Healthcare in Time of Crisis

The Greek healthcare system was rocked by the economic crisis. What is the situation for Greeks and for health professionals today?

K. S. : Our new reality is defined by a loss of almost 100 billion dollars in GDP over four years (2009–2013), the biggest loss amongst OECD coun­tries. This led to an unemployment rate of well over 20 %, and even higher amongst the young. Under these cir­cumstances, public health policy is mostly limited to the application of the Memorandum of Understanding2 provisions to control expenditure. Per capita public health expenditure has decreased by 25 % (2010–2013) and public health funding by over five bil­lion euros (2009–2013). It is now one of the lowest amongst EU members in relation to the country’s GDP.

How does this situation impact the access to healthcare services?

K. S. : The Greeks are reporting in increasing numbers an inability to pay, even for a mere doctor visit. Public pharmaceutical expenditures have decreased from 5.3 billion euros in 2008 to 2 billion euros in 2015 – raising questions about what and who can be covered. Patients suffe­ring from life-threatening conditions increasingly face access hurdles.3 It has also impacted healthcare profes­sionals, because of the “no new hires” policy and of challenges with sup­plies. The extensive reduction in the number of doctors in 2014 made the much-needed reform of the system virtually impossible.

Are mutual support initiatives the best way to face the health crisis?

K. S. : Self-managed community health clinics and pharmacies, initiatives led by universities, municipalities or by the Church, are the best possible civil society responses to the crisis. Simi­lar initiatives were also deployed wit­hin the NHS,4 such as the community practice within the SOTIRIA Hospital Cancer Unit, which provides care to the uninsured. However, this citizen commitment cannot replace the State, and volunteers have begun to show signs of exhaustion.

How can Greece build a fairer future?

K. S. : It is critical that we start with funding. Most health inequalities stem from income inequality. In a country with over one million unemployed, it is paradoxical to link healthcare access to job status and expect universal coverage. Therefore, it is essential to address the needs of the uninsured, who are in excess of two million people. Greece is the only country with a health system funded equally by taxes and social contributions. Shif­ting healthcare funding to a purely tax-based system would cut employment costs, reduce the unemployment rate and raise the income of the employed. Equally critical to restoring equality is the integration of primary care ser­vices, a need persisting within the NHS for over thirty years. It is urgent that we assign a single attending physician as an initial contact to each citizen in order to better respond to the needs of those who do not have the means to cover their healthcare costs.

What role do you play in this ongoing reflection?

K. S. : Our research measures, reports and underlines obstacles met by patients when accessing healthcare as well as the impact of the econo­mic crisis on their living conditions. Our “HOPE” stu­dies have looked into the challenges faced by patients with rheumatoid arthritis, multiple sclerosis, cancer or Hepatitis C. We also submitted a proposal to reform the health system and published a book on an alter­native, one that would better respond to the obvious lack of patient parti­cipation in health decisions over the past decades. A pan-European study that we have just completed confirms the improved health outcomes due to patient group involvement.

Is the reconstruction of the health system a priority for the new government?

K. S. : Despite the bad practices and bud­get cuts that resulted from the Memo­randums, the healthcare system has been modernized over the past five years through the introduction of e-prescri­bing, e-diagnosis, treatment protocols and patient registries. New discussions are foreseen on pharmaceutical reim­bursement. The current government cannot merely look for ways to reduce spending, but needs to prioritize the needs of vulnerable patients.

By Hélène Martinez

1. University of the Peloponnese, Tripoli, Greece.

2. A number of reforms that Greece is committed to implement in exchange of a support from the European Union.

3. To know more, see the series of “HOPE” studies, University of Peloponnese.

4. National Health System.