All EU Member States have been taking measures to control the cost of health care, but only to a limited extent in Greece. Moreover, there is considerable convergence in the policies adopted. The methods employed differ according to the way in which their health care systems are organised and financed. Where the government or the main health insurers own their health care facilities and pay health professionals on a salaried basis - what the International Labour Organisation calls the direct system of financing - control is easier than where health care providers are contracted by the government or the main insurers - the indirect system of financing (ABEL-SMITH and MOSSIALOS, 1994).
Cost containment measures can operate on consumer demand or on supply. The most common measures acting on consumer demand are described here as cost-sharing. Two further measures to restrict demand for publicly financed services are a no claim bonus (in an insurance scheme) and the introduction of income tax concessions for those who decide to use private services. Another approach is to reduce demand for health services by introducing more promotive and preventive action. Cost containment measures acting on supply include: introducing expenditure ceilings through prospective budgets, sometimes reinforced by controls on manpower; adopting less costly alternatives to in-patient care; influencing authorising behaviour; reducing the production of doctors and hospital beds; limiting the use of technologies and controlling pharmaceutical prices. These measures aim to contain expenditure through simply reducing costly services, providing incentives to adopt more cost-effective treatments or both.
Cost containment measures are seldom introduced singly. Where more than one measure is introduced, it becomes difficult to separate the effect of each one separately. This confounding is likely to be more pronounced with a major reform.
What may appear to be the effect of a cost containment measure may in fact be simply a reflection of an international trend. For example, an increase in turnover of hospitals may be due to technological change influencing all or most countries, such as the introduction or spread of key-hole surgery or day surgery. Thus national data needs to be compared with international data. But such comparisons need to be carefully chosen and carefully handled, in view of the possible lack of comparability of concepts.