25 September 2017 Helliniko
Under Funding of the Greek Public Health System and Its Improvement Don’t Mix
During the entire summer the Greek government, and especially the Ministry of Health, has flooded the public with “information” on the many sided reform of the Primary Health Care System and the establishment of Local Healthcare Units (TOMY). But the foundations of these measures are not sound. Success requires ensuring the continued funding from the budget and the existence of a health map.
The Health Ministry admits that the TOMY will be funded for four years by “European sources because the domestic spending is not feasible.” This plan has the approval of “the institutions”. Long story short, we’re building a new primary health system with an ensured funding of only four years and, naturally for as long as the “institutions” agree. And this is what the Greek Ministry of Health is celebrating.
Something else that doesn’t bode well for such a system is the philosophy of “Gate-keeping” (the process of determining who will have access to the system) as well as the absence of a patient association in the scheme of things. One wonders whether this reform is not a danger to public health.
For the implementation of the 2017 budget the funding for hospitals and primary health care clinics was €200 million less than the target. Unfortunately the 2018 budget shortfall will be and additional €500 million. Instead of strengthening the budgets for hospital deficiencies such as ICU operation, hospitalization for the uninsured, etc, they are being further decreased (*1 & *2)
Last year the government voted in a law concerning the 3 million citizens who are uninsured, which allowed them cost-free access to the Greek public health system. But this took place without a substantial raise in the budget for the health care system. And this led to a deterioration of the primary and secondary health care systems which now has to care for a greater number of patients than before with fewer resources. The hospitals are underperforming as they try and save money for covering both the uninsured patients and operation of departments such as ICUs.
We know these are lean times, but they are skimping even on informing patients. Many of our fellow citizens don’t know anything about their rights. Simple solutions, such as having a telephone information line for the public hasn’t been instituted. The patients have to search by going from one public hospital to another to learn if they can have a medical exam (such as a ct scan) without cost. Most give up before they get the information they need. We publicly call on the Ministry of Health to state how many uninsured patients were prescribed diagnostic tests such as CT scans, MRIs, ultrasounds in the past year and how many of these exams were eventually carried out. Only then will we know if there is true access for uninsured patients to diagnostic tests.
At the same time the Greek Ministry of Health is jumping with joy at a donation of 200 million euro made to the Greek Public Health System by the Niarchos Foundation for equipment purchase. We believe that this is potentially a major mistake. Basically society will become addicted to the idea that the operation of the health system (and tomorrow the education system?) is not the responsibility of the government but depends on the Niarchos Foundations of this world and on the “charity” and “generosity” of outside sources.
The state could purchase the needed equipment if we could achieve the upgrading of the health services, without the aid of philanthropists. The amortization period of the purchase price would be short. To the simple question “where will the money be found” we answer “Ask EOPYY how many millions has been paid to so many private health centers. They know where to find the money.”
The public hospitals are underperforming and patients with serious illnesses, such as cancer are required to wait 3 to 6 months to begin radiation therapy. *3. Hospital supplies, such as gloves (!) are disappearing and therapists must use bags on their hands to clean the patients, or buy their own gloves *4.
The toxic cocktail of under-funding, vastly fewer patient appointments in relation to real need, a primary health care system imposed by the lenders and the WHO according to a failed model, no health map, lack of substantial public funding as well as an absolute lack or provision for preventative medicine means that the fight waged by the social clinics is not yet won.
The volunteer, social clinics have been fighting this good fight since the beginning of the memorandum period, with its austerity measures. We have asserted that existing law should cover the uninsured with access to the public health system. But sufficient funding is required for effective implementation of the law. And of course we must not forget our lenders. After intense struggle on the part of the social clinics and others, saw some headway. The second memorandum asked for the health care coverage of the uninsured, but at the same time austerity remained the order of the day. Why did they do that? Because they knew that whatever measures were passed into law, without proper funding, they would be empty promises. It doesn’t cost anything and as a bonus, it covered their collective backsides from the distinct possibility of criminal charges in the future if they are ever called on the carpet for the devastating consequences of this imposed austerity.
Public health should not be subject to the constraints of the memorandum. A Greek primary health care service has to take into account the realities in Greece. Social policy and severe imposed austerity don’t mix. It only leads to disaster and an increasing number of victims.
Even when the will for a social policy is expressed when it is implemented with insufficient funding, it means nothing. This is the case with the uninsured having access to public health and the “reform” of the primary health system. The obligations of the memorandum don’t allow the appropriate funding. The law is a dead letter and the policy will, sooner or later, dissolve
Finally the reduction of welfare spending by 0.5% of the GDP per year (900 million euro) or 2.7 billion for the years 2016-17-18 (the 3rd memorandum period) *5 explains the tragedy currently experienced by persons living with disabilities and their families. There is no sensitivity on the part of the government or the so called “loyal opposition”. How could there be from those who voted for the 3rd memorandum? The memorandum agreements are strangling the Health system and the welfare system.
Sources of information: (in Greek)
5) Page 53 of Third Memorandum (August 2015)
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