Eopyy.gov.gr

Eopyy.gov.gr

EOPYY (National Organization for the Provision of Health Services) is the main public health insurance organization in Greece, established in 2011 to manage a unified health insurance fund and act as the sole purchaser of publicly funded health services. Here are the key aspects of EOPYY:

Organization and Governance

- EOPYY operates under the supervision of the Ministry of Health as a self-governing public entity. - It functions as a monopsony, being the sole purchaser of health services for over 95% of the Greek population. - EOPYY is responsible for negotiating, contracting, and remunerating both public and private healthcare providers.

Key Responsibilities

- Manages the unified health insurance fund - Provides a comprehensive health benefits package through the Unified Health Benefits Regulation (EKPY) - Contracts with public healthcare providers (PEDY primary care networks and ESY hospitals) and private providers - Sets preconditions for contractual commitments with healthcare providers - Reimburses healthcare costs for insured individuals

Health Services Network

- Public providers: PEDY (primary care networks) and ESY (public hospitals) - EOPYY-contracted private providers: doctors, clinics, diagnostic laboratories, etc. - Offers primary, ambulatory, and hospital care services

Reimbursement and Pricing

- Uses a system of third-party payments with regulated patient co-payments - Reimburses contracted providers based on negotiated contracts, insurance prices, or state tariff lists - Hospital inpatient care is reimbursed using KENs (equivalent to Diagnostic-Related Groups) - Publishes reimbursement tariffs and contracted health professionals on its website

Patient Access and Benefits

- Insured individuals have access to a unified health benefits package - Services are provided through public and EOPYY-contracted private providers - Co-payments vary depending on the type of service and provider affiliation - Public facilities generally have no co-payment requirement for the EOPYY health benefits package

International Role

- Acts as the Greek liaison body for reimbursement of sickness benefits under EU Regulation 883/2004 - Serves as the competent institution for place of stay or residence in cross-border healthcare - Member of the European Healthcare Fraud and Corruption Network (EHFCN)

E-services and Tools

- Operates an e-prescription system for monitoring pharmaceutical consumption and referrals - Provides e-tools for accessing information on benefits, reimbursement tariffs, and contracted providers - Implements the e-disbursement initiative (e-DAPY) for services, costs, and administrative functions of private providers

Challenges and Reforms

- Established as part of major structural reforms in the Greek healthcare system - Aims to improve efficiency, transparency, and cost control in healthcare provision - Faces ongoing challenges in managing healthcare costs and ensuring access to services

EOPYY plays a central role in the Greek healthcare system, aiming to provide comprehensive health coverage while managing costs and improving efficiency in healthcare delivery.