14 April 2016 Helliniko
Implementation of the New Law for the Uninsured, What are the facts?
A week and more has passed since the publication of the joint ministerial decisions A3/25132 enacting the new law concerning the access of the uninsured to the Greek Public Health system. Based on these decisions, here is what we see regarding the new law.
The positive thing about it is that the unworkable three member committees have been eliminated. Also, the requirement that the uninsured accept hospital costs as pubic debt to go on their tax bill is no more. The uninsured will also be able to have diagnostic tests, though only at public health facilities. And a very very few uninsured patients will be able to obtain medication at no cost.
Having said that, there is no way to describe the new law as universal and cost free access to the health system for the uninsured. And here is why:
1) Diagnostic Tests: The uninsured can only have diagnostic tests from the woefully inadequate and over-stretched public health facilities. This means that, in reality, only a few can use it. In many areas of the country, the public primary health faculties (PEDY) don’t have basic equipment for CT scans etc. The insured have the right to go to private facilities, with their public insurance paying a good portion of their tests. The uninsured will not
For example, in Chania, Crete (a good sized town) there is no dermatologist in any public health facility – so the only choice for the uninsured is private providers. There is only one endocrinologist at the hospital and none at the local PEDY. Additionally basic specialties aren’t represented in the PEDY, such as pediatrician, cardiologists, etc. They have no ability whatsoever to carry out basic tests such as thyroid hormones tests, INR (for those who take blood-thinners) etc.
We take Chania as an example because their situation is relatively good, with fewer gaps than many places and the hospital does have CT scan and MRI equipment. But here is the strange thing: If an uninsured person needs to have an MRI of the brain, for example, first he has to be examined by a neurologist who must issue an electronic prescription for the MRI. What neurologist? There isn’t one at the PEDY in Chania. If this can occur, not just in a village but in a good sized town, then where will uninsured patients turn?
2) Pharmaceutical coverage: The uninsured have had access to electronic prescriptions from the health system since the summer of 2014. What they did not have was access to either no or reduced co-pays for prescription drugs. With the new law, a very small number of patients will have access to medication with no additional payment. The income scale to qualify for this doesn’t bear comment. Maximum incomes are 2,400€ per year for a single person, and 6,000€ for a family with four dependents, or a single parent family with five dependents.
So, what’s going to change? The majority of uninsured patients will still be dependent on social solidarity clinics. If they can’t find one, then we’re back to patients not getting proper care and more disease and illness and increased mortality.
3) Radiation therapy: The waiting period for radiation therapy is on average 4 months in the public health system. Uninsured cancer patients don’t have the right to have these therapies from private providers with coverage by the state system. So they have to wait, with all the negative consequences to health and life-span that that implies.
4) Funding: the budget for covering medical and pharmaceutical expenses of uninsured patients is only 100 million Euros, which is terribly small.
- The law does not insure universal health care and most certainly not cost free access to health care.
- The waiting times at the public hospitals for diagnostic tests will increase dramatically. The result being that the uninsured who have no other choice, and the insured who don’t have the economic wherewithal to meet the co-pays of private test centers associated with EOPPY will have their diagnostic tests seriously delayed, and as a result, their therapy seriously delayed as well.
- The majority of uninsured patients will continue to not take needed medicines – or in the best of cases, will have difficulty in following needed drug therapy.
- As far as cost free hospital care for the uninsured, we’ll reserve judgement for a few months, to see how it works in practice.
Unfortunately, the step forward taken by the new law is a very small one. The impact on public health and the morbidity and mortality rates will continue their downward spiral. Austerity Kills.
In the two weeks or so since the Ministerial Decisions were issued and the Primary Health Clinics (PEDY) doctors still do not have the ability to give uninsured the electronic medical prescriptions needed for diagnostic tests.
METROPOLITAN COMMUNITY CLINIC AT HELLINIKO
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