Welfare state transformations in Greece and the shrinkage of the NHS: refugee and migrant health policy (1999-2024)
Published:
Feb 5, 2025
Keywords:
health social policy refugees migrants privatisation securitization
Abstract
Health policy is an indicator of transformations of welfare states and a product of these transformations, also preserving its own dynamics. The article attempts a critical assessment of refugee and migrant health policy in Greece over the last 25 years, placing it in the context of securitization and reform of the public health sector in Europe based on the 'toolbox' of the New Public Management (NPM). Focusing on three dimensions of health policy (agenda-setting, financing, ensuring access to access to health care) we trace intersections and continuities in a process of intensifying securitisation and transformation of the NHS under the NPM paradigm. Fragmentation and privatisation, dependence on a precarious external (European) funding and barriers in all dimensions of access, have been a constant features of the last 25 years, not exclusively in periods 'crises'. Contrasting trends, both in 2015-16 and during the reception of refugees from Ukraine, have shown alternative possibilities, without reversing the enduring shrinkage of the NHS.
Article Details
- How to Cite
-
Παπαδάτος-Αναγνωστόπουλος Δ. (2025). Welfare state transformations in Greece and the shrinkage of the NHS: refugee and migrant health policy (1999-2024). Social Policy, 19, 59–80. https://doi.org/10.12681/sp.38692
- Issue
- Vol. 19 (2024)
- Section
- Articles
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution Non-Commercial License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g. post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Authors are permitted and encouraged to post their work online (preferably in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
Downloads
Download data is not yet available.
References
Βιβλιογραφία
Ξενόγλωσση
Abel-Smith, B. et al. 1994. Report on the Greek Health Services. Athens: Pharmetrica.
Abubakar, Ibrahim, Robert W Aldridge, Delan Devakumar, and Miriam Orcutt. 2018. “The UCL–Lancet Commission on Migration and Health: The Health of a World on the Move.” Lancet 392(10164): 2606–54.
Arrow, Kenneth. 1963. “Uncertainty and the Welfare Economics of Medical Care.” American Economic 33(5).
Björngren Cuadra, Carin. 2012. “Right of Access to Health Care for Undocumented Migrants in EU: A Comparative Study of National Policies.” European Journal of Public Health, Vol. 22, No. 2, 22(2): 267–271.
Bollini, Paola, and Harald Siem. 1995. “No Real Prograss Towards Equity: Health of Migrants and Ethnic Minorities on the Eve of the Year 2000.” Soc. Sci. Med. 41(6): 819–28.
Bozorgmehr, Kayvan, Louise Biddle, Oliver Razum, and Bayard Roberts. 2021. “Health Policy and Systems Responses to Forced Migration: An Introduction.” In Health Policy and Systems Responses to Forced Migration, eds. Kayvan Bozorgmehr, Bayard Roberts, Oliver Razum, and Louise Biddle. Cham: Springer Nature, 1–14.
Buzan, Barry, Ole Wæver, and Jaap de Wilde. 1998. Security. A New Framework for Analysis. London: Lynne Renner Publishers.
Carpenter, Mick. 2003. “On the Edge: The Fate of Progressive Modernization in Greek Health Policy.” International Political Science Review 24(2).
Carrera, S. et al. 2018. Update Study "Fit for Purpose? The Facilitation Directive and the Criminalisation of Humanitarian Assistance to Irregular Migrants. Brussels: European Union. https://www.europarl.europa.eu/RegData/etudes/STUD/2018/608838/IPOL_STU(2018)608838_EN.pdf.
Chauvin, Pierre et al. 2007. “Access to Health Coverage.” In European Survey on Undocumented Migrant’s Access to Health Care, Paris: Observatoire européen de l’accès aux soins de Médecins du Monde. Médecins du Monde, 28.
Council of Europe. 2013. Commissioner for Human Rights, Report by Nils Muižnieks Commissioner for Human Rights of the Council of Europe Following His Visit to Greece from 28 January to 1 February 2013, CommDH(2013)6. Strasbourg: Council of Europe: Commissioner for Human Rights.
Dardot, Pierre, and Christian Laval. 2022. “Η Επιχειρηματική Κυβέρνηση.” In Ο Νέος Λόγος Του Κόσμου. Ένα Δοκίμιο Για Τη Νεοφιλελεύθερη Κοινωνία, Αθήνα: Angelus Novus, 413–70.
Economou, Charalampos, and Claude Giorno. 2009. Improving the Performance of the Public Health Care System in Greece. Paris: OECD.
Economou, Charalampos, Daphne Kaitelidou, Marina Karanikolos, and Anna Maresso. 2017. Greece: Health System Review. Health Systems in Transition. eds. Charalampos Economou, Daphne Kaitelidou, Marina Karanikolos, and Anna Maresso. Copenhagen: European Observatory on Health Systems and Policies.
ECRE & Greek Council for Refugees. 2020. Asylum Information Database. Country Report: Greece (Update 2019). European Council on Refugees and Exiles (ECRE).
EquiHealth. 2013. Assessment Report: The Health Situation at EU Southern Borders - Migrant Health, Occupational Health, and Public Health.
European Commission. 2015. “Meeting on the Western Balkans Migration Route: Leaders Agree on 17- Point Plan of Action (25 October 2015).” https://ec.europa.eu/commission/presscorner/detail/en/IP_15_5904.
———. 2022. “Managing Migration: EU Financial Support to Greece.” https://home-affairs.ec.europa.eu/system/files/2022-01/202202_Eu Budget-financial support to greece.pdf.
Falkenbach, Michelle, and Scott L. Greer. 2018. “Political Parties Matter: The Impact of the Populist Radical Right on Health.” European Journal of Public Health (Nov; 28(Suppl 3)): 15–18.
Ferrera, Maurizio. 1996. A New Social Contract? The Four Social Europes: Between Universalism and Selectivity. Florence.
Fraser, Nancy. 2017. “Crisis of Care? On the Social-Reproductive Contradictions of Contemporary Capitalism.” In Social Reproduction Theory. Remapping Class, Recentering Oppression, ed. Tithi Bhattacharya. London: Pluto.
Freeman, Scott, and Mark Schuller. 2020. “Aid Projects: The Effects of Commodification and Exchange.” World Development 126.
Fundamental Rights Agency (FRA). 2015. “Healthcare Entitlements of Migrants in an Irregular Situation in the EU-28.” https://fra.europa.eu/en/publication/2016/healthcare-entitlements-migrants-irregular-situation-eu-28#publication-tab-0.
Geddes, Andrew, Leila Hadj Abdou, and Leiza Brumat. 2020. Migration and Mobility in the European Union. 2nd ed. London: Macmillan, Red Globe Press.
Gough, I. 2008. Η Πολιτική Οικονομία Του Κοινωνικού Κράτους. Αθήνα: Σαββάλας.
Hatziprokopiou, Panos, and Anna Triandafyllidou. 2013. Governing Irregular Migration: States, Migrants and Intermediaries at the Age of Globalisation.
Hood, Christopher. 1991. “A Public Management for All Seasons?” Public Administration 69(1): 3–19.
Huysmans, Jef. 2006. “Agency and the Politics of Protection. Implications for Security Studies.” In The Politics of Protection. Sites of Insecurity and Political Agency, eds. Jef Huysmans, Andrew Dobson, and Raia Prokhovnik. London and New York: Routledge, 1–18.
Immergut, Ellen M. 2021. “Health Politics Today.” In Health Politics in Europe: A Handbook. Edited by: , Oxford University Press, eds. Ellen M. Immergut, Karen M. Anderson, Camilla Devitt, and Tamara Popic. Oxford and New York: Oxford University Press, 3–31.
Ingleby, David et al. 2005. “The Role of Health in Integration. State of the Art Report.” In Social Integration and Mobility: Education, Housing and Health, eds. L. Fonseca and J. Malheiros. IMISCOE, 89–119.
Ingleby, David, and Roumyana Petrova-Benedict. 2016. “Recommendations on Access to Health Services for Migrants in an Irregular Situation: An Expert Consensus.” (October): 1–61. http://equi-health.eea.iom.int/index.php/9-uncategorised/336-expert-consensus.
Jowett, Matthew, Sarah Thomson, and Tamás Evetovic. 2015. “Changes to Public Funding for the Health System.” In Economic Crisis, Health Systems and Health in Europe. Impact and Implications for Policy, eds. Sarah Thomson et al. Berkshire and New York: European Observatory on Health Systems and Policies, 51–77.
Kapsalis, Apostolos. 2003. Migrants, Health and Social Exclusion. National Report. Athens: European Net for cooperation and exchanges about the social exclusion and health issues of migrants. MIGHEALTHNET.
Kentikelenis, Alexander et al. 2014. “Greece’s Health Crisis: From Austerity to Denialism.” Lancet 383(9918): P748-753.
Khan, Mishal S et al. 2016. “Pathogens, Prejudice, and Politics: The Role of the Global Health Community in the European Refugee Crisis.” The Lancet Infectious Diseases.
Kondilis, Elias et al. 2012. “Economic Crisis and Primary Care Reform in Greece: Driving the Wrong Way?” Br J Gen Pract. 62(598): 264–265.
Krause, Monika. 2014. The Good Project. Humanitarian Relief NGO’s and the Fragmentation of Reason. Chicago and London: The University of Chicago Press.
Lough, O., S. Phillips, A. Spencer, and M. Daigle. 2023. Beyond Survival: Exploring Wellbeing in Humanitarian Action. HPG Working Paper. London. www.odi.org/en/publications/beyond-survival-exploring-wellbeing-in-humanitarian-action/.
Lucassen, Leo. 2017. “Peeling an Onion: The ‘Refugee Crisis’ from a Historical Perspective.” Ethnic and Racial Studies.
Mladovsky, Philipa. 2009. “A Framework for Analysing Migrant Health Policies in Europe.” Health Policy (9): 55–63.
———. 2020. “Security over Health: The Effect of Security Policies on Migrant Mental Health in the UK.” In Health Policy and Systems Responses to Forced Migration, eds. Kayvan Bozorgmehr, Bayard Roberts, Oliver Razum, and Louise Biddle. Cham: Springer.
Mullen, Penelope M. 1991. “Which Internal Market? The NHS White Paper and Internal Markets.” In Markets, Hierarchies & Networks. The Coordination of Social Life, eds. Grahame Thompson, Jennifer Frances, Rosalind Levačić, and Jeremy Mitchell. London, Thousand Oaks, New Delhi: SAGE Publications and The Open University, 96–103.
Navarro, Vicente. 1977. “Social Class, Political Power and the State, and Their Implications in Medicine.” International Journal of Health Services 7(2): 255–92.
Nørredam, Marie, and Allan Krasnik. 2011. “Migrants’ Access to Health Services.” In Migration and Health in the European Union, eds. Bernd Rechel et al. New York: Open University Press: European Observatory on Health Systems and Policies Series.
Norredam, Marie, Anna Mygind, and Allan Krasnik. 2005. “Access to Health Care for Asylum Seekers in the European Union—a Comparative Study of Country Policies.” Access to health care for asylum seekers in the European Union—a comparative study of country policies 16(3): 285–289.
Papataxiarchis, Evthimios. 2022. “An Ephemeral Patriotism: The Rise and Fall of ‘Solidarity to Refugees.’” In Challenging Mobilities in and to the EU during Times of Crises, eds. Maria Kousis, Aspasia Chatzidaki, and Konstantinos Kafetsios. Cham: Springer, 163–84.
Parsanoglou, Dimitris. 2022. “Crisis Upon Crisis: Theoretical Reflections on Greece’s Response to the ‘Refugee Crisis.’” In Challenging Mobilities in and to the EU during Times of Crises, eds. Maria Kousis, Aspasia Chatzidaki, and Konstantinos Kafetsios. Cham: Springer and IMISCOE, 241–62.
Petmesidou, M., E. Pavolini, and A. M. Guillén. 2014. “South European Healthcare Systems under Harsh Austerity: A Progress–Regression Mix?” South European Society and Politics 19(3): 331–352.
Pollitt, Christopher, Sandra van Thiel, and Vincent Homburg. 2007. “Introduction.” In The New Public Management in Europe: Adaptation and Alternatives, eds. Christopher Pollitt, Sandra van Thiel, and Vincent Homburg. Basingstoke and New York: Palgrave MacMillan, 1–9.
Polyzoidis, Periklis. 2015. “NGOs and Social Welfare in Greece Reassessed: Comparative Insights and Crisis Repercussions.” In Austerity and the Third Sector in Greece. Civil Society at the European Frontline, eds. Jennifer Clarke, Asteris Huliaras, and Dimitri A. Sotiropoulos. Farnham and Burlington: Ashgate, 109–24.
Polyzos, Nikos et al. 2014. “The Introduction of Greek Central Health Fund: Has the Reform Met Its Goal in the Sector of Primary Health Care or Is There a New Model Needed?” BMC Health Services Research 14(583).
Popic, Tamara, and Guergana Stolarov-Demuth. 2021. “Regional Outlook. Southern Eastern Europe.” In Health Politics in Europe: A Handbook. Edited by: , Oxford University Press, eds. Ellen M. Immergut, Karen M. Anderson, Camilla Devitt, and Tamara Popic. Oxford and New York: Oxford University Press, 811–15.
Romero-Ortuño, R. 2004. “Access to Health Care for Illegal Immigrants in the EU: Should We Be Concerned? , 11(3),.” European Journal of Health Law 11(3): 245–272.
Saurman, Emily. 2016. “Improving Access : Modifying Penchansky and Thomas ’ s Theory of Access Improving Access : Modifying Penchansky and Thomas ’ s Theory of Access.” Journal of Health Services Research & Policy 2016 21(1): 36–39.
Simonet, Daniel. 2004. “Assessment of New Public Management in Health Care: The French Case.” Health Research Policy and Systems 12.
Skleparis, D., and I. Armakolas. 2016. “The Refugee Crisis and the Role of NGOs, Civil Society, and Media in Greece Columbia University.” In Balkan Human Corridor: Essays on the Refugee and Migrant Crisis from Scholars and Opinion Leaders in Southeast Europe, ed. D. L. Phillips. Columbia University, 81–97.
Spiegel, Paul, Rebecca Chanis, and Antonio Trujillo. 2018. “Innovative Health Financing for Refugees.” BMC Medicine 16(90).
Thomson, Sarah. 2015. “Changes in Health Coverage.” In Economic Crisis, Health Systems and Health in Europe. Impact and Implications for Policy, eds. Sarah Thomson et al. Berkshire: Open University Press, European Observatory on Health Systems and Policies, 79–104.
Tiihonen, Seppo. 2004. From Governing to Governance. A Process of Change. Tampere: Tampere University Press.
Voss, Maike, Katharina Wahedi, and Kayvan Bozorgmehr. 2010. “Health Security in the Context of Forced Migration.” In Health Policy and Systems Responses to Forced Migration, eds. Kayvan Bozorgmehra, Bayard Roberts, Oliver Razum, and Louise Biddle. Cham: Springer, 119–40.
WHO. 2020. “Constitution of the World Health Organization (1946).” In Basic Documents. Including Amendments Adopted up to 31 May 2019, World Health Organization. https://apps.who.int/gb/bd/pdf_files/BD_49th-en.pdf#page=7 (accessed: 22.7.2020).
WHO Regional Office for Europe. 2015. “Greece: Assessing Health-System Capacity to Manage Sudden Large Influxes of Migrants.” World Health Organization Report: 1–28. http://www.euro.who.int/en/publications/abstracts/greece-assessing-health-system-capacity-to-manage-sudden,-large-influxes-of-migrants-2015%0Apapers3://publication/uuid/8332554C-AD30-4196-BE88-F820F6CB890E.
———. 2018. No PUBLIC HEALTH without REFUGEE and MIGRANT HEALTH. Report on the Health of Refugees and Migrants in the WHO European Region. Copenhagen. https://apps.who.int/iris/bitstream/handle/10665/311347/9789289053846-eng.pdf?sequence=1%26isAllowed=y.
World Health Orgranization. 2020. “Greece: Assessing Health Systems Capacity to Manage Large Influx of Refugees and Migrants in an Evolving Context.” (December).
Ελληνόγλωσση
Αδαμακίδου, Θεοδούλα, and Αθηνά Καλοκαιρινού-Αναγνωστοπούλου. 2008. “Το Οργανωτικό Πλαίσιο Της Πρωτοβάθμιας Φροντίδας Υγείας Στην Ελλάδα.” Νοσηλευτική 47(3): 320–33.
Γεωργούλας, Στράτος. 2001. “Η Νέα Μεταναστευτική Πολιτική Στην Ελλάδα Και η Νομιμοποίησή Της.” In Μετανάστες Στην Ελλάδα, eds. Αθανάσιος Μαρβάκης, Δημήτρης Παρσάνογλου, and Μίλτος Παύλου. Αθήνα: Ελληνικά Γράμματα, 199–226.
Ευρωπαϊκή Επιτροπή. 2015. “Ευρωπαϊκό Πρόγραμμα Δράσης Για Τη Μετανάστευση [COM(2015) 240 Final].” https://eur-lex.europa.eu/legal-content/EL/TXT/PDF/?uri=CELEX:52015DC0240.
ΚΕΕΛΠΝΟ. 2016. “Γνωμάτευση Για Την Κατάσταση Των Κέντρων Φιλοξενίας Προσφύγων Από Την Οπτική Της Δημόσιας Υγείας.” https://eody.gov.gr/Portals/0/Αρχεία/Νέα - Ανακοινώσεις/2016/Γνωμάτευση Κέντρων Φιλοξενίας_21-7-2016.pdf (ανάκτηση: 7.7.2020).
Κονδύλης, Ηλίας et al. 2023. Η Εξέλιξη Του Υγειονομικού Προσωπικού Στα Νοσοκομεία Του ΕΣΥ Πριν Και Κατά Τη Διάρκεια Της Πανδημίας. Θεσσαλονίκη.
Κουραχάνης, Νίκος. 2019. Πολιτικές Στέγασης Προσφύγων. Αθήνα: Τόπος.
Κωτσονόπουλος, Λουδοβίκος. 2016. Η Χαμένη Συναίνεση. Κοινωνικό Κράτος, Καπιταλισμός, Δημοκρατία. Αθήνα: Ίδρυμα Σάκη Καράγιωργα.
Λινού, Αθηνά, Πάνος Χατζηπροκοπίου, Ιωάννα Κοτσιώνη, and Έλενα. Ριζά. 2009. Έκθεση Για Την Υγεία Των Μεταναστών Στην Ελλάδα. Αθήνα: Ιατρική Σχολή – Εργαστήριο Υγιεινής, Επιδημιολογίας και Στατιστικής Ιατρικής.
Μπάγκαβος, Χρήστος, and Νίκος Κουραχάνης. 2022. Όψεις Εργασιακής Ενσωμάτωσης Των Προσφύγων. Αθήνα: Τόπος.
Μπένος, Αλέξης. 1996. “Γενικός Ιατρός: Ηγέτης Της Ομάδας ΠΦΥ ή Διαχειριστής Υπηρεσιών Και Πόρων;” In Η Πρωτοβάθμια Φροντίδα Υγείας Στην Ελλάδα, eds. Γιάννης Κυριόπουλος and Τάσος Φιλαλήθης. Αθήνα: Θεμέλιο & Ακαδημία Επαγγελμάτων Υγείας, 207–217.
———. 2021. “Κοινωνικός Προσδιορισμός Της Υγείας Και Ανισότητες Στην Πανδημία COVID-19.” In COVID-19. Πανδημία Και Οι Σύγχρονες Απειλές Στη Δημόσια Υγεία, eds. Ηλίας Κονδύλης and Αλέξης Μπένος. Αθήνα: Τόπος.
Οικονόμου, Χαράλαμπος. 2004. Πολιτικές Υγείας Στην Ελλάδα Και Τις Ευρωπαϊκές Κοινωνίες. Αθήνα: Διόνικος.
Παπαδάτος-Αναγνωστόπουλος, Δ Κουραχάνης, Ν, Μακρίδου, Ε. 2020. Η Διαχείριση Της Επιδημικής Κρίσης COVID-19 Στους Προσφυγικούς Πληθυσμούς Στην Ελλάδα. Κριτική Ανάλυση. Θεσσαλονίκη: Κέντρο Έρευνας και Εκπαίδευσης στη Δημόσια Υγεία, την Πολιτική Υγείας και την Πρωτοβάθμια Φροντίδα Υγείας.
Πεμπετζόγλου, Μαρία. 2015. “Σχέσεις Δημόσιου-Ιδιωτικού: Η Ευρωπαϊκή Εμπειρία Και Οι Επιλογές Της Μεταρρύθμισης.” In Υγεία Και Μακροχρόνια Φροντίδα Στην Ελλάδα, eds. Μαρία Πετμεζίδου et al. Αθήνα, 181–210.
Προεδρία της Ελληνικής Δημοκρατίας. 2016. “Ανακοίνωση Της Προεδρίας Της Δημοκρατίας Για Τη Σύσκεψη Των Πολιτικών Αρχηγών Υπό Τον Πρόεδρο Της Δημοκρατίας.” https://www.presidency.gr/anakoinosi-tis-proedrias-tis-dimokratias-gia-ti-syskepsi-ton-politikon-archigon-ypo-ton-proedro-tis-dimokratias/.
Σαλβάνου, Αιμιλία. 2022. Αρρώστια Και Περίθαλψη Στη Μικρασιατική Καταστροφή Και Στους Πρόσφυγες. Αθήνα: Εφημερίδα των Συντακτών.
Συνήγορος του Πολίτη. 2017. Η Πρόκληση Των Μεταναστευτικών Ροών Και Της Προστασίας Των Προσφύγων. Ζητήματα Διοικητικής Διαχείρισης Και Δικαιωμάτων. eds. Μαρία Βουτσίνου et al. Αθήνα: Συνήγορος του Πολίτη.
Υπουργείο Μεταναστευτικής Πολιτικής. 2016. “Ν. 4375/2016. Οργάνωση Και Λειτουργία Υπηρεσίας Ασύλου, Αρχής Προσφυγών, Υπηρεσίας Υποδοχής Και Ταυτοποίησης.” Εφημερίδα της Κυβερνήσεως.
Φιλαλήθης, Τάσος. 2023. “Το Εθνικό Σύστημα Υγείας: Προσδοκίες, Αντιστάσεις, Επιτεύγματα, Απογοητεύσεις.” In Υγεία, Κοινωνία, Κράτος: Διακόσια Χρόνια Δυτικής Στροφής, ed. Κατερίνα Γαρδίκα. Αθήνα: Τράπεζα Πειραιώς και Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών, 73–84.
Φούσκας, Θεόδωρος, and Χαράλαμπος Οικονόμου. 2014. “Μεταναστευτικές Ροές Προς Την Ελλάδα Και Επιπτώσεις Στη Δημόσια Υγεία: Εποχική Γρίπη ή Ανίατη Ασθένεια;”
