Overview
Greece has a universal healthcare system which allows for citizens to seek care through both public and private outlets. The country’s public system includes around 130 general and specialized hospitals. Greece also has 13 military and 2 university hospitals. The Mitsotakis administration, which began a second term in June 2023, has vowed to implement many necessary healthcare sector reforms. The 2023 budget for health expenditure, which totals $10.9 billion and represents 10.4% of the total budget, focuses on early diagnosis and prevention, particularly for breast, cervical and colon cancers, cardiovascular diseases, and childhood obesity. Within the budget, funding is allocated to building and upgrading 157 health centers and 80 hospitals. As the healthcare system is severely understaffed, the budget includes hiring for 6,000 new positions and increasing doctor’s salaries by 10% to attract and retain talent. $255 million is allocated to the digital transformation of the healthcare system, which will represent strong opportunities for data and IT solutions providers.
After years of underinvestment in the healthcare system during the financial crisis, Greece’s health expenditure is expected to see a 4.2% annual growth rate (CAGR) in 2023. Experts predict health expenditure will reach 10.7% of GDP by 2027, to match the European average. Private expenditure will see a more substantial increase, while government expenditure will maintain a steadier pace of growth.
Greek citizens also have the option of using the private healthcare system. Private healthcare providers generally offer a higher standard of care and shorter waiting times than their public counterparts. There are 139 private hospitals in Greece and the majority of private sector operations are smaller clinics.
Most major multinationals are present in the market, with many having local partnerships and productions. U.S. healthcare firms have strong ties to Greece. Pfizer opened an innovation center in Thessaloniki in 2021, and firms including Jansen, Merck and Lilly, among others, have local productions facilities throughout the country.
Pharmaceuticals
Greece’s pharmaceutical market is forecast to grow by 8.2%: from $7.5 billion in 2022 to $7.8 billion in 2023. By 2027, the market is predicted to reach $9.8 billion. However, there are significant structural issues in Greece that must be addressed to maintain sustainable market growth for the pharmaceutical sector. Market expenditure is well below pre-financial crisis levels. The pharmaceutical market in Greece remains challenging for innovative drugmakers due to aggressive pricing mechanisms and restrictive government policies. Greece’s clawback system for pharmaceutical products was implemented as a measure to help balance the budget following the 2010 financial crisis and clawback amounts that companies pay have increased considerably over the past decade. Innovative products pay greater clawback amounts, in some cases up to 70% of the final product price. The Greek government has committed to reducing clawbacks in compliance with European Union requirements under the Recovery and Resilience Plan, with phased reduction by 2025, and has implemented some measures to offset pharmaceutical expenditure clawbacks through R&D and investment expenses. While this relieves some pressure for the industry, significant changes are necessary to secure the entry of new innovative medicines into the market.
The government is expected to continue to rationalize pharmaceutical spending by setting pricing ceilings on patented drugs in order to promote the use of more cost-effective generic medicines. Greece is one of the few countries in the European Union to have a relatively high minimum price for generics, set at $6.60.
Greece is currently struggling to overcome a problem with a lack of drug availability. This shortage is a global phenomenon due to a lack of raw materials and packaging materials combined with global supply chain issues due to the war in Ukraine and the energy crisis. These factors have resulted in a significant shortage of over-the-counter medicines. Regarding arrears, while there is significant improvement in the last few years, there are still high payment deficits and payment delays suppliers.
Medical Devices and Diagnostics
Greece’s medical device market is expected to grow at an annual rate of 5.1% to reach $1.4 billion by 2027. Market performance will be constrained by high inflation and high hospital debt, and the country will be impacted by underdeveloped domestic production. The medical devices sector will also continue to be hampered by complexities and delays in the reimbursement process, clawbacks, and delays in medical devices certifications.
As domestic producers do not have the manufacturing capability for high-valued medical equipment, over 80% of these products are imported. Although U.S. medical devices have opportunities in Greece, there is significant competition, particularly from EU firms. Greece imports the majority of its medical devices from Germany, Netherlands, and Belgium, with the People’s Republic of China (PRC) as the leading non-EU supplier. The U.S. is the eighth-largest provider of medical devices equipment to Greece. Major U.S. firms Johnson & Johnson, Medtronic, Boston Scientific, among others, are active in the market.
Medical devices must be approved by the European Commission before they can be marketed in Greece. In addition, the National Organization for Healthcare Provision (EOPYY) has its own medical devices approval register. Firms are encouraged to work with local distributors to help navigate both the EU and local requirements.
Opportunities
- Government Projects: As of July 2023, $3.4 million has been allocated to several hospitals in Western Greece to secure modern medical equipment. European Union Recovery and Resilience funds have designated $1.69 billion to the Greek healthcare system with expected procurements to occur in both the pharmaceutical and medical device categories. Medical equipment purchased by hospitals, especially CT and MRI apparatus, primarily replace obsolete technology. Entities interested in such opportunities need to work with a local partner to navigate the government tender process and comply with requirements. Our team can connect interested firms with potential local partners and distributors. Please see the tenders and contracts that are published by the Ministry of Health.
- Private Sector Projects: Several non-profit organizations and private hospitals are expected to develop healthcare infrastructure projects in the near term which will propel medical device purchases. The Stavros Niarchos Foundation (SNF) supports a series of infrastructure and education projects to improve the health sector in Greece and has put forward a proposal to build three new hospitals throughout the country. The agreement for the start of construction for the SNF General Hospital of Komotini, the SNF University Pediatric Hospital of Thessaloniki, and the SNF General Hospital of Sparta was signed on August 4, 2023. For more information visit SNF projects. The Onassis Foundation is developing the Onassis National Transplant Center, currently under construction, which will be the first and only organ transplant center in the country. For more information visit Onassis Health. As the country sees new investments in the hospital sector to improve Greek’s healthcare capacity and quality, we expect new opportunities for U.S. firms to partner in project management or provide medical equipment. For private opportunities, entities should engage with these entities prior to tender announcements to ensure that they do qualify to participate in such tenders once they are released.
- Opportunities in Health ICT: The strong need to digitize the healthcare system will provide opportunities to implement smart and connected technologies, including the implementation of electronic health records (EHRs) and harmonization of healthcare systems. A fragmented healthcare system based on geographic disparity has meant that a country-wide effort to digitalize has not yet been realized. Approximately $2.35 billion has been allocated to the digitalization of health care, and we expect opportunities in the implementation in the adoption of the National Electronic Health Record, a program to digitize patient records. Greece also has potential for development of AI and big data in the healthcare sector. For information on public sector tender opportunities, visit Health ICT public sector.
- Telemedicine: Although telemedicine in Greece has lagged behind other European countries, the Covid-19 pandemic has accelerated uptake that would have otherwise taken years. There could be opportunities for U.S. telemedicine solutions providers.
Resources
The Greek National Organization for Medicines (EOF) is the national competent authority for regulating pharmaceuticals. EOF was established in 1983, with Act 1316, and is a public entity of the Ministry of Health Social Solidarity. Its purpose is to promote the health and safety of the population by regulating medicinal, medical devices, blood and tissue products, biobanks and by actively developing the pharmaceuticals sector. Medical trade is duty-free within the EU. Import duties are collected from production coming from non-EU countries. Duties assessed on medical equipment imported from the U.S. vary by product, ranging from 5-12 %.
Hellenic Association of Pharmaceutical Companies
Association of Health – Research and Biotechnology Industry at https://www.seiv.gr/
American Hellenic Chamber of Commerce Pharmaceutical Committee: Pharmaceutical Committee
American Hellenic Chamber of Commerce Medical Devices Committee: Medical Devices & Diagnostics Committee
As a member of the European Union Greece’s legislation concerning medical devices complies with EU directives.
Intellectual property (IP) regulations in Greece are harmonized with EU procedures.
To learn more please contact Healthcare Specialist Mary Simopoulou at Mary.Simopoulou@trade.gov.