Greek Health Ministry announces to public: “Do not get sick around holidays, it is not convenient for us.”

If you are thinking, that headline cannot be true, you are correct. It is a parody. It is based on encounters with the Greek health care system this summer, which were almost exactly the same as encounters with the Greek health care system fifteen years ago. Some of the inadequacies or failures of this system are so absurd that parody becomes inevitable.

I normally highlight positive examples on this site, but I want to write about the health care system in Greece, and right now, I do not have many positive health care initiatives to highlight, so even bringing up the discussion is something that is a positive step. If you have examples of a program, a technology, a hospital that is helping deliver accessible, effective healthcare to people in Greece, please share them here.

A report published this month in the British medical journal The Lancet set off a small flurry of articles in international media on the looming health crisis in Greece  This, however, is a discussion that should have been a priority long go, both within Greece and among Greek diaspora, who travel to Greece and are continually called upon by the Greek government to help promote tourism to Greece.

Funding for national health programs is being drastically cut just as the number of people coming to public hospitals rose 30 percent since the start of the crisis, according to the Health Ministry. At a December 5 news conference, the president of the Athens-Piraeus Doctors’ Union (EINAP) warned that the health care system risks collapse due to a lack of resources and rapidly increasing out-of-pocket costs for patients.

Image by New Diaspora. New Dialogue. illustration contributor.

 

Non-profits witness the growing crisis among Greeks dropped by government services

One small positive action I can point to at this time comes from outside the state system.  Medecins Sans Frontieres (MSF) is conducting an assessment of the situation in Athens, though this only highlights the fact that an assessment of the situation across the country is desperately needed.

Non-profit organizations in Greece are increasingly called upon to fill in where the government cannot provide basic services, and the most troubling news on the state of health care in Greece comes from this sector.

MSF Greece and Medecins du Monde have been serving migrants and refugees, who are excluded from national healthcare, but recently began receiving increasing numbers Greek patients.  MSF set up clinics to serve migrants and refugees in Greece’s overflowing detention centers as early as 1995. Now, Greeks without insurance – pensioners, unemployed or homeless people, HIV and tuberculosis (TB) patients, and even some middle-class shopkeepers – are visiting MSF clinics, according to MSF Greece director, Apostolos Veizis.

“We are seeing the budgets of some health service areas such as social support and the treatment of certain diseases being hit by cuts of up to 80 percent,” he continues.

Medecins du Monde saw an increase in the number of Greek patients since 2010:

Of the 30,000 patients the group has attended to in the last year, some 35 percent are Greek citizens, up from 10 percent in 2010. Some nine percent of this figure are children. Source.

Despite all the romanticized headlines of people ‘turning back to the land in response to the economic crisis’ in Greece, the head of Medecins du Monde, Nikitis Kanakis, reports to the EU Observer that the group is beginning to see signs of mild malnutrition in some Greek patients, spurring the group to launch a campaign for food donations.

Health reform

In early September, doctors responded to the Health Ministry’s proposed reforms with a 48 hour strike, with the head of the Panhellenic Physicians Association warning that more militant action was to come. The reforms would include recruitment of more nurses, no new hiring of doctors, and permitting private doctors to work in state hospitals once a week (which is odd, given that this already takes place). The management of emergency departments is also set to change under the new legislation, which was scheduled to be ready after October 15.

Let’s check in on how the democratic dialogue process is playing out in this reform process:

Replying to the minister’s claim that doctors refused dialogue, the head of the national medical association said that the government had at no time sent any outline of its plans for the National Organisation for the Provision of Healthcare Services (EOPYY), adding that doctors had participated in dialogue for months but were never given specific details of the government’s intentions. Source.

In a press conference on October 11, Health Minister Andreas Loverdos highlighted how many spending cuts have been made.  I’m pretty sure the public already sees and feels that there is less spending. Mr. Loverdos does not discuss what health care is actually being provided with the little spending that apparently remains, if that even remains for much longer.

The health minister underlined that more spending cuts are possible and used as an example cosmetic plastic surgery operations made in public hospitals that cost 2,000 euros with the surgeons using the hospital facilities and supplies. “Such illegal behaviors continue,” he said, adding that public health inspectors are investigating similar cases and that he has personally notified the first-instance court head public prosecutor Eleni Raikou.

This is the example you would like to highlight, Minister Loverdos? Why not highlight these spending cuts, reported in the EU Observer:

The government is slashing the number of hospitals from 133 down to 83, cutting the number of clinical units from 2000 down to 1700, limiting to 30,000 the number of functional beds – or 80 percent of estimated needs. Source.

Or highlight that funding to the Hellenic Red Cross was cut.

Perhaps these were superfluous; perhaps the health care sector was bloated, like the rest of the public sector?  Perhaps not: based on the report published in The Lancet, people were less likely to visit a doctor in 2009 than in 2007 due to long wait times and long travel distances.  The study suggests that much of this is the result of significant budget cuts to health care. In addition, suicides and HIV infection rates rose, and appear to be results of increasing financial hardships and intravenous drug use.

The situation is also hitting mental healthcare facilities hard. In August, the Finance Ministry cut funding for state mental healthcare facilities by 45 percent. This comes at a time when suicides are on the rise, and many appear linked to financial difficulties.

..recent data published in July found that the number of suicides in Greece had increased by 40 percent between 2007 and 2009, while the report cited by Stylianidis also suggested that 12 percent of people facing financial difficulties or ruin had expressed a “death wish.” Source.

In August, the Guardian described the Greek health care system as “on the brink of catastrophe,” though sadly, these issues, and even this brink of catastrophe, are nothing new. Drug companies have halted shipments to some state hospitals due to government debt that goes back to 2007.  As early as 2001, the Greek state was spending the lowest percentage of all the then-15 EU member states on healthcare costs, leaving Greek citizens to pay the most out-of-pocket share in the EU.

This large out-of-pocket expense is for state hospitals.  My experience visiting friends and family in one state hospital in northern Greece was that the hospital had no toilet paper in the patient bathrooms 15 years ago and again this year, had no screens on windows in some rooms to keep mosquitoes away from sick or healing patients, and had nurses smoking inside the hospital or conversing and laughing loudly at reception desks in cancer wards. I visited a friend in a military hospital a few years ago, and a man who appeared to be a migrant street vendor walked into the room asking for one euro from patients that wanted a remote for the television. He indeed had possession of the television remotes, so he was not a first time visitor to patient rooms. I wondered what collection methods he used when time was up on the one-euro rental.

Patient tip: Bring your own entertainment, or sew a pocket into your backless paper hospital gown to hold spare change for the TV remotes.

Over a decade ago and again this year I saw basic, basic aspects of health, sanitation and respect for patients and families go unaddressed in state hospitals.  (Read just how far this can go in a Greek hospital these days in this recent post by blogger KeepTalkingGreece.)

Patient tip:  Bring your own toilet paper.

What does the EU say about this?  From the 2001 Kathimerini article cited above:

On Wednesday, the European Commission adopted the proposal tabled by Diamantopoulou and proposed that EU governments institute an annual exchange of data and policies from member countries, in an effort to upgrade healthcare services for the elderly. Furthermore, the European Commission proposed three common objectives for member states: The achievement of universal access to healthcare and care for senior citizens; the highest possible quality care; and the financial viability of healthcare systems in the long run. These proposed common objectives are the result of an analysis by the Commission which found that national healthcare systems, while very different in design, delivery and funding, are confronted with similar core challenges both today and in the future.

Contrast the tone and underlying foundation of those European Commission proposals with statements from Commission officials this year in response to drug companies halting shipments of cancer drugs to hospitals in Greece due to hospital debts:

“It’s a commercial decision from a company,” [European] commission health spokesman Frederic Vincent told reporters in Brussels. “We would have to see if the countries make any specific request if this problem is conferred to Spain, Italy, Portugal,” he added, noting that the EU has little-to-no powers over national healthcare plans. Source.

2001 principles: knowledge exchange and common challenges.

2011 principles: no EU power over national healthcare.

My experience.

In case you have not been privileged with hearing about or experiencing any personal encounters with the disappointing condition of the healthcare system in Greece, particularly outside the largest cities, I’ll share mine:

My niece raised a fever on the Friday evening before the big August 15 holiday, after the antibiotics prescribed by a doctor in a nearby clinic did not help her. A doctor from our village stopped by on her time off to see her, and said it was a virus, so she never needed the antibiotics – not too surprising, as it turns out this clinic is known for inattentive diagnoses. She recommended taking the girl to a hospital for some extra tests, to rule out meningitis, based on her symptoms.

This is where it became complicated. The two nearest hospitals (one in a small city 15 minutes away, and the other in a small city 30 minutes away) rotated pediatrician duty.  A pediatrician was on duty 15 days in one hospital, and 15 days in the other.   So we had to find a ride, and late on Friday night drive over half an hour to find a hospital with a pediatrician that could run the tests to rule out meningitis.

You can live in a city of approximately 100,000 people, the capital of a prefecture, and you will only find a pediatrician at a hospital for your child 50% of the time.

Don’t get sick on a holiday.

We cannot complain however.  In late August, a man from our village suffered an aneurism and had to be taken to the third nearest hospital to find an open emergency unit.  Sadly, he did not recover.  Maybe the outcome would have been the same even if the emergency unit in the nearest hospital, 15 minutes away, was staffed and functioning. We cannot know.

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