Essential Public Healthcare Services Utilisation and Excess non-COVID-19 Mortality in Greece

Elias KondilisFilippos TarantilisAlexis Benos

Public Health

Available online 10 July 2021


Ensuring access to care for all patients - especially those with life threatening and chronic conditions - during a pandemic is a challenge for all healthcare systems. During the COVID-19 pandemic many countries faced excess mortality partly attributed to disruptions in essential healthcare services provision. This study aimed to estimate the utilization of public primary care and hospital services during the COVID-19 epidemic in Greece and its potential association with excess non-COVID-19 mortality in the country. 

Study design

Observational study.


Retrospective analysis of national secondary utilization and mortality data from multiple official sources, covering the first nine months of the COVID-19 epidemic in Greece (February 26th to November 30th, 2020).


Utilization rates of all public healthcare services during the first nine months of the epidemic dropped significantly compared to the average utilization rates of the 2017-19 control period; hospital admissions, hospital surgical procedures and primary care visits dropped by 17.3% (95% CI: 6.6%-28.0%), 23.1% (95% CI: 7.3%-38.9%), and 24.8% (95% CI: 13.3%-36.3%) respectively. This underutilization of essential public services – mainly due to supply restrictions such as suspension of outpatient care and cancelation of elective surgeries - is most probably related to the 3,778 excess non-COVID-19 deaths (representing 62% of all-cause excess deaths) that have been reported during the first 9 months of the epidemic in the country.


Greece’s healthcare system, deeply wounded by the 2008-18 recession and austerity, was ill resourced to cope with the challenge of the COVID-19 epidemic. Early and prolonged lockdowns have kept COVID-19 infections and deaths at relative low levels. However, this “success” seems to have been accomplished at the expense of non-COVID-19 patients. It is important to acknowledge the “hidden epidemic” of unmet non-COVID-19 needs and increased non-COVID-19 deaths in the country and urgently strengthen public healthcare services to address it.



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