ATHENS – In a ruling setting a key precedent, Greece’s highest administrative court ruled the country’s Single Social Security Entity (EFKA) must pay 100 percent of the costs of treatment in a private facility if it can’t be provided at a state hospital.
The decision from the Council of State said the expenses must be covered in a clinic not affiliated with the National Healthcare System in cases of emergency admissions, when there are no beds in state-run hospitals, or the hospital lacks the necessary diagnosis and treatment methods, or medical equipment isn’t working, said Kathimerini.
It came from a case that dating back to 2004 when the spouse of an insured man was admitted to hospital as an emergency in her sixth month of pregnancy.
The baby born prematurely had to be admitted to the neonatal intensive care unit for a private maternity hospital for two months. When an incubator was made available in Aghia Sofia state-run hospital, the baby was transferred.
EFKA agreed to pay only 8,599 euros of a total of 24,370 euros in hospital bills incurred by the insured, so the man sued and the high court found the social security fund is “obliged to provide its insured with hospital care and when it is objectively unable to do so, it must pay the entirety of the costs incurred by the insured due to this inability, and not only pay the difference.”