Reducing private health expenditure in Greece: the case for regulated complementary health insurance

Greece records the highest level of private health expenditure in the European Union, driven largely by out-of-pocket payments that undermine financial protection and exacerbate inequities. Despite universal coverage, benefit gaps, cost-sharing arrangements, and limits in publicly financed service availability shift a substantial financial burden onto households. Within a dual insurance system, voluntary private health insurance frequently overlaps with public benefits and does little to reduce excessive out-of-pocket spending. A regulated complementary health insurance framework, embedded within a three-tier financing structure, could convert part of private spending into pooled and prepaid contributions while preserving the primacy of public coverage. Targeted regulatory, institutional, and design reforms are therefore proposed to ensure that complementary insurance supports equity-oriented health financing rather than reinforcing disparities.