Cooperation of Private Doctors with Public Hospitals

Legal Framework

The cooperation of private doctors with hospitals of the National Health System (NHS) was established by Article 11A of Law 2889/2001, as added by Law 5107/2024. For the first time, this provision allowed private doctors to collaborate with NHS hospitals to perform medical acts outside regular hours, including surgeries involving hospitalization.

Prior to this, private doctors (excluding contract-based ones) could not legally participate in public hospitals. Under this law, private doctors can use hospital facilities in exchange for compensation, covering all associated costs (operational, salary-related, staff remuneration). However, cooperation requires approval from the hospital’s Administrator, and further details are determined by a Joint Ministerial Decision (JMD) to ensure smooth and all-day hospital operations.

The JMD Γ2α/οικ.35764/11.08.2025 (Government Gazette B’ 4389/11.08.2025) issued by the Deputy Minister of National Economy & Finance and the Ministers of Health outlines the implementation details, specifying that private doctors of all specialties can perform medical procedures, participate in outpatient services, diagnostic, therapeutic, and interventional acts beyond regular hours, and conduct surgeries requiring hospitalization, as per Article 9(1) and (10) of Law 2889/2001.

To qualify for cooperation with NHS hospitals, a private doctor must:

• Be an active member of the local Medical Association
   
• Hold a valid medical license
   
• Hold a valid medical specialty title
   
• Be up to date with tax and insurance obligations
   

Further conditions include:

• No disruption to the regular or extended hospital schedule, especially the emergency roster
   
• No reduction in surgeries, consultations, or diagnostic procedures performed by NHS doctors during evening shifts
   

• The doctor applies to the hospital’s Administrative Service
   
• The hospital Director or Board Chair issues approval based on a recommendation from the head of the relevant department and the Medical Director
   
• Decision is issued within 20 days and communicated to the doctor within 5 working days
   
• A contract is then signed specifying:
   
  • Purpose and scope
     
  • Duration
     
  • Rights and obligations
     
  • Use of infrastructure
     
  • Staff collaboration terms
     
  • Reimbursement obligations
     
  • Participation in hospital operations, outpatient clinics, surgeries, and inpatient care
     
  • Fees, penalties for breach, termination terms, and oversight bodies
     

A draft contract is included as an annex to the JMD.

• Must hold professional liability insurance (min. €100,000 per incident, €1,000,000 annually)
   
• Must collaborate harmoniously with hospital staff
   
• Must monitor the patient’s health until discharge, even after surgery or invasive treatment
   
• May participate in educational, scientific, and research activities within their department
   

Compensation is defined per service:

• For participation in hospital operations and extended hours:
   
  • Visits: paid directly by patient via hospital
     
  • Other procedures: paid by patient’s insurance provider
     
• For surgeries requiring hospitalization:
   
  • Paid by patient via hospital
     
  • Fee aligned with that of a Coordinating Director / Professor
     
• For non-surgical inpatients:
   
  • Fee based on DRG severity:
     
    • €600 for very severe
       
    • €550 for severe
       
    • €400 for moderate
       
    • €250 for minor cases
       
• Hospitals charge an additional 20% fee for use of infrastructure
   
• All amounts are paid to the hospital, which clears and distributes to the doctor quarterly
   

If a doctor violates the terms:

• Cooperation license is revoked and the contract terminated
   
• Doctor is banned from reapplying for 1 year
   
• On second offense: 2-year ban
   
• On third: permanent ban from NHS cooperation
   

The Regional Health Authority enforces these measures.
Before any penalty, the doctor can submit objections within 10 days.

• License duration: 2 years, renewable upon application 1 month before expiry
   
• Doctors may terminate cooperation by submitting a termination request, with effect 1 month later
   
• Until then, they must fulfill all obligations, including shifts
   

• Hospitals must accept private doctors’ patients under the same terms as other patients
   
• Payments for non-regular hour services:
   
  • Visits: patient pays hospital
     
  • Diagnostic/interventional acts: insurance may pay
     
  • Surgeries: patient pays doctor via hospital
     
• DRG-based fees apply for inpatient care
   
• Doctors are paid set amounts, with no right to extra or informal fees
   
• The hospital withholds 20% as infrastructure usage fee
   
• Any extra payment beyond the contract constitutes a breach, leading to contract termination and possible disciplinary action by the Medical Association (e.g., reprimand, fine, suspension, or license revocation)
   

There are concerns regarding the constitutionality of setting fixed fees for private professionals. Critics argue this could conflict with Article 5(1) of the Constitution, which guarantees economic freedom, including the right to set one’s own fees.

Link for relevant Government Gazette : 

https://www.e-nomothesia.gr/kat-ygeia/iatroi/kya-g2a-oik-35764-2025.html#google_vignette