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Not surprisingly, health care costs per head in Greece are the lowest in the European Union and the country spends a relatively small percentage of its GDP on health. Public and private medicine operate alongside each other in Greece and complement one another, although public health facilities are limited in some areas, particularly on the islands. Transfers from provincial and island hospitals to hospitals in Athens or other major hospitals (e.g. the University Hospital at Ionnina) are common.

The government is currently improving the health system and a substantial investment (much of which comes from EU funding) is being made on upgrading the country’s existing hospitals, building new facilities (e.g. a large hospital on Corfu is scheduled to open in 2005), developing mobile medical units, installing high-tech equipment, and improving accident and emergency facilities.

GGreece’s public health system (IKA) provides free or low cost health care for those who contribute to Greek social security, plus their families and retirees (including those from other EU countries). Members are charged 25 per cent of the actual cost of prescriptions, although there are higher charges for non-essential medicines plus substantial contributions for many services, including spectacles, dentures and other treatment. Essential dental treatment is largely free.

IIf you don’t qualify for health care under the public health system, it’s essential to have private health insurance. This is recommended in any case if you can afford it, owing to the inadequacy of public health services and long waiting lists for specialist appointments and non-urgent operations in some areas.

Visitors to Greece should have holiday health insurance if they aren’t covered by a reciprocal arrangement. Note that the EU Health Card (old Form E-111) covers basic medical care only and it’s advisable to have extra holiday insurance to cover eventualities such as repatriation.

Greeks are among the world’s healthiest people and have one of the highest life expectancies in the EU. The incidence of heart disease is among the lowest in the world, which is attributed in large part to their diet (which includes lots of garlic, olive oil and red wine), as is that of cancers. However, the country has a high rate of smoking-related health problems and the proportion of smokers is one of the highest in the EU.

If you need to see a specialist you don’t need a referral from your doctor. Specialists generally have waiting lists, but if it’s urgent you can usually pay to see a private specialist and claim up to 85 per cent of the cost from IKA afterwards. Free home visits by doctors are uncommon, although you can arrange one for a small fee.

Hospitals

Emergency treatment is free to all nationalities in public hospitals and there are outpatient clinics (yatr’a) attached to hospitals in rural areas. They’re typically open from 8am to noon and treat minor health problems and it’s often easier to obtain prompt emergency treatment here than at a public hospital.

There are 24-hour emergency hospitals in major towns and on the large islands, and private hospitals and clinics in major towns and resort areas. English-speaking Greek doctors and foreign doctors practise in resort areas and major cities, and advertise in the local expatriate press. In a medical emergency you should phone 166 for an ambulance.

Chemists

Pharmacists are highly qualified in Greece and you can obtain treatment for minor ailments at chemists (farmak’o) as well as medical advice. In larger towns and resort areas, pharmacists often speak English.

Pharmacies aren’t usually open in the afternoon or at weekends, but a duty roster is posted in pharmacy windows and published in the local press indicating the nearest pharmacy that's open outside normal business hours.

Homeopathic remedies are widespread and there are homeopathic pharmacies in most large towns.

If you’re visiting, living or working in Greece, it’s extremely risky not to have health insurance for your family, because if you’re uninsured or under-insured you could be faced with some very high medical bills.

When deciding on the type and extent of health insurance, make sure that it covers all your family’s present and future health requirements before you receive a large bill. A health insurance policy should cover you for all essential health care whatever the reason, including accidents, e.g. sports accidents, and injuries, whether they occur in your home, at your place of work or when travelling. Don’t take anything for granted, but check in advance.

If you’re planning to take up residence in Greece and will be contributing to Greek social security, you and your family will be entitled to subsidised or (in certain cases) free medical and dental treatment. The Greek national health system is operated by the Idrima Kinonikon Asfalisseon (IKA).

When you start work or retire to Greece you must obtain a medical booklet (iatrico vivliario) from your local IKA office, which must be presented each time you visit a doctor or hospital. Doctor and hospital treatment within the Greek system is free, but you will be charged 25 per cent of the cost of prescriptions (pensioners pay 10 per cent).

Most foreign residents also subscribe to a complementary health insurance fund that pays the portion of medical bills that isn’t paid by social security. Residents who don’t contribute to social security should have private health insurance, which is mandatory for non-EU residents when applying for a visa or residence permit. Note that some foreign insurance companies don’t provide sufficient cover to satisfy Greek regulations, therefore you should check the minimum cover necessary with a Greek consulate in your country of residence.

If you live in a remote area of Greece that isn’t covered by a local IKA office, you’ll have to pay the cost of any medical treatment in advance and re-claim it from the nearest IKA office. However, the refund will be only a proportion of the cost (up to around 85 per cent) and you will be responsible for the balance. If you receive treatment under these circumstances, it’s necessary to obtain receipts and documentation in order to make a claim.

If you contribute to Greek social security, you and your family are entitled to free or subsidised medical and dental treatment.

Benefits include general and specialist care, hospitalisation, laboratory services, discounted drugs and medicines, basic dental care, maternity care, appliances and transportation (four-fifths of the cost is paid by IKA). The vast majority of the Greek population is covered by the Idrima Kinonikon Asfalisseon (IKA), Greece’s public health scheme, including retired EEA residents (with a residence permit) receiving a state pension.

If you aren’t entitled to public health benefits through payment of Greek social security or being in receipt of a state pension from another EU country, you must usually have private health insurance and must present proof of your insurance when applying for your residence permit. If you’re an EU national of retirement age, who isn’t in receipt of a pension, you may be entitled to public health benefits if you can show that you cannot afford private health insurance.

Anyone who has paid regular social security contributions in another EU country for two full years prior to coming to Greece is entitled to public health cover for a limited period from the date of their last contribution. Social security form E-106 or the European Health Card (EHC) must be obtained from the social security authorities in your home country and be presented to the local provincial office of IKA in Greece. Similarly, pensioners and those in receipt of invalidity benefits must obtain form E-121 or the EHC from their home country’s social security administration. Retirees living in Greece and receiving a state pension from another EU country are entitled to free state health benefits.

You will be registered as a member of IKA and given a social security card, a list of local medical practitioners and hospitals, and general information about services and charges. If you’re receiving an invalidity pension or other social security benefits on the grounds of ill health, you should establish exactly how living in Greece will affect those benefits.

In some countries there are reciprocal agreements regarding invalidity rights, but you must confirm that they apply to you. Citizens of EU countries can make payments in their home country entitling them to use public health services in Greece and other EU countries.

Further information about Greek social security can be obtained from IKA (Tel. 520-055 564, www.ika.gr.en/english).

If you aren’t covered by Greek social security, you should take out private health insurance.

It’s advantageous to be insured with a company that will pay large medical bills directly. Most private health insurance policies don’t pay family doctors’ fees or pay for medication that isn’t provided in a hospital, or there’s an ‘excess’ payment that often exceeds the cost of treatment. Most will, however, pay for 100 per cent of specialists’ fees and hospital treatment in the best hospitals.

Generally, the higher the premium, the more choice you have regarding doctors, specialists and hospitals. You should avoid a company that reserves the right to cancel a policy when you reach a certain age, e.g. 65 or 70, or which increases premiums sharply as you get older, as trying to take out a new policy at the age of 65 or older at a reasonable premium is difficult. If you already have private health insurance in another country, you may be able to extend it to cover you in Greece.

Private health insurance is popular among the Greeks and there are numerous national companies offering policies, including Alico AIGlife (www.alico.gr), Ethniki Asfalistiki (www.ethniki-asfalistiki.gr), Generali (www.generali.gr) and La Vie Assurance (www.iatriko.gr).

Foreign private health insurance companies with policies covering Greece include AXA PPP Healthcare (www.axappphealthcare.com), BUPA International (www.bupa-intl.com), Exeter Friendly Society (www.exeterfriendly.co.uk) and International Health Insurance (www.ihi.com).

Note that almost all hospitals and clinics included under foreign private health insurance schemes are situated in Athens or Thessaloniki.

Visitors spending short periods in Greece, e.g. up to a month, should have a travel health insurance policy, particularly if they aren’t covered by an international health policy.

If you plan to spend up to six months in Greece you should either take out a travel policy, a special long-stay policy or an international health policy, which should cover you in your home country and when travelling in other countries. Note that premiums vary considerably and it’s important to shop around.

Most international health policies include repatriation or evacuation (these may be optional), which may also include shipment (by air) of the body of a person who has died abroad to his home country for burial. Note that an international policy also allows you to choose to have non-urgent medical treatment in the country of your choice.

Most international insurance companies offer health policies for different areas, e.g. Europe, world-wide excluding North America, and world-wide including North America.

Most companies offer different levels of cover, for example, basic, standard, comprehensive and prestige levels of cover. There’s always an annual limit on the total annual medical costs, which should be at least €300,000 (although many provide cover of up to €1.2 million), and some companies also limit the fees for specific treatment or care, such as specialists’ fees, operations and hospital accommodation. A medical examination isn’t usually required for international health policies, although pre-existing health problems are excluded for a period, e.g. one or two years.

Claims are usually settled in major currencies and large claims are usually settled directly by insurance companies (although your choice of hospitals may be limited). Always check whether an insurance company will settle large medical bills directly, because if you’re required to pay bills and claim reimbursement from an insurance company, it can take several months before you receive your money (some companies are slow to pay). It isn’t usually necessary to translate bills into English or another language, although you should check a company’s policy. Most international health insurance companies provide emergency telephone assistance.

The cost of international health insurance varies considerably depending on your age and the extent of cover. Note that with most international insurance policies, you must enrol before you reach a certain age, e.g. between 60 and 80, to be guaranteed continuous cover in your old age.

premiums can sometimes be paid monthly, quarterly or annually, although some companies insist on payment annually in advance. When comparing policies, carefully check the extent of cover and exactly what is included and excluded from a policy (often this is indicated only in the very small print), in addition to premiums and excess charges.

In some countries, premium increases are limited by law, although this may apply only to residents of the country where a company is registered, and not to overseas policyholders. Although there may be significant differences in premiums, generally you get what you pay for and can tailor premiums to your requirements.

The most important questions to ask yourself are: does the policy provide the cover required and is it good value for money.  If you’re in good health and are able to pay for your own out-patient treatment, such as visits to your family doctor and prescriptions, then the best value may be a policy covering only specialist and hospital treatment. .