The Hellenic Competition Commission (HCC) has published the final report of its wide-ranging sector inquiry into the provision of private health services and related insurance services, highlighting rising costs, transparency concerns, and growing market concentration.
The inquiry, designed to gather broad input from stakeholders including consumers, health providers, and insurers, assessed both the competitive landscape and the regulatory framework governing the sector. The Commission used surveys, questionnaires, and two public teleconsultations to inform its findings.
Rising Demand and Household Burden
The report notes a sharp increase in demand for private health services over the past five years, with the public health system struggling under limited investment and a shrinking number of hospitals. In 2023, households directly covered 34% of total health spending, largely through co-payments and out-of-pocket expenses. Private insurance accounted for only 4.3% of spending, well below the EU average.
While foreign investment funds have been active in acquiring providers, overall market concentration remains moderate. However, regulatory asymmetries in licensing and clinic expansion — with three parallel regimes in place — have created a “three-speed” private clinic sector, distorting competition. The Commission recommends further rationalizing the framework to allow clinics to expand capacity and meet growing demand.
Shifting Insurance Models
The private health insurance sector has grown steadily, with demand for policies rising by around 10% between 2023 and 2024. Yet the nature of contracts has changed: long-term policies have sharply declined, replaced by annually renewable plans that offer insurers more pricing flexibility.
The market remains moderately concentrated, with the four largest insurers negotiating directly with Greece’s major hospital groups. Management companies play a key intermediary role, handling claims and negotiations for most insurers. Two firms dominate this niche, raising questions about market power and access to sensitive commercial data — though the report found no evidence of collusion.
Vertical Integration Raises Competition Risks
The report flags a growing trend toward vertical integration between insurers and healthcare providers, a development that could reduce patient choice. Notable examples include the acquisition of Ethniki Insurance by the CVC-backed Hellenic Healthcare Group and Generali’s recent purchase of Euroclinic. Such integration, the Commission warns, risks steering patients toward large groups at the expense of competition.
Mounting Costs and Pricing Concerns
Both health services and insurance premiums have seen steady price increases, driven by higher morbidity, aging populations, and rising hospital care costs. The Commission highlights high price opacity and discrimination, making it difficult for patients to compare services or anticipate future insurance costs.
It also warns that the planned introduction of a new index to replace the EDY could inadvertently dampen competition, especially if based on a narrow pool of insurance plans. Index-based pricing, the report cautions, risks becoming a focal point for tacit collusion.
Calls for Greater Transparency and Consumer Protection
The HCC stresses the need for standardized, easily comparable price lists for clinic services, as well as clearer health insurance contract terms. Improving transparency, the Commission argues, would strengthen consumers’ negotiating position and stimulate competition.
The report also urges policymakers to ensure that competition considerations are integrated into health policy design from the outset, to avoid regulatory distortions that undermine consumer welfare and economic efficiency.
Looking Ahead
The HCC concludes that effective competition in the private health and insurance sectors is crucial not only for affordability but also for quality. It calls for regulatory reforms, stronger consumer protections, and careful oversight of market integration trends to safeguard patients and ensure a sustainable, competitive health ecosystem in Greece.
