Greece could benefit from a National Cancer Fund, supported by ‘health taxes’, study suggests

Greek health economists support the creation of a €1,4 billion National Cancer Fund, a strategy for financing oncology care that leverages existing revenues, such as excise duties.

The total cost of cancer management in Greece is estimated at around €1.35 billion, corresponding to about 8% of total health expenditure. The equivalent figure in EU countries averages around 9% to 9.5% of total health expenditure.

“An important percentage of that sum is public spending, but there is also a not insignificant part that is private,” Kostas Athanasakis, Assistant Professor of Health Economics and Health Technology Assessment at the Department of Public Health Policies, University of West Attica, told Euractiv.

“Policies around cancer should be supported with funds so that the public sector’s role is strengthened; strengthening the role of the public sector is key to addressing inequalities in cancer,” he added, commenting on a recent study by the Institute of Health Economics (i-hecon), that is based on the WHO’s best practice of combining subsidies and health taxes. Professor Athanasakis is also head of i-hecon.

Public spending accounts for 62% of health expenditure in Greece and private for 38%, while in Europe as a whole, they account for 78% and 22% respectively.

‘Non-traditional’ funding

“Cancer is an issue of high priority for Greece,” Athanasakis said, explaining that future steps towards forming a National Plan should be based on designing an effective strategy, and they will need adequate resources in order to be implemented.

Discussions on strengthening Greece’s efforts on battling cancer in all fields, from prevention to rehabilitation or palliative care, peaked after the Greek health minister, Adonis Georgiadis, announced last February that the ministry is drafting the long-awaited National Cancer Plan. It was paired with the enactment of the national cancer registry.

According to Athanasakis, health systems are gradually starting to rely on multiple sources of funding beyond the traditional ones, such as taxation and social security contributions.

“The last few years, in the discussion internationally, the so-called ‘health taxes’ have started to emerge,” he added, explaining that it is - at its core - a public health policy which focuses on taxing products that have proven negative impact on health, such as tobacco, alcohol and sugar-sweetened beverages.

“Its first goal is to prevent the consumption of said products, in combination with other public health interventions. That also produces a fiscal outcome, a revenue,” the Professor explained. “Earmarking this revenue for supporting the health system is vital for the success of a policy on health taxes,” he added.

“We propose, if not all, a significant part of that revenue is directed towards cancer policies in order to support equity in access for the population,” he said.

The goal is to incentivise consumers to choose the better options.

“We already collect excise duties, a part of which could be directed towards health, and we can examine if it can be expanded. For this approach to work properly, it must combine taxes on the products that have proven negative impact on health with subsidies on beneficial products,” Athanasakis told Euractiv.

Interconnection and patient experience

“We must ensure that [the action plan] transitions from paper to practice and focus on how it will be implemented,” George Kapetanakis, President of the Hellenic Cancer Federation (ELLOK), explained to Euractiv.

“We know on which pillars the strategy should be based on, thanks to the European action plan. However, what we are observing in cancer care [in Greece] is the existence of silos, that is, the fragmentation of cancer care,” Kapetanakis warned.

He pointed out that whatever important actions are taken so far do not have the expected impact on patients and the health system. “Through overall strategic planning, we could achieve better interconnection between actions, giving an intersectoral dimension to cancer care,” he added.

As Kapetanakis explained, that means that in addition to cancer management, prevention is approached through collaboration between different ministries, not only health but also education, finance, digital governance, energy, environment and so on.

“It also means that we support and ensure rehabilitation and reintegration into society, and of course, palliative care,” Kapetanakis stressed.

According to the head of ELLOK, “Because this is a complex and multifactorial framework, and experience has shown that it cannot be easily created through standalone initiatives or decisions, interconnection is important so that the information can be used throughout the system.”

An important piece of information for Kapetanakis is patient experience: “In this environment, the needs, preferences, experiences and outcomes of the patients are pivotal and need to be taken into consideration because it will allow us to move to the right direction, evaluate and redefine the elements that may need amendment.”

Industry support

In a press event organised by Bristol Myers Squibb Greece last June, the need to accelerate the development and implementation of a National Strategic Plan for Cancer, as well as the need to ensure adequate funding for all stages of oncological care, was underlined.

“The Greek government has recently committed to developing and implementing a national cancer strategy. As Bristol Myers Squibb, one of the leading biopharmaceutical companies, our role goes beyond developing and delivering innovative medicines,” Elizabeth Prodromou, General Manager of BMS Greece, told Euractiv.

Prodromou added that the company is collaborating with “all involved state, scientific and social stakeholders to sustainably shield the country across all stages of cancer, from prevention and screening to treatment and palliative care.”

The proposed approach by the Institute of Health Economics moves in the right direction, as she explained: “This role is served by the scientific proposal for the establishment of a National Cancer Fund through earmarking revenues from health taxes on products with a negative impact on the disease burden.”

“We owe it to the patients and citizens in Greece to build a better healthcare system that approaches cancer holistically, shifting the focus from survival to quality of life,” Prodromou said.

[Edited by Brian Maguire | Euractiv’s Advocacy Lab]