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Household health expenditure in Greece

Principal Investigator: Dr Ilias Kyriopoulos

Household health expenditure represents a critical intersection of macroeconomic monitoring, distributional analysis, and financial vulnerability assessment. Health shocks and high out-of-pocket health costs can constrain aggregate consumption, amplify income shocks, increase household indebtedness, and create liquidity pressures that affect credit quality and financial inclusion. Understanding these dynamics and exploring health-related financial distress is important for comprehensive assessments of household financial resilience.

In the case of Greece, the issue of household health expenditure (HHE) is of particular policy relevance. Historically, Greece’s health financing has heavily relied on out-of- pocket payments. In 2023, Greece recorded the third-highest OOP expenditure among OECD countries, at 34% of total health expenditure compared to an EU average of approximately 15%. This reliance on household payments has long-standing implications for access to care, equity, and financial risk protection. Given their regressive nature, OOP payments disproportionately affect lower- income households, exacerbating existing socioeconomic inequalities.

From 2008 to 2024, Greece’s health system navigated successive pressures and has implemented several measures that may have influenced how households pay for health care. The economic crisis and ensuing fiscal consolidation lowered public health spending relative and introduced budget controls and higher user charges, shifting more costs to households and coinciding with increases in unmet need among groups facing unemployment, lack of insurance, or chronic illness. The COVID-19 pandemic brought temporary funding boosts but also service disruptions, backlogs, and a short-term tilt toward private provision, while the post-pandemic period has unfolded amid inflation and broader cost-of-living pressures. Despite reform attempts to improve coverage, private payments, including informal fees, medicines, and consultations, remain salient.

Examining household health spending over this period – spanning crisis, austerity, recovery and pandemic – can clarify distributional trends and inform evidence-based policy responses to moderate OOP burdens and strengthen health financing system in Greece.

Despite the clear policy relevance and importance, empirical evidence on HHE in Greece remains scarce. Regular publications provide only aggregate figures, which neither reveal the composition and distribution of HHE nor identify its drivers or the characteristics of the household most affected. Analyses based on micro-data – covering HHE and financial protection against the risk of illness – appear mainly in ad hoc academic studies.

The proposed project addresses this gap by focusing on five themes and addressing the following questions:

1. Trends and levels of HHE a. How did HHE evolve from 2008–2024, in absolute terms and as a share of total consumption/income? b. How do trends differ by household type, urban/rural status, and region?

2. Composition of spending

a. How has the mix of HHE changed across major categories (e.g., medicines, outpatient, inpatient, dental)? b. Which components drive changes in total HHE, and does this differ by household type or income group?

3. Determinants and drivers of HHE a. Which household characteristics are associated with higher HHE, and how have these associations changed over time?

4. Financial protection a. What is the incidence and intensity of catastrophic health expenditure over 2008–2024? b. What is the impoverishing effect of OOP payments? (changes in poverty headcount/gap/severity before and after health payments) c. Which spending components most affect financial protection? d. How do inequalities in catastrophic and impoverishing payments vary by socioeconomic status, region, and household type?

Research Team

  • Dr Ilias Kyriopoulos

    Principal investigator: Dr Ilias Kyriopoulos, Assistant Professor, Department of Health Policy, LSE; Programme Co-Director of the Executive MSc in Economics, Policy, and Management; Research Affiliate, HOC

  • Professor Elias Mossialos

    Co-Investigator: Professor Elias Mossialos, Cheng Yu Tung Chair in Global Health; Director of LSE Health

  • Effrosyni Choumpavli

    Co-Investigator: Effrosyni Choumpavli, Health Policy Associate, LSE Health