Through the implementation of Voluntary Environmental Agreements (VEAs) and Sustainable Balanced Scorecard, a Health Care Region will be able to significantly increase the sustainability performance of the operation of its sustainable health facilities. A systematic literature review was conducted in environmental management policies in the healthcare system, in order to define the environmental footprint in the Greek health sector. VEAs are used as a policy tool to promote environmental innovation in local hospitals, as well as the Sustainable Balanced Scorecard for method tools to assess the sustainable performance of local hospitals in a health care region. The operation of local hospitals has a number of negative effects and a significant number of positive effects on the local environment under proper environmental management policies and innovation. This has also been mentioned in the reports of the governmental-NHS Sustainable Development Unit (SDU), and international, non-governmental organization-Health Care Without Harm (HCWH). Local hospitals, both public and private, are now more than ever invited to adapt to the new developments and move towards a more environmental and social friendly mentality- strategy in the regional health care system. The need to address modern environmental problems should lead to the creation of Voluntary Environmental Agreements (VEAs) to every health care region, which will promote the health care sustainable development goals in local hospitals. The Sustainable Balanced Scorecard could give a trustworthy sustainable performance evaluation of the local hospitals, to create a commonly shared sustainable language, which is especially crucial for an organization made up of so many highly skilled, diverse and strong-willed professionals.

Public procurement is generally an important sector of the economy and, in most countries, is controlled by the introduction of regulatory and policy mechanisms. In the Greek healthcare sector, recent legislation redefined centralized procurement through the reestablishment of a state Health Procurement Committee (EPY), with an aim to formulate a plan to reduce procurement costs of medical devices and pharmaceuticals, improve payment time, make uniform medical requests, transfer redundant materials from one hospital to another and improve management of expired products. The efforts described in this paper began in early 2010, under the co-ordination of the Ministry of Health (MoH) and with the collaboration of senior staff from the International Monetary Fund (IMF), the European Commission (EC) and the European Central Bank (ECB). The procurement practices and policies set forth by EPY and the first measurable outcomes, in terms of cost savings, resulting from these policies are presented. The importance of these measures is discussed in light of the worst economic crisis faced by Greece since the restoration of democracy in 1974, as a result of both the world financial crisis and uncontrolled government spending.