The context for supply and demand of public online services in Greece

Greece, officially known as The Hellenic Republic, is the southernmost country on the European mainland. The country is divided into 13 administrative regions, nine mainland and four insular. These are further subdivided into 51 prefectures (nomoi), each with an elected prefect (nomarkhis). The current government's decentralisation policy has led to greater political influence for the regions.

According to the latest official census paper (National Statistical Service of Greece, 2001) Greece has a population of 10.9 million inhabitants. Of those, 65.7% live in the urban centres and 34.3% inhabit the rural areas. Although the country's population is increasing steadily, it is important to consider the elevated immigration rates during the past 15 years. In 1991, 11.7 per 1,000 inhabitants were migrants, significantly above the respective EU15 average, which was 3.2. Ethnic minorities come mainly from the northern bordering countries, such as Albania and Bulgaria.

Key figures about Greece[1]

	Greece	Ø EU15	Ø EU25
Old age dependency ratio	25.8	25.5	24.5
Population density	83.2	119.8	116.3
GDP per head	82.7	108.6	100
GDP Growth - 5 year average	4.14%	1.85%	1.92%
Unemployment rate	10.5%	8.1%	9.0%
Inequality index	33	30	29

Although Greece is striving to develop and strengthen its economy, GDP indicators reveal that it is still lagging behind in comparison to the rest of the EU, despite being one of its senior members. However, the Bank of Greece notes that "macroeconomic stabilisation has been accompanied by healthy growth rates. Since 1996 output growth has exceeded the Euro area average. Greek growth has averaged 3.5 per cent compared with 2.4 per cent in the Euro area as a whole"[2].

Unemployment in the country is a critical issue, as in most of the EU. Even though the unemployment rate for men is below the EU average, women are far more affected by unemployment, thus raising total unemployment to 2 percentage points above the EU15 average. Also, part-time employment is limited for both sexes, in contrast to the rest of the Union.

Greek households and businesses are rarely connected to the Internet although Internet service providers observe a clear rise in the demand for new computers and Internet connections. One reason for the slow penetration rates of the Internet in the country are believed to be high prices. Broadband penetration rates are still negligible, as DSL packages are available to the public only since 2003, and still at present networks only cover the three major cities.

Information society indicators[3]

	Greece	Ø EU15	Ø EU25
Households with Internet access	17%	45%	42%
Broadband penetration	0.2%	7.6%	6.5%
Price for Internet use basket	55.92	49.57	48.35
ICT expenditure as percentage of GDP	3.6%	3.2%	2.6%
Digital Divide Index	30.8	53.0	50.1

Greece's performance on the UN telecom index[4]

ICT expenditure is higher than the EU average, yet from an Information Technologies point of view this indicator is misleading since most of the expenses are actually destined for telecommunications. In fact, Greeks have a marked affinity for mobile telecommunications - with eight out of ten owning a mobile phone, although not using its WAP services.

eHealth in Greece

During the last couple of years there have been systematic efforts towards the design, development and deployment of advanced broadband eHealth services in various healthcare sectors, including primary care, pre-hospital health emergency management and hospital care. However, this effort has not yet achieved appreciable results and, for this reason, the public is not yet able to use online health services despite ample demand for them. In general, eHealth services are a much-awaited development since the Greek people are among the least satisfied with the National healthcare system in the EU. From a scale of one to ten they rate the quality of health services in the country with 3.7 in spite of the fact that Greeks actually have one of the largest ratios of doctors per inhabitants in the EU, which would normally be an indication of high quality service provision.

One way of explaining this paradox is that, in effect, the population in Greece is divided into two groups - in terms of healthcare provision - the advantaged that live in urban centres where there is a concentration of high-level medical expertise and equipment, and the less fortunate that inhabit the often secluded rural areas and islands, which suffer from poor quality and limited availability, of health services. Concerning this issue, there is a generic policy, the Information Society Initiative, for the provision of telemedicine services with the aim to improve healthcare provision all over the country though the use of Health Telematics Technologies, but unfortunately, it does not encompass any specific regulation to encourage the private sector to invest in this activity.

Key figures about the Greek Health System[5]

	Greece	Ø EU15	Ø EU25
Percentage satisfied with own health	84.8 %	82.5 %	79.8 %
Prevalence of long-term illness	13.0%	13.8%	20.0%
Doctors per 100,00 inhabitants	454	233	251
Health expenditure as percentage of GDP	6.8 %	7.4 %	7.3 %

Electronic health in Greece is still lagging, largely because of the weak Internet penetration in the country. Very few Greeks report having searched the Internet for health related matters (7.4%) in 2002 and, in any case, this was irrelevant for 66% of the population because they are not Internet users. In this light, it is not surprising that not many online health services, whether public or private are available to Greek citizens. eHealth portals only cover a limited range of online services. In the public sector, an example is the website of the Hellenic Centre for Infectious Disease Control (KEEL) that, besides health information, provides information and contact details about its counselling, psychological support, social services, and psychiatric evaluation and monitoring. Other than that, some portals with integrated electronic services of the Regional Health System (PESI) have been announced and are expected to be ready within a two-year time frame. The situation in the private sector is not much different; the two main Greek Internet news and information portals contain sections on health matters, two targeted at the general public ( http://health.in.gr , http://news.pathfinder.gr/health ), and one targeted at professionals ( http://doctors.in.gr ). Also, a popular health and lifestyle magazine offers an online version with interactive features as the "Ask a doctor" ( http://vita.dolnet.gr ). These portals also play the role of mediator to other sites, mainly foreign ones, where users can find more information about their situation.

Availability of health information on the Web is slightly more elevated. One example is Iatronet ( www.iatronet.gr), which purports to help patients and professionals acquire carefully selected information about health, preventive medicine, nutrition, sports, personal diet and wellbeing. Other information websites such as this one exist, but they are more oriented to professionals, focussing on specialised topics.

With regards to the online presence of pharmacies, according to current legislation, pharmacies are not authorised to sell any pharmaceutical products over the Internet. As a result, Greek pharmacies with websites only provide information and sell non-medical products, such as beauty products, online.

Moreover, health related administrative transactions over the Internet are scarce: The National Social Security Organisation (IKA) allows users to print out and transfer insurance stamps but no other administrative transaction service is available to the public.

Satisfaction with National Healthcare System[6]

Primary healthcare in Greece is provided through a variety of settings, both public and private. This fragmentation creates disparities in the access to, and the quality of the provided services, in addition to problems of allocation of resources, and ultimately diminishes their effectiveness. As a consequence, there is an absence of standardised eServices provided through websites. An exception is the small number of public health clinics and private GPs that offer healthcare services and information online. In particular, an increasing number of specialists tend to develop personal websites not for mere professional publicity, but also to provide health information.

In some cases, websites also provide interaction tools for the public. Besides e-mail, which is currently offered by all such sites, health and medical information in terms of question and answer forms are provided so that the public can ask more personal questions. These services are similar to online consultation, and do not cover any other form of interactive service (e.g., test results or prescription renewal). Similarly, there is no fully operational service with online diagnosis.

General Practitioners with Websites[7]

With regards to alternative communication and consultation means for obtaining healthcare, due to the transportation difficulties in remote areas (about 80% of the country is mountainous or hilly), telephone consultation has already been utilised extensively in the public and private healthcare sector. A number of telephone services are currently offering consultation. The most typical situation is the provision of diagnosis or even prescription of a medication by a family doctor who is familiar with the history of the patient. Additionally, there are a few structured 24-hour, 7 days per week consultation telephone services that cover time critical cases. The providers of such services are the National Centre of Emergency Assistance (EKAB), the Organization Against Drugs (OKANA) and the National Centre of Poisoning.

Additionally, IKA (the largest Social Security Organisation in Greece) introduced, in 2003, an open line for doctor appointments all over Greece. Those insured with IKA can - by means of a single phone call (call number 184) or by visiting the health care unit - arrange an appointment with a doctor of their choice. This service is supported by a data processing system, which enables scheduling of patient appointments for medical, laboratory and hospital tests.

User orientation in eHealth services

In Greece, eHealth service delivery remains fragmented and uncoordinated. No major investments have been made by the private sector due to the financially unrewarding nature of the services. As yet, there have been no specific legal provisions concerning health technologies, which has led to technologies being introduced without standards or formal consideration of user needs. However, new laws that are being introduced may assure that online service quality, cost effectiveness, and appropriate use of health technology will receive more attention.

During the last decade, considerable progress in the development of the Hellenic Health System has taken place. Socio-economic change, public health initiatives, and progress in medical care have enhanced basic health indices, such as life expectancy, and have raised public expectations concerning health and healthcare. As a result, health professionals have to cope with a continuously growing demand for quality services, including services that take advantage of new technologies. However, the impact of this demand for quality and universal access of online health services is still restricted due to the fact that public and private budgets for this kind of investment have been stagnant or even declining in recent years.

Internet Use for Searching Health Information[8]

Despite limited investments, the Hellenic government has published a White Paper on the Development of the Information Society in Greece in the coming years ("Information Society" Initiative). The Paper stresses the importance of ICTs in the continuous improvement of the quality of life. More specifically, in the healthcare sector, initiatives are geared towards the introduction of IT systems in hospitals, their interconnection with the national communication infrastructure, the training of healthcare personnel in new technologies, and the provision of incentives for the development of telemedicine applications. In addition, the creation of a unified electronic patient file is being promoted, and measures for the safety, confidentiality and reliability of telemedicine services are being formulated.

The Ministry of Health and Welfare is implementing a number of projects for the improvement of health and welfare services with the use of ICT. In this respect, the prospect of a further diffusion of ICT in the healthcare sector is expected to entice investment in telemedicine services and telecommunication applications, mainly from the private sector. However, policies regarding online or telephone-based consultations need to be drawn up since the health regulatory framework in Greece only predicts face-to-face interaction with the doctor. Special care needs to be taken in the future to include a legal framework to regulate the new means of interaction between patients and doctors

In the spotlight: HYGEIAnet

The policy framework aims to improve the overall level of medical services, to provide better access to healthcare services, and to manage resources in the healthcare sector in a rational and fair manner. A number of information technology-related actions are being planned and implemented. They are based on the idea that technological challenges for the future in the area of healthcare will be directly associated with the requirement for access to more and better information in a usable and accessible manner. The actions planned are, for the time being, of a pilot nature and due to the fact that some of them have not yet yielded the expected results, the public has not yet been informed of their outcomes.

With regards to user orientation of the eServices, there is no specific policy that covers the needs of end users. Usefulness, usability, accessibility and all other service characteristics that determine user orientation are being examined per project, in the specific context of use or application, and there are no generic rules that developers or providers are obliged to follow.

On the other hand, Greece has achieved scientific excellence in research and development of health telematics and telemedicine solutions. For example, the Centre for Medical Informatics and Health Telematics Applications of ICS-FORTH develops technologies for Electronic Health Care Records, Mobile Health, Medical Imaging and Biomedical Informatics. Many of the technologies developed by the Centre are deployed and used in various hospitals, health centres, ambulances (EKAB), etc. The Centre has also obtained a number of international awards for some of its software technologies. However, no currently deployed service is targeted to citizens or patients.

eUser - the Project

The eUser study is funded by the European Commission's IST (Information Society Technology) programme. eUser is a major research and support project which has set out to provide solid evidence as to users' real needs regarding eGovernment, eHealth and eLearning offers, as well as providing data about their attitudes and the uptake levels of current public online services. The project supports the IST programme to achieve its key objectives of putting the user and his/her needs at the centre of IST developments. It provides empirical information on key public eServices domains -eGovernment, eHealth, eLearning - identified as priorities by the European Council, and assesses the demand/supply match in these fields.

The eUser Approach

To achieve its objectives, eUser addresses both generic user-related issues and domain-specific topics, and develops a globally accessible repository of evidence-based knowledge, methods and best practice examples. It pursues an extensive programme of active knowledge translation, transfer and dissemination supported by sophisticated online knowledge dissemination tools. The knowledge base will consolidate both existing knowledge and approaches, and novel data generated by the project through representative population surveys (demand side) in old and new Member States, and through comparative analyses of readiness to address user aspects of public eServices in each Member State (supply side).

The project is designed in two phases. Phase I - the preparatory phase - has developed a conceptual framework that systematically identifies and cross-references user issues and service characteristics in relation to online public services. An EU-wide population survey regarding the needs, experiences and requirements of both current and potential users of online public services has been carried out in early 2005. Concerning the supply side, information from national public sector environments has been collected, about the degree to which the European public sector pays sufficient attention to user-orientation of online services. Good practice examples regarding user-appropriate online public service provisions are being identified and described.

All these results build the basis and provide content for the eUser interactive online knowledge base and support service which is being set up as an online observatory on user issues. This constitutes the basis for active support services on user-centred topics which are being made available inside and outside the IST programme.

eUser Country Briefs

This document has been prepared by FORTH based on information from primary research as well as secondary data sources such as Eurostat and other Commission Services.

25 eUser eHealth Country Briefs are available in a common format, one for each member of the enlarged European Union. You can access and download these documents in PDF format (for free) from our website.

Notes About The Data Sources Used In This Document