To tell a very long story in a short space, here is a summary of the inequalities in health care that have taken place since austerity policies were introduced in Greece over the last years. Health care was far from perfect before the crisis started in 2008. But whatever the many faults of the system, one way or another, the general public had access to public health.
From the beginning of the crisis up to August of 2013, no government bothered much about the uninsured – who according to the president of EOPYY (Public Health Care Providers) reached more than 3 mln. in September of 2013. These people, most long term unemployed, were virtually cut off from pubic health care for having been without a job for more than two years, a limit set by OAED (the unemployment bureau). Those who had a serious illness were doomed to an early death – unless they could lay their hands on the necessary money. The rest put their families in debt as owing money to state hospitals was added to tax debt.
So what changed in August of 2013? For the first time since 2011, after the government had been under a tremendous pressure from the volunteer social solidarity clinics, the Minister of Health, Adonis Georgiadis came up with the health voucher system. It stated that 100,000 of the long term unemployed would be eligible for health care. But this was just a drop in the ocean. Many of the 3 mln people were in need f more than primary care. On top of that, they needed medicine, diagnostic tests and often very expensive therapies.
For the first time in January of 2014 the government decided to grant the uninsured partial access to the Greek Public Health System. This came about after the furor that broke out when a patient of MCCH died. He had been on a list of ten patients whose life was at risk which had been delivered to the Ministry of Health in December of 2013. Unfortunately the Ministry had not even responded, in spite of vigorous public campaign from the social clinics. On the day of the patients, death, the Ministry finally decided to react. On the day of our patient’s death, and for the first time since the crisis began, there started a pubic debate on the health problems of the uninsured that still continues. The Ministry finally admitted that there was a problem and the Minister of Health at the time, Mr. Georgiadis, proclaimed that, apart from the changes in primary health care, all uninsured patients would have access to the newly formed PEDY (Public Health Clinics). What the minister did not mention was that in just a month’s time, he forced 3,000 doctors out EOPYY after giving them the choice of keeping their private practice or working for PEDY, but not both. So PEDY had half the doctors to face providing primary health care for a vastly larger number of people. Very soon as many as half of the clinics had to close because they were understaffed and lacked physicians of various specialties.
In the summer of 2014, the government went a step further and granted secondary (hospitalization) health care to uninsured patients who needed it. Unfortunately, a patient had to pass inspection by a three person committee. Even today, these committees have not even been selected for most of the public hospitals. Patients are still waiting, as usual, and trying to cope with their illnesses in vain.
At the same time, the previous government took another step forward. Both insured and uninsured were allowed access prescription medicines bought with a contribution from the state. For the first time insured and uninsured could get medicines with the same co-pay level. But the co-pays were increased. The amount contributed by the patient surpasses more than 25% of the cost of the medicine. The average co-pay amount is 35-40% and in some extreme cases, can reach 75%. As a result, not only could the uninsured not afford medicines, but many of the insured couldn’t either. Finally, the previous government did nothing to allow the uninsured to have access to diagnostic tests.
These years of austerity have seen an increasing exclusion of the public from the Greek public health system. There have been unbelievable situations which have led to deaths because patients couldn’t afford the necessary care or necessary medication. The examples are numberless. Insured cancer patients having their treatments (booked way in advance) cancelled because the hospital no longer had the necessary funds to provide treatment. No alternative treatment center was suggested. Uninsured cancer patients, completely cut off from treatment, looking for alternative sources of treatment – sometimes for more than 6 months before they found help from a social clinic. An uninsured cardiac patient was literally ejected from surgery at Greek public hospital for not having 18,000 Euros to pay. In 2012, more than one maternity clinic kept new-borns from their mothers until they could pay delivery costs. All these cases were reported by the foreign press who got their facts from the voluntary community clinics that have been trying, all these years, to stop this uncivilized treatment.
Today we are not much better off than we were with the previous government. There is a new decision from the Ministry of Health to help the uninsured in conjunction with the social clinics. However this has not yet to be published in the government gazette, so the decision cannot be implemented as yet.
The direction is clear; the Greek public is increasingly excluded from the Greek Public Health System. This is particularly dangerous in a country with close to 2/3rds of the population living just above or below the poverty level. The biggest problem is the sheer lack of money in the Greek public health system. It renders useless any legal or ministerial efforts. Funding for the public health system has been reduced by 50% since 2009. Without this being addressed, nothing significant will change.*
communications team of the Metropolitan Community Clinic at Helliniko
*Note, this piece was written before the government signed the new memorandum in 2016, which promises a new round of reductions to the Greek Public Health system reducing spending to 0.5% of GDP, which means a further overall reduction of 933 million euros, against the GDP of 2014.