24 February 2016 Helliniko
What is this New Law for the Uninsured?
Are we speaking here of equal, universal and cost free access of uninsured patients to health care?
Or maybe it’s just another vague step taken by the government?
New health care legislation for the uninsured has just been passed by the Greek parliament. It is an effort to do away with the multiple basic faults and under-funding of the former ministerial decisions of 2014 (during the administration of former health minister Andonis Georgiadis). Under that scheme, there was no access whatsoever to diagnostic tests, no reduction in the co-pays for costs for medicines, and access to hospitals could only be claimed after patients cleared bureaucratic hurdles of numerous committees that never did anything.
Starting in 2010 when the first memorandum was launched, there has been a steadily unfolding drama of the uninsured – which affects some three million people (just under 1/3 of the population). Up to the summer of 2014 access to public health was not possible for these people. They had neither access to primary health care facilities (IKA-PEDY) nor to hospital care. The result of these policies was a rapid worsening of all health indicators in Greece. In the 2012 official statistics of the ELSTAT (Hellenic Statistical Authority) shows a marked increase in deaths, infant deaths, and more deaths than births. All the markers of public health took a dive.
From 2011 to 2014, the various ministers of health did not only fail to do anything, but had the audacity to declare there were no problems, even as cancer patients and other patients died because they had no help whatsoever. Such declarations, made with a straight face and no sign of any guilt, have been widely reported through news broadcasts and documentaries in the international media including CNN, BBC and others.
In the summer of 2014 after tremendous pressure from the movement of social solidarity clinics throughout Greece, the government then in power was forced to take action in the form of ministerial decisions. But still the uninsured were not given anything close to real access to public hospitals. Uninsured patients were unable to have diagnostic tests. The accounting department of the hospitals continued to charge for medical expenses and, as a condition of hospital admission, forced patients to sign an unethical “acceptance of debt”.
Social solidarity clinics and dispensaries started to appear in 2011 and have worked steadily since then. And every month, they have seen an ever increasing number of patients.
So, with this background, the present government, after an unjustified delay of more than 12 months, has passed a new law addressing equal and universal health care for uninsured patients in the public health system.
We can only make a first assessment while waiting for the new ministerial decisions which will give more form and detail to the law (and we do hope that they will be issued immediately to avoid any further delay). We are going to list some fundamental points and a lot of questions which the government should respond to promptly and with clarity.
A few fundamentals:
- We cannot talk about equal and universal access of patients to diagnostic tests when access is only to public health facilities. We continue to have citizens in two categories, a) the insured with access to both private health facilities affiliated with EOPPY as well as strictly public health facilities and b) the uninsured who can only access strictly public health facilities. In the provinces and rural parts of Greece, are primary health care facilities staffed with an adequate number of doctors and specialists? To which public health clinic, outside of a major city, can a patient find an endocrinologist, a cardiologist, pediatrician, etc? What public hospital, outside major cities, provides exams such as CT scans, MRI’s etc. Not to mention that in the more remote areas of Greece, the primary health care units are dramatically understaffed with almost no ability for diagnostic tests, and the public hospitals are in tatters. There is, as well, a tragic lack of resources throughout most of Greece.
- The 100,000 Euro for expenses is grossly inadequate
- The elimination of the three-member committee is a positive step. But will this, in practice, solve the problem of the uninsured receiving hospital care without onerous bureaucratic hurdles?
- The law does not give access to health care to immigrants without documentation and who don’t have long term health problems. A positive note is that are exceptions for certain categories such as children, pregnant women etc.
- The very large category of uninsured who owe money to their public health carriers will have their access to health care with terms and conditions that will be stipulated in ministerial decisions.
And this is when the questions start:
- What are the prerequisites and what are the terms and conditions for these patients?
- Why not disband ESAN? The private company that oversees budget management of public health facilities will “evaluate” them. Those that are negatively evaluated will be entrusted to the private sector (as put forth in the 3rd memorandum agreement).
- Will primary health facilities be staffed with the specialists that exist at present?
The new law for including the uninsured in the health care system is a step forward, but a faint-hearted one since it:
- Does not provide equal, cost free, universal health care to the uninsured.
- Does not provide for a substantial increase in public health spending.
- Does not substantially upgrade public primary health care facilities.
- Does not disband ESAN.
For this to happen, health care in Greece needs to be freed from the choke-hold of the Memorandum. The policies of austerity and the criminal reduction of expenditure in health care must be stopped.
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