Countries reported using a wide range of strategies to adjust to having fewer financial resources. The challenge has been to maintain universal access to high quality health care by introducing policies that generate savings and efficiency gains. Under normal circumstances such policies are often a priority, but the crisis has provided additional impetus in many countries. The strategies countries adopted include efforts to:

  • adapt provider payment
  • strengthen pharmaceutical policy
  • prioritise and strengthen primary care access and quality
  • reduce costs by restructuring organisations and facilities
  • prioritise cost-effective investment
  • improve population health.


Publications

Belda-Iniesta C. Cost-effectiveness, cancer burden and financial crisis: a perfect storm. Clin Transl Oncol. 2012 Oct;14(10):713-4. 

Bernal-Delgado E, Campillo-Artero C, García-Armesto S. [Health services supply and the economic crisis: either we fund goods and services according to their value or we become bankrupt. SESPAS report 2014.]. Gac Sanit. 2014 Mar 22 [Epub ahead of print]

Burnett S, Mendel P, Nunes F, Wiig S, van den Bovenkamp H, Karltun A, RobertG, Anderson J, Vincent C, Fulop N. Using institutional theory to analyse hospitalresponses to external demands for finance and quality in five European countries. J Health Serv Res Policy. 2015 Dec 17. [Epub ahead ofprint] 

Carman AL, Timsina LR, Scutchfield FD. Quality improvement activities of local health departments during the 2008-2010 economic recession. Am J Prev Med. 2014 Feb;46(2):171-4. 

Christofidou M, Bartzavali C, Militsopoulou M, Anastassiou ED. The economiccrisis in Greece affects HCVRNA RTPCR determination. Dig Liver Dis. 2016Jan;48(1):98.

Clemens T, Michelsen K, Commers M, Garel P, Dowdeswell B, Brand H. European hospital reforms in times of crisis: Aligning cost containment needs with plans for structural redesign? Health Policy. 2014 Mar 18. [Epub ahead of print]

Domínguez-Rodríguez A, Méndez-Vargas C, Sánchez-Grande A, Avanzas P, Abreu-González P. Healthcare administration and the economic crisis: Apropos of a case. Gac Sanit. 2014 Jan 29 [Epub ahead of print] 

Fanourgiakis J, Kanoupakis E. Health technology assessment (HTA): a brief introduction of history and the current status in the field of cardiology under the economic crisis. J Evid Based Med. 2015 Aug 20. [Epub ahead of print].

Flokou A, Aletras V, Niakas D. A window-DEA based efficiency evaluation of the public hospital sector in Greece during the 5-year economic crisis. PLoS One 2017 May 23;12(5):e0177946. doi: 10.1371/journal.pone.0177946. eCollection 2017.

García-Armesto S, Campillo-Artero C, Bernal-Delgado E. Disinvestment in the age of cost-cutting sound and fury. Tools for the Spanish National Health System. Health Policy. 2013 May;110(2-3):180-5. 

Gené-Badia J, Gallo P, Hernández-Quevedo C, García-Armesto S. Spanish health care cuts: penny wise and pound foolish? Health Policy. 2012 Jun;106(1):23-8.

Hajiioannou J, Tsiouvaka S, Exarchos S, Lachanas V, Samara M, Skoulakis C, Bizakis J. Histopathologic examination of routine tonsillectomies in times of Greek austerity. Necessity or luxury? A retrospective study of 823 patients. Clin Otolaryngol. 2014 May 11. [Epub ahead of print] 

Horný M, Burgess JF Jr, Horwitt J, Cohen AB. Advanced Diagnostic Imaging in Privately Insured Patients: Recent Trends in Utilization and Payments. J Am Coll Radiol. 2014 May 7. [Epub ahead of print]

Janssen D, Jongen W, Schröder-Bäck P. Exploring the impact of austerity-driven policy reforms on the quality of the long-term care provision for older people in Belgium and the Netherlands. J Aging Stud. 2016 Aug;38:92-104

Karamanoli E. Greece's financial crisis dries up drug supply. Lancet. 2012 Jan 28;379(9813):302.

Kheirandish M, Rashidian A, Kebriaeezade A, Cheraghali AM, Soleymani F. A review of pharmaceutical policies in response to economic crises and sanctions. J Res Pharm Pract. 2015 Jul-Sep;4(3):115-22.

Krania E, Avgerinou E, Limaki E, Bartzis G, Mantzana V. E-prescribing in Greece: Myth or reality. Stud Health Technol Inform. 2013;190:194-7. 

Leopold C, Zhang F, Mantel-Teeuwisse AK, Vogler S, Valkova S, Ross-Degnan D, Wagner AK. Impact of pharmaceutical policy interventions on utilization of antipsychotic medicines in Finland and Portugal in times of economic recession: interrupted time series analyses. Int J Equity Health. 2014 Jul 25;13:53.

Lievens D, Vander Laenen F, Christiaens J. Public spending for illegal drug and alcohol treatment in hospitals: an EU cross-country comparison. Subst Abuse Treat Prev Policy. 2014 Jun 30;9:26.

Majeed A. Primary care in Europe: entering the age of austerity. J Ambul Care Manage. 2012 Jul-Sep;35(3):162-6. 

Maynard A. Health Care Rationing: Doing It Better in Public and Private Health Care Systems. J Health Polit Policy Law. 2013 Aug 23. [Epub ahead of print] 

McHugh SM, Tyrrell E, Johnson B, Healy O, Perry IJ, Normand C. Health workforce planning and service expansion during an economic crisis: A case study of the national breast screening programme in Ireland. Health Policy. 2015 Sep 4. [Epub ahead of print]

Mladovsky P, Srivastava D, Cylus J, et al. Policy summary 5. Health policy responses to the financial crisis in Europe. World Health Organization on behalf of the European Observatory on Health Systems and Policies, 2012 

Niakas D. Greek economic crisis and health care reforms: correcting the wrong prescription. Int J Health Serv. 2013;43(4):597-602.

Nuti S, Vainieri M, Frey M. Healthcare resources and expenditure in financial crisis: scenarios and managerial strategies. J Matern Fetal Neonatal Med. 2012 Oct;25 Suppl 4:48-51. Review. 

O'Riordan M, Fitzpatrick F. The impact of economic recession on infection prevention and control. J Hosp Infect. 2015 Jan 7. [Epub ahead of print].

Palese A, Vianello C, Cassone A, Polonia M, Bortoluzzi G. Financial austerity measures and their effects as perceived in daily practice by Italian nurses from 2010 to 2011: A longitudinal study. Contemp Nurse. 2014;48(2):168-80. 

Pericás JM, Aibar J, Soler N, López-Soto A, Sanclemente-Ansó C, Bosch X. Should alternatives to conventional hospitalisation be promoted in an era of financial constraint? Eur J Clin Invest. 2013 Jun;43(6):602-15. 

Petrou P. Pharmacoeconomics in the years of crisis: a solution or just a resolution? A Cyprus perspective. Expert Rev Pharmacoecon Outcomes Res. 2014 Jun 23:1-10.

Petrou P, Vandoros S. Cyprus in crisis: Recent changes in the pharmaceutical market and options for further reforms without sacrificing access to or quality of treatment. Health Policy. 2015 Mar 17. [Epub ahead of print]

Petrou P, Talias MA. Navigating through the maze of pricing and affordability of branded pharmaceuticals in the midst of the financial crisis: a comparative study among five European recession countries, from a Cyprus perspective. J Pharm Policy Pract. 2016;9:8.

Pettoello-Mantovani M, Namazova-Baranova L, Ehrich J. Integrating and rationalizing public healthcare services as a source of cost containment in times of economic crises.Ital J Pediatr. 2016 Feb 24;42(1):18.

Polyzos N, Karanikas H, Thireos E, Kastanioti C, Kontodimopoulos N. Reforming reimbursement of public hospitals in Greece during the economic crisis: Implementation of a DRG system. Health Policy. 2013 Jan;109(1):14-22. Epub 2012 Oct 10. 

Polyzos N, Kastanioti C, Zilidis C, Mavridoglou G, Karakolias S, Litsa P, Menegakis V, Kani C. Greek National E-Prescribing System: Preliminary Results of a Tool for Rationalizing Pharmaceutical Use and Cost. Glob J Health Sci. 2016;8(10):55711.

Pompili M, Vichi M, Innamorati M, Lester D, Yang B, De Leo D, Girardi P. Suicide in Italy during a time of economic recession: some recent data related to age and gender based on a nationwide register study. Health Soc Care Community. 2013 Dec 6. [Epub ahead of print]

Reiter KL, Jiang HJ, Wang J. Facing the recession: how did safety-nethospitals fare financially compared with their peers?hospitals fare financially compared with their peers? Health Serv Res. 2014 Dec;49(6):1747-66.

Rooshenas L, Owen-Smith A, Hollingworth W, Badrinath P, Beynon C, Donovan JL. “I won't call it rationing": An ethnographic study of healthcare disinvestment in theory and practice. Soc Sci Med. 2015 Mar;128:273-81.

Saltman RB, Cahn Z. Restructuring health systems for an era of prolonged austerity: an essay by Richard B Saltman and Zachary Cahn. BMJ. 2013 Jun 24;346:f3972. 

Sbarouni V, Tsimtsiou Z, Symvoulakis E, Kamekis A, Petelos E, Saridaki A, Papadakis N, Lionis C. Perceptions of primary care professionals on quality of services in rural Greece: a qualitative study. Rural Remote Health. 2012;12:2156.

Schrijvers G. Global payment for health services as a solution in the financial crisis in Europe. Int J Integr Care. 2012 Oct 31;12:e228.

Shah GH, Ye J, Leep CJ, Leider JP. Local Health Departments' Approaches to Deal With Recession: What Strategies Are Used to Minimize the Negative Impact on Public Health Services to Community? J Public Health Manag Pract. 2015 Apr 22. [Epub ahead of print]

Shortt J. A historical perspective of the effect of the great recession on hospitals. AORN J. 2014 Aug;100(2):177-87.

Souliotis K, Papageorgiou M, Politi A, Frangos N, Tountas Y. Estimating the Fiscal Effects of Public Pharmaceutical Expenditure Reduction in Greece. Front Public Health. 2015;3:203. 

Sukkar E. Greeks feel effects of drug shortages caused by austerity measures. BMJ. 2012 May 21;344:e3589. 

Svaljek S. The recent health reform in Croatia: True reforms or just a fundraising exercise? Health Policy 2013 Oct 3 [Epub ahead of print]

Tsiachristas A, Lionis C, Yfantopoulos J. Bridging knowledge to develop an action plan for integrated care for chronic diseases in Greece. Int J Integr Care. 2015 Oct-Dec;15:e040.

Theodorou M, Georgiou M, Nikolentzos A, Bellali T. Reconsidering Planning and Management of Medical Devices Procurement in Public Health Services in Cyprus. Glob J Health Sci. 2015 Apr 19;7(6):44091. 

Thomas S, Burke S, Barry S. The Irish health-care system and austerity: sharing the pain. Lancet. 2014 May 3;383(9928):1545-6.

Ueda P, Kondo N, Fujiwara T. The fiscal crisis in the health sector: Patterns of cutback management across Europe. Health Policy. 2015 Jul;119(7):954-63

Vandijck D, Cleemput I, Hellings J, Vogelaers D. Infection prevention and control strategies in the era of limited resources and quality improvement: A perspective paper. Aust Crit Care. 2013 Aug 19 [Epub ahead of print] 

Vandoros S, Stargardt T. Reforms in the Greek pharmaceutical market during the financial crisis. Health Policy. 2013 Jan;109(1):1-6. 

Villalonga A. How to make savings in anaesthesia in times of financial crisis. Rev Esp Anestesiol Reanim. 2013 Mar;60(3):121-3.

Vogler S, Zimmermann N, Leopold C, de Joncheere K. Pharmaceutical policies in European countries in response to the global financial crisis. South Med Rev. 2011 Dec;4(2):69-79. 

Vogler S, Zimmermann N, de Joncheere K. Policy interventions related to medicines: Survey of measures taken in European countries during 2010-2015 medicines: Survey of measures taken in European countries during 2010-2015. Health Policy. 2016;120(12):1363-1377.

Vlastarakos PV, Kalampalikis E. The impact of the economic crisis on neonatal hearing screening in Greece. Cent Eur J Public Health. 2015 Mar;23(1):85-6.