, (mil. of packages)
mil. packages
600
500
566.5
562.5
521.2
512.4
400
479.4
484.6
493.2
300
200
469.0
465.8
434.3
424.3
394.8
404.6
416.1
97.5
96.8
86.9
88.1
84.5
80.0
77.1
2012
farmacies
2013
Total
2014
100
0
2008
2009
2010
Pharmacies/Wholesalers
201 1
Hospitals/EOPYY
Source: EOF 2015 *Possible smaller packaging replacements
8 . Total pharmaceutical sales recorded monthly by the National Organization of Medicines (EOF) and include pharmaceutical sales by
pharmaceutical companies to hospitals (at hospital prices) and Wholesalers / Pharmacies (at retail prices) . Sales also recorded in terms
of number of packages .
9 . Parallel exports in 2014 were €306 .7 mil . and are included here .
|46|
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Pharmaceutical products can be classified according to their patent protection status .
According to IMS, the penetration rate of patent protected medicinal products reaches
11 .2%, which is higher than in other European markets (7%) but can be justified by their
significantly lower prices compared to other EU countries (0 .82 € per unit on average
compared to 1 .72€) .
Respectively, the market share of non-protected pharmaceutical products amounted to
64 .2% (off-patent 35 .0% & generics 28 .7%) showing an upward trend compared to previous
years (Figure 33), while a large margin in terms of price is not recorded between them .
figure 33: Penetration of pharmaceuticals in european countries (in volume) based
on patent status
100%
90%
24.6%
20.2%
14.3%
8.6%
5.9%
14.3%
17.9%
7.9%
4.7%
12.4%
80%
37.7%
70%
60%
28.7%
41.7%
50.4%
52.8%
73.1%
49.5%
66.1%
50.5%
57.1%
50%
40%
30%
30.7%
20%
10%
46.2%
35.5%
26.7%
28.9%
29.1%
24.3%
13.3%
24.5%
23.5%
11.2%
7.4%
8.6%
9.7%
7.7%
7.1%
7.3%
8.2%
4.7%
7.0%
Greece
Italy
Spain
France
Germany
Ireland
Portugal
Belgium
UK
A vg EU
0%
on-patent
of f-patent
Generics
Others
Source: IMS, 09/2014 Note: Includes only retail sales for all countries
|47|
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figure 34: Pricing in european Countries, 2014 (price per unit, €)
4.00
3.50
3.00
2.50
4.00
3.50
3.00
2.50
2.00
2.00
1.50
1.00
0.50
-
Spain
France
Germany
Ireland
Portugal
Belgium
1.50On-patent
Greece
0.82
0.73
1.08
1.79
3.55
2.54
0.80
2.06
1.02
1.72
Of f-patent
0.29
0.30
0.23
0.30
0.59
0.39
0.23
0.28
0.27
0.31
0.21
0.14
0.12
0.17
0.14
0.19
0.13
0.17
0.10
0.13
1.00Generics
Italy
UK
A vg EU
0.50Source: IMS, 09/2014 Note: only retail sales are included
-
Greece
Spaindata,France
Germany
Ireland
Portugal
Belgium
UK
A vg EU
Based on
latest Italy
available
in 2014
the over-the-counter
(OTC) market
amounted
to
On-patent
0.82 mil.euro
0.73
1.08
1.79
3.55
2.54
0.80
2.06
1.02
1.72
mil.euro
€331 mil, showing higher levels than previous years . Analyzing, the number of packages
Of f-patent
0.30
0.23
0.30
0.59
0.39
0.23
0.28 331 0.27
0.31
0.29
120 sales
350
sold in the
market
for 2014,
there
is an increase
of 14 .9%
compared
to 2013
reaching
Generics
0.14
0.12
0.17
0.14
0.19
0.13
0.17
0.10
0.13
0.21
292.3
of 95 .9 mil packages .
300
100
258.4
250
figure 35: otC sales, 2012-2014 (in mil. €)
200
83.5
78.2
150
mil.euro
60
mil.euro
331
350 100
300
50
250
0
200
150
80
95.9
120
292.3
100
258.4
2012
2013
83.5
Value
78.2
95.92014
V olume
80
40
20
0
60
40
100
20
50
0
0
2012
2013
Value
2014
V olume
Source: AESGP, 2015, IMS, 2015
Note: Depending on the source of information used, there may be deviations over EOFs’ sales data .
|48|
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figure 36: otC total sales in various countries, 2014
Germany
6,502
Brazil
6,200
Poland
2,734
Italy
2,429
Mexico
1,541
UK
1,344
Ukraine
999
Spain
997
Austria
774
Netherlands
741
Switzerland
642
Belgium
623
Sweden
575
Argentina
471
Hungary
387
Greece
331
Finland
261
Portugal
212
New Zealand
211
166
Denmark
Lithuania
75
Latvia
59
Croatia
54
Estonia
46
urkeyT
44
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
Source: AESGP, 2015 *Note: Different definition of OTC in Greece and other European counties
OTC share in Greece is among the lowest compared with the rest of Europe . However, it
should be noted that the respective market share depends largely on the range of nonprescription medicines included in each country . In 2014, vitamins and minerals (23%) had
the greatest share of the market followed by analgesics (20 .2%) and cold remedies (19 .9%) .
table 9: otC sales by group in Greece, in mil.€
otC groups
Cough and cold
Analgesics
Digestives
Skin treatment
Vitamins and minerals
Others
total
2012
54 .5
56 .3
17 .3
24
49 .8
56 .5
258.4
2013
60 .1
58 .9
20 .6
27
62 .1
63 .6
292.3
2014
66
67
24
28 .5
76 .2
69 .3
331
%13/14
9 .8%
13 .8%
16 .5%
5 .6%
22 .7%
9 .0%
13.2%
% of total, 2014
19 .9%
20 .2%
7 .3%
8 .6%
23 .0%
20 .9%
100%
Source: AESGP, 2015, data processing IOBE
|49|
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6 .2 PRODUCTION
According to Prodcom database (Eurostat) in terms of value (ex-factory prices),
pharmaceutical production in Greece was estimated at €857 mil in 2014, approximately
2 .8% lower than in 2013 .
figure 37: Domestic Production of pharmaceutical products, 2000-2014 (mil. €)
1,000
mil.euro
mil.euro
900
802
800
677
700
600
500
337
400
372
431
450
890
866
918
907
881
825
857
71 1
515
300
200
100
-
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 201 1 2012 2013 2014
source: Eurostat 2015, PRODCOM Database .
*Any changes based upon review of data from Eurostat
Figure 38 below shows the evolution of production index for the pharmaceutical industry . In
particular, the index declined in the first half of 2014, which was then partially compensated
by the increase in the second half of the year .
figure 38: Industrial Production Index for Pharmaceutical goods (2010=100)
106
103
104
103
103
104
101
102
99
100
98
96
94
94
q1
q2
97
97
q2
q3
95
93
94
92
90
88
86
q3
2012
q4
q1
q2
q3
2013
q4
q1
q4
2014
Source: EL .STAT, 2015, seasonally adjusted and adjusted data by working days
|50|
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The diagram below shows the evolution of turnover index in the pharmaceutical industry,
as a proportion of the turnover in both the domestic market as a whole but also as exports
to Eurozone and non-Eurozone countries .
figure 39: turnover Index in Pharmaceutical Industry (2010=100)
250
194
200
171
151
118
100
144
140
150
116
103
166
153
111
114
115
151
151
147
111
107
105
111
98
87
89
89
88
85
86
90
88
88
85
85
82
81
84
q1
q2
q3
q4
q1
q2
q3
q4
q1
q2
q3
q4
103
50
0
2012
2013
Index of turnover-Domestic market
2014
Index non-domestic
turnover-Euro area market
Index non-domestic
turnover- non Euro area market
Source: EL .STAT, 2015, seasonally adjusted and adjusted data by working days
The importance of the pharmaceutical industry in the years of recession can be
represented in the figure below . The added value of the pharmaceutical sector as part of
total manufacturing for the country is stabilized near 3% after a recessive period during
2005-2008, despite the economic crisis . When compared with other national manufacturing
industries, the pharmaceutical sector is ranked 10th in 2014 (Table 10) .
%
5.0%
mil. (2010)
1,000
4.6%
900
800
700
4.5%
4.0%
805
3.8%
3.4%
746
672
600
500
3.4%
2.8%
624
505
400
4.0%
3.2%
3.0%
2.9%
3.1%
3.0%
616
519
507
474
3.5%
533
2.5%
2.0%
300
1.5%
200
1.0%
100
0.5%
0
0.0%
2005
2006
2007
2008
Value added mil.
2009
2010
|51|
201 1
2012
2013
(2010=100)
Share of pharmaceutical sector in total manufacturing
facts and figures agg.indd 51
28/3/16 1:28 PM
figure 40: Added value Pharmaceutical sector Production
%
5.0%
mil. (2010)
1,000
4.6%
900
800
700
4.5%
4.0%
805
3.8%
3.4%
746
672
600
500
3.4%
2.8%
624
505
400
4.0%
3.2%
3.0%
2.9%
3.1%
3.0%
616
519
507
474
3.5%
533
2.5%
2.0%
300
1.5%
200
1.0%
100
0.5%
0
0.0%
2005
2006
2007
2008
V alue added mil.
2009
2010
201 1
2012
2013
(2010=100)
Share of pharmaceutical sector in total manufacturing
Source: Eurostat,2015, data processing IOBE
table 10: share of added value in Manufacturing 2013
Manufacturing
C 10: Manufacture of food products
C 19: Manufacture of coke and refined petroleum products
C 24: Manufacture of basic metals
C: 33: Repair and installation of machinery and equipment
C 25 Manufacture of fabricated metal products . except machinery and equipment
C 23: Manufacture of other non-metallic mineral products
C 11: Manufacture of beverages
C 20: Manufacture of chemicals and chemical products
C 28: Manufacture of machinery and equipment n .e .c
C 21: Manufacture of basic pharmaceutical products and pharmaceutical
preparations
C 18: Printing and reproduction of recorded media
C 14: Manufacture of textiles . wearing apparel
C 17: Manufacture of paper and paper products
C 27: Manufacture of electrical equipment
C 26: Manufacture of computer . electronic and optical products
C: 32: Other manufacturing
C 12: Manufacture of tobacco products
C 13: Manufacture of textiles
C 22: Manufacture of rubber and plastic products
C 31: Manufacture of furniture
C 30: Manufacture of other transport equipment
C 29: Manufacture of motor vehicles . trailers and semi-trailers
C 15: leather and related products
share in total
Manufacturing 2014
26 .1%
10 .4%
10 .0%
7 .4%
6 .7%
5 .1%
4 .3%
4 .2%
3 .3%
3.1%
2 .3%
2 .3%
2 .2%
1 .7%
1 .7%
1 .7%
1 .7%
1 .3%
1 .3%
1 .3%
1 .0%
0 .5%
0 .3%
Source: Eurostat (last data11/11/2015), data processing ΙΟΒΕ, 2015
* C 21: Manufacture of basic pharmaceutical products and pharmaceutical preparations include only the companies active in the production
of medicines and pharmaceutical preparations . In C 21 manufacturing companies are not included firms that belong to subsector 46 .46
Wholesale of pharmaceutical products .
|52|
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66 .3 EMPLOYMENT
The European pharmaceutical industry is a high-tech sector offering employment to
690 .000 people (estimations EFPIA Facts & Figures, 2014) . According to Eurostat, in 2014
13 .3 thousands people were employed in the manufacturing of pharmaceutical products
in Greece, demonstrating a slight increase 0 .8% higher compared to the previous year .
figure 41: employment in the production of pharmaceuticals
thousands people
15.0
14.0
13.7
3.0%
14.0
13.2
13.3
2.2%
13.0
2.0%
1.0%
12.0
0.8%
0.0%
11.0
-1.0%
10.0
-2.0%
9.0
-3.0%
8.0
-4.0%
7.0
-5.0%
6.0
-6.0%
-5.7%
5.0
201 1
2012
2013
Employment in the pharmaceutical production sector
-7.0%
2014
% change
Source: Eurostat . 2015
Employment in the pharmaceutical sector represents 0 .4% of total employment of the
Greek economy, while this share increases to 3 .6% with regards to employment in the
industrial sector overall . Both shares are higher than the respective average in Europe .
It is worth noting that Ireland has the highest share in Europe, representing 13 .3% of total
industrial employment .
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figure 42: share of employment in the production of pharmaceuticals in the eu (2014)
% economy
% industry
1.8%
16.0%
1.6%
14.0%
1.4%
12.0%
1.2%
10.0%
1.0%
8.0%
0.8%
6.0%
0.6%
3.6%
0.4%
4.0%
2.1%
2.0%
0.0%
0.0%
Ireland
Slovenia
Denmark
Malta
Belgium
Croatia
Hungary
Austria
UK
France
Spain
Greece
Bulgaria
Italy
Cyprus
EU-28
Czech Rep.
Germany
Poland
Latvia
Sweden
Netherlands
Finland
Portugal
Romania
Slovakia
0.2%
% economy (left axis)
% Industry (right axis)
Source: Eurostat . Labour Force Survey . 2015
According to the International Standard Classification of Education, in the manufacturing
sector of medicinal products, the majority of employees 61 .3% (8 .128 people) have university
education (level 5) which indicates the high educational training of the industry .
table 11: educational employment structure in pharmaceutical production (2014)
1-Primary education or first stage of basic
education
2-Lower secondary or second stage of
basic education
3-(Upper) secondary education
4-Post-secondary non-tertiary education
5-First stage of tertiary education
6-Second stage of tertiary education
Total
sector 21
total economy
Number of
Percentage
Percentage
persons
total Industry
Percentage
563
4 .2%
13 .6%
15 .9%
383
2 .9%
9 .8%
13 .9%
3 .285
24 .8%
33 .5%
41 .7%
227
1 .7%
9 .0%
8 .9%
8 .128
61 .3%
32 .5%
19 .3%
666
5 .0%
1 .0%
0 .2%
13 .252
100 .0%
100 .0%
100 .0%
Source: EL .STAT . (ISCED . International Standard Classification of Education – Unesco)
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6 .4 ExTERNAL TRADE
The pharmaceutical industry is also an important driver for the country’s external trade .
Imports and exports of medicinal products amounted to €2 .7 bln and €1 .0 bln respectively
in 2014 . This is translated to a reduction of 2 .2% in imports and 0 .7% in exports respectively
compared to previous year, thus lowering the pharmaceutical trade deficit by 3 .1% at €1 .65
bln compared to €1 .7 bln in 2013 .
It is worth mentioning that based on data from the Panhellenic Exporters Association in
2014 medicinal products are the second export product in value terms after mineral oils
in Greece .
figure 43: Pharmaceutical trade balance (mil.€)
5,000
4,000
3,770.1
4,025.4
3,571.2
3,275.4
3,000
2,941.4
2,759.0
2,698.2
1,056.1
1,048.7
-1,702.9
-1,649.5
2013
2014
mil.
2,000
1,000
892.9
971.0
1,043.4
921.1
969.2
0
-1,000
-2,000
-3,000
-2,877.2
-3,054.4
2008
2009
-2,527.8
-2,354.3
2010
2011
-1,972.1
-4,000
Trade Balance
Imports
2012
Exports
Source: Eurostat. 2015. International trade. EU Trade Since 1988 By CN8. 2015. data processing ΙΟΒΕ
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6 .4 RESEARCH AND DEVELOPMENT (R&D)
Greece was ranked in the last places among EU countries in the R&D investment list,
spending €100-120 mil according to EOF estimations . With respect to the number of clinical
studies conducted in 2014, irrespective of phases, it was found that 1 .778 clinical studies
took place in Greece, which is similar to that in countries such as Romania and far less
than countries more research intensive, such as Germany, France and United Kingdom .
figure 44: number of Clinical trials, all phases and stages. 2014
number of studies
410
581
618
640
659
667
1,016
1,183
1,205
1,213
1,778
1,737
2,039
2,568
2,591
2,853
3,978
3,484
4,095
4,005
2,000
5,917
4,000
4,980
7,349
6,000
6,142
8,000
10,565
10,000
7,837
13,025
12,000
12,418
14,000
-
Source: Clinical trials .gov . 2014
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7
Pricing of Pharmaceutical Products
Prices of medicinal products in Greece are set based on an international price referencing
(IPR) system. Specifically, as set by the Law 4213, Chapter 4, art.22, prices for medicinal
products are set based on the average of the 3 lowest prices of the EU member-states. The
above provisions are specified by ministerial decisions. During 2014 there were significant
changes in pricing and profit margins for pharmacists as reflected in Tables 12 & 13.
Ministerial decision GG1907/Β/15.7.2014, as described below, sets the provisions under
which pricing of pharmaceutical products is currently set out. Any intermediate provisions
published within this year are presented in Table 14.
In order for a medicinal product to be priced for the first time, it needs to have been priced
in at least three EU member-countries. Only orphan medicinal products may be priced
even if prices are available in only two other EU countries.
Maximum wholesaler price (ex-factory) of on-patent products is based on the average of
the three lowest prices of the EU member-states which publish reliable data. Respectively,
the maximum wholesale price of off-patent products is automatically reduced either to
50% of the last price the product held under patent protection or to the average of the three
lowest prices of the EU member-states, respecting the lowest between the two. Generic
prices are set to 65% of the price of the respective reference medicinal product.
For the medicinal products for which there is no generic in the market during the last twelve
months, based on EOPYY sales, the average of the three lowest prices in the Member States
of the European Union is exclusively used. When a generic product becomes available in
the market (with sales), its price is reduced by 50%, even if the resulting price is lower
than the average of the three lowest prices in the EU Member States. The latter is valid for
all medicinal products for which patent protection has expired after 01.01.2012, including
the respective generics (market authorization after 01.01.2012 & LOE after 01.01.2012). For
those products with loss of exclusivity before 01.01.2012, horizontal price reductions are
applied as defined by the respective ministerial decree. Similarly, for generics authorized
prior to 01.01.2012.
For medicinal products that are exclusively produced in Greece and/ or have Greek patent
rights, price is set based on invoice / tariff which contain production and packaging costs, as
well as administration - distribution – dissemination costs and research and development
costs.
Prices are revisited regularly downwards each time a price bulletin is issued. Products
excluded from repricing are any products belonging in the negative list and OTC list.
Exceptionally, for reasons of safeguarding public health and for covering adequately patient
needs, blood products are exempted from repricing. Finally, the latter may not be priced
lower than the average of the three lowest.
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Price definitions
Maximum Wholesale Price: Maximum Wholesale Price of Medicinal Products is
the price at which medicinal products are sold to pharmacies . This price includes
the gross profit margin of the wholesaler, which is calculated as a percentage
on the maximum price of the ex-factory . Gross profit margin (mark-up) a) for all
medicinal products reimbursed by social security funds is set as a percentage of
4 .9% on the maximum net ex-factory price (up to €200) and 1,5% on the maximum
net ex-factory price (>€200) b) for non-prescription medicinal products (OTC) as
a percentage of 7 .8% on the maximum net ex-factory price and c) for medicinal
products that belong to par .2, art .2, L3816/2010 as a percentage of 2% on hospital
price . The latter is called as Special Wholesaler Price .
Maximum retail Price: Maximum Retail Price of Medicinal Products is the price at
which medicinal products are sold by pharmacies to consumers, and it is defined
by the wholesale price, adding the lawful profit margin of the pharmacy as set
out in the respective ministerial decree and the applicable Value Added Tax (VAT
6 .5%) . In particular, for pharmacies the mark up is determined as follows: a) 35%
on the wholesale price for non-prescription medicinal products (OTC) b) 35% on
the wholesale price for non-reimbursed prescription products c) for reimbursed
products (see Table 6) and for products with price > €3 .000 is set a percentage of 2% .
ex-factory price: The maximum producer’s price (ex-factory) is the sale price by
the marketing authorization holders (MAHs) to wholesalers and is calculated based
on the wholesale price reduced a) for prescription medicinal products which are
not reimbursed by the Social Insurance Funds by 4 .67%, b) for prescription nonreimbursed medicinal products by 5 .12% and c) for non-prescription (OTC) medicinal
products by 7 .24% .
Maximum Hospital Price: Maximum Hospital Price of Medicinal Products is the
price at which medicinal products are sold by the Marketing Authorization Holders
to the State, State hospitals, Social Care Units, public law legal entities referred to in
par . 1 of Article 37 of Law 3918/2011, pharmacies of private clinics with over 60 beds
and EOPYY pharmacies . The maximum hospital price shall be determined on the
basis of the ex-factory price reduced by 8,74% .
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7.1 Pharmaceutical products price structureProfit margins of wholesalers vary
depending on
the reimbursement status of each product that is, on whether the product belongs in
the positive, negative, OTC list or if they fall under L.3816/2011 provisions and its relative
wholesaler price. For medicines belonging in the positive list (and therefore reimbursed
by the social security funds) profit margins and the price structure are set as follows:
Table 12: Mark-up in the pharmaceutical supply chain. 2014
Wholesalers
(over ex-factory)
Pharmacies
Reimbursed
Products up to 200€
Reimbursed Products
> 200.01€
OTC
Negative list
products
4.9%
1.5%
7.8%
5.4%
Table 13
Table 13
35%
35%
Source: Ministerial Decision Νο. 3457.2014 (Gazette of Government Β 64)
Για τα φαρμακεία το ποσοστό μικτού κέρδους (mark-up) για όλα τα αποζημιούμενα φάρμακα από τους ΦΚΑ σύμφωνα με το κάτωθι πίνακα.
Table 13: Mark-up for pharmacies
Wholesale price (€)
0-50
50.01-100
100.01-150
150.01-200
200.01-300
300.01-400
400.01-500
500.01-600
600.01-700
700.01-800
800.01-900
900.01-1000
1000.01-1250
1250.01-1500
1500.01-1750
1750.01-2000
2000.01-2250
2250.01-2500
2500.01-2750
2750.01-3000
Percentage mark-up pharmacies
30.00%
20.00%
16.00%
14.00%
12.00%
10.00%
9.00%
8.00%
7.00%
6.50%
6.00%
5.50%
5.00%
4.25%
3.75%
3.25%
3.00%
2.75%
2.50%
2.25%
Source: M.D. (1907/Β/15.7.2014)
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Mark-up margins mentioned above are the maximum margins allowed in the case of OTC
products for both wholesalers and pharmacists, and they are allowed to voluntarily reduce
them and offer these products in lower prices as long as it is recorded in the respective
invoice.
Additionally, these margins are applied to all reimbursed products sold in private
pharmacies including products belonging in the L.3816/2010 list. When the latter are
directly sold by private pharmacies and the respective cost is not reimbursed by EOPYY or
any other SSF, pharmacist margin is set based on the table above and for products with
wholesaler price greater than €3.000 this changes to 2%.
According to the price structure of medicinal products, the current rate of 6.0% VAT and
the respective profit rates in the supply chain based on wholesale prices (IMS elements
03/2015), the weighted average percentage of the final value attributable to the manufacturer
lays at 67.8%, wholesaler at 3.4% and pharmacist to 22.8%
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7 .2 PHARMACEUTICAL PRICE INDEx
The prices of medicinal products in Greece followed a slightly upward trend until 2009,
however, significantly lower than the rate of inflation . Pricing reforms introduced from
2009 onwards led to an overall decline of 26 .5% in the pharmaceutical price index until 2013 .
figure 45: Drugs Price Index vs Price Index of other basic Goods (2005=100)
150
140
136.7
130
121.6
120
111.3
110
108.9
100
90
80
74.7
70
60
2005
2006
2007
2008
2009
2010
201 1
2012
Harmonised Index of Consumer Prices
Pharmaceutical products
Health
Medical services; paramedical services
2013
Hospital services
Source: Eurostat . 2015
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7.3. Reimbursement of pharmaceuticals
Regarding the reimbursement of medicinal products, the most important legislative
changes during 2014 are summarized below:
According to Law 4249, Article 127 (GG 73 / 03.24.2014), Social Security Funds reimburse
patent protected medicinal products that have received market authorization in Greece
after 1.1.2012, if they are reimbursed by Social Security Funds in 2/3 of EU Member - States
or in at least 12 EU member- states after an health technology assessment evaluation,
provided full compliance with the Community EC Directive 89/105 / EG Directive on
transparency. The Minister of Health has the authority to exempt medicinal products which
are characterized as essential to the life risk coverage of patients or orphan drugs, only
when covered by international clinical protocols. New generics are automatically included
in the list if the reference medicinal products (off patent) are also included.
The positive list is prepared by EOF and after approval from the Minister of Health it is
published in Government Gazette. Following either price revision or after price setting of
new medicinal products, the positive list and the corresponding reference values must be
reviewed within 30 days (GG64 / 01.16.2014).
For the setting up, the revision and the completion of the reimbursement list, the system
of Anatomical Therapeutic Chemical Classification (Anatomic Therapeutic Chemical
classification - ATC) from World Health Organization (WHO) is used and a reference pricing
system by therapeutic category is applied. The reference price is calculated for each
available strength and/or pack size in each cluster.
As defined in the ministerial decision published in GG1144 / 05.06.2014, the reference price
is calculated as the weighted average of the lowest cost of daily treatment generics that
account for 20% of market sales during the last six months prior to the calculation of prices.
Sales are based on EOPYY expenditure.
In cases where a patient chooses a medicinal product with retail price equal to the
reimbursement price, then he pays the statutory co-payment (0%, 10%, or 25%). In
cases, where the patient decides to choose a product where retail price is greater than
the reimbursement price, then he must pay the set co-payment and additionally the
full difference between these prices. Finally, when the retail price is lower than the
reimbursement price, up to 50% of the difference between them is deducted from the set
co-pay. Based on the ministerial decision published in GG1276/20.05.2014, the maximum
amount a patient can pay on top of the set co-pay cannot exceed € 50 per pack. Finally, all
pharmaceutical products belonging in L.3816 / 2010 list are fully reimbursed by SSFs and
are available to patients without co-payment.
It should be noted that based on a later ministerial decision (GG2243/18.08.2014), in cases
where a medicinal product with no generic presence is chosen, and its retail price is
greater than the reimbursement price, patient must pay 50% of the difference between
the prices on top of the set co-pay and the remaining 50% is paid by pharmaceutical
companies in the form of a rebate, starting from 15.09.2014 onwards.
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Table 14: Legislative changes re pricing, reimbursement & rebates, 2014
Ημερομηνία Gazette / Ministerial Decision
16.1.2014
21.01.2014
07.02.2014
06.05.2014
MD 3457 - GG 64/Β
MD 3594 - GG 18
MD 12449 - GG 256/Β
MD 38733 & MD 38714
20.05.2014
04.06.2014
- GG 1144/Β
MD 43066 - GG 1277/Β
MD 45001 - GG 1435/Β
10.06.2014
02.07.2014
15.07.2014
24.07.2014
31.12.2014
MD 49515 - GG 1530/Β
MD 58430 - GG 1805/B
MD 61771 – GG 1907/B
MD 65470 - GG 2013/Β
MD 112654 - GG 3677
16.1.2014
13.02.2014
07.03.2014
24.03.2014
26.03.2014
06.05.2014
MD 3457 - GG 64/Β
MD 14228 - GG 329/Β
MD 21261 - GG 572/B
Law 4249 - GG 73/Α
MD 22405 - GG 740/Β
MD 38733 & MD 38714
10.05.2014
- GG 1144/Β
Law 4262 - GG 114/Α
14.05.2014
14.05.2014
20.05.2014
20.05.2014
06.06.2014
11.07.2014
21.07.2014
30.07.2014
29.08.2014
16.12.2014
16.1.2014
17.02.2014
10.05.2014
23.05.2014
18.08.2014
18.08.2014
31.12.2014
Law
PRICING
Pricing Provisions
Pricing Provisions
Pricing Provisions – amendment of GG64B
Pricing & supply provisions for OTC
Pricing Provisions & L.3816/2010 list
Supply & administration provisions for medicinal
products
Pricing Provisions
Pricing Provisions
Pricing Provisions
Pricing Provisions
Pricing Provisions
REIMBURSEMENT
Pricing Provisions, article 14
Revision of reimbursement list
Approval of reimbursement list
Reorganization of Greek Police (article 127)
Approval of reimbursement positive list
Pricing Provisions – Amendment of article 14, GG 64B
Authorisation for economic activity and other provisions
(article 54)
MD 38907 - GG 1222/Β
Updated OTC list
Law 4263 - GG 117/Α
Midterm Fiscal Term Strategy 2015-2018
MD 43066 - GG 1277/Β
Approval of Reimbursement list
MD 43063 & MD 43063 - GG 1277/Β Cap to co-payment-50€/package
MD 49516 - GG 1511/B
Provisions for the prescription and reimbursement of
oncological medicinal products
MD 60490 - GG 1894/B
Approval of reimbursement list
MD 62836 - GG 1981/Β
Updated OTC list
MD 66788 - GG 2083/Β
OTC List
MD 74288 - GG 2336
Reimbursement list
MD 108477 - GG 3376/Β
Reimbursement list
REBATES
MD 3457GG 64/Β
Pricing Provisions
Law 4238/2014 - GG 38/Α
Article 52 Offsetting state debts with rebates & clawback
Law 4262 - GG 114/Α
Supplementation of Article 54 - calculation of clawback
MD 41767 / GG1322
Offsetting of second half 2013 EOPYY, hospitals and MAHs
MD 70519 & MD 70520 - GG 2243/Β Rebate & Claw back
MD 70522 - GG 2247/Β
Rebate
MD 6931 - GG 3676/B
Modification of Ministerial Decision 50-50
|63|
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8 State’s debt towards pharmaceutical firms
The Hellenic Association of Pharmaceutical Companies (SFEE) collects and records data
related to State’s debts of its member companies (on a voluntary basis). Below an overview
of total receipts, sales invoices and debts until 31.12.2014 only for the pharmaceutical
industry (end date of data collection 31.12.14) are presented. The data collected refer to
invoices in the period described above.
Data for sales, receipts and outstanding debts re NHS hospitals, EOPYY, Military hospitals,
judicial hospitals, private entities and IFET are requested. However, comparable data from
all companies refer to outstanding debts from NHS, EOPYY and military hospitals, which
also constitute the largest part of health expenditure.
Specifically, findings show that:
• The total amount of sales of SfEE member-companies to the State during the period
01.01.2013 to 31.12.2014 amounted to €1.943 mil., while respective receipts amounted to
€1.314 mil. (Note: The aforementioned amounts are part of the total, as they involve only
companies – members that they have sent detailed data of sales-receipts).
• The total amount of outstanding debts from the State re invoices until 31.12.2014 amounted
to €789.9 mil. It should be noted that any debts remaining unsettled before 31.12.2012 are
also included here (estimated to €31.9 mil). If broken down to each stakeholder, €496.1
mil account for EOPYY, €276 mil for NHS Hospitals and €17.7 mil for Military Hospitals.
(These amounts include also companies which sent aggregated data).
• The settlement of state debts for 2013 is almost completed (94.86% paid back).
• Despite the downward trend shown in Figures 46 & 47, only 40.1% of state debts for 2014
have been paid back. In particular, 56% of NHS hospitals debts and 30.2% of EOPYY debts
have been settled for 2014.
It becomes evident that pharmaceutical companies are significantly behind in settling state
debts both standalone and comparative to other providers such as pharmacies, private
clinics, diagnostic centres, etc. A stable repayment policy must be established directly so
as to avoid inability of pharmaceutical companies to support both the market and their
businesses.
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figure 46: total state debts evolution towards sfee member companies’ until
31.12.2014
700
700
600
600
500
500
550
550
415
415
597
597
450
450
573
573
455
455
568
568
598
598
648
648
632
632
633
633
627
627
608
608
496
496
430
430
429
429
400
400
348
348
368
368
376
376
343
343
300
300
295
295
276
276
200
200
100
100
30
30
23
23
22
22
22
22
23
23
21
21
24
24
25
25
24
24
21
21
18
18
0
0
EOPYY
EOPYY
Source: SFEE
ESY
ESY
Military
Military
figure 47: state debts evolution towards sfee member companies’ until 31.12.2014
(Invoices for 2014 only)
600
600
482
482
500
500
560
560
493
493
260
260
300
300
165
165
200
200
0
0
546
546
362
362
400
400
100
100
519
519
50
50
2
2
45
45
Source: SFEE
100
100
90
4
90
4
145
145
7
7
200
200
190
190
10
10
EOPYY
EOPYY
259
259
210
210
202
202
12
12
12
12
ESY
ESY
16
16
274
274
18
18
249
249
17
17
214
214
204
204
17
17
15
15
Military
Military
|65|
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9 Appendix
Based on article 6 of the European Regulation (EU) 1338/2008 of the European parliament
re matters of public health and the respective under voting Implementation Regulation
and in cooperation from OECD & WHO the new compilation of SHA data was created.
As such, ELSTAT was obliged to communicate SHA data to Eurostat and to International
Organizations (OECD and World Health Organization) according to the new SHA 2011 and a
revision was done from 2009-2013.
Transition table from SHA 1.0 to SHA 2011 codes
System of Health
Accounts SHA 1.0
Funding Sectors (HF)
System of Health
Accounts SHA 2011
HF.1.2
General Government (excl. Social Security
Funds)
Social Security Funds (SSFs)
HF.2.2
Private Voluntary Insurance Schemes
HF.2.1
HF.2.3
Private Households Out-of pocket Expenditures
HF.3.1
HF.2.4
Non Profit Institutions Financing Schemes
HF.2.2
HF.2.5
Corporation Financing Schemes
HF.2.3
HF.1.1
HF.3
HF.0
System of Health
Accounts SHA 1.0
HP.1
HP.2
HP.3.1-3.4. HP.3.6
Rest of the World
HF.1.1
HF.1.2
HF.4
n.e.c
Health care providers (HP)
Hospitals (public and private)
Residential. Long-term care facilities
HF.0
System of Health
Accounts SHA 2011
HP.1
HP.2
Providers of ambulatory health care
HP.3
Providers of ancillary services
HP.4
HP.4
Retailers and other providers of medical goods
HP.5
HP.5
HP.6
HP.7
Providers of preventive care
Providers of health care system administration
and financing
Rest of Economy
HP.9
Rest of the World
HP.9
HP.0
n.e.c
HP.0
HP.3.5. HP.3.9
HP.6
HP.7
HP.8
Codification at the category of health care activities (HC-health care) remains unchanged between SHA 2011 & SHA 1.0.
|66|
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NOTES
facts and figures agg.indd 67
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NOTES
facts and figures agg.indd 68
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