Primary Health Care in Greece: Institutional Evolution, Sustainability Challenges and the Cultural Dimension

Primary Health Care (PHC) constitutes the structural and normative foundation of equitable, resilient, and sustainable health systems. In Greece, PHC has undergone a complex process of institutional evolution since the establishment of the National Health System (NHS) in 1983, culminating in the comprehensive reform of 2017. Despite successive legislative interventions designed to strengthen accessibility, continuity, and universality, the operational consolidation of PHC remains incomplete and structurally fragmented.

This article provides an institutional and theoretical analysis of PHC development in Greece through the lens of sustainability and health system resilience. It examines governance arrangements, financing mechanisms, workforce capacity, digital integration, and the implementation of the family physician model. Drawing upon contemporary PHC performance frameworks, health system governance theory, and sustainability scholarship, the study argues that the primary challenge lies not in legislative design but in persistent implementation gaps, structural underinvestment, weak coordination, and insufficient integration of social determinants.

Beyond institutional and economic dimensions, the paper conceptualizes the cultural and community dimension as a structural component of sustainability, linked to social capital, trust, and resilience. It concludes that the transition toward a sustainable PHC model in Greece requires systemic coherence, strategic resource allocation, workforce reinforcement, interoperable digital systems, institutionalized evaluation mechanisms, and integration of social and cultural determinants into health planning.