Kathi Apostolidis: Demolishing the Greek national healthcare system the amateur way

It takes vision, passion for healthcare, compassion for those who suffer, knowledge, a dedicated team of experts, commitment from all stakeholders, and experience of what it means to be a patient to plan a new strategy for the healthcare sector. These are all missing from what the Greek Ministry of Health has done for the last two years.

What the Ministry of Health has achieved up until now are just separate agreements with different interest groups of the healthcare sector, each fighting fiercely to safeguard their own benefits. Thus, pharmacists have successfully safeguarded their profession, and doctors are allowed to continue practising privately.
 All the negotiations were made separately with each interest group, and of course, in the absence of the least used resource in healthcare: the patient. None of the numerous committees, task force groups, or consulting bodies, which proposed measures for the healthcare reform included patient participants.

Patients have a vested interest in healthcare policies as both taxpayers and insurance payers. They have not been consulted at all so far, and there is no sign that the situation will change. The reform of the healthcare system could be very different, if the Ministry had invited all “partners in health” to sit around a table, discuss the problems, and jointly decide what measures should be taken to safeguard the public and social character of the Greek national healthcare system.

The healthcare system and the social insurance system were far from rational, but they managed to function and cover, even partially, the needs of large groups of the population. However two years of economic hardship have destroyed both of these systems due to excessive expenditure, budget cuts, and piecemeal measures.  

The national healthcare system suffers from many disparities, under the table payments, overpricing, carelessness, and unwarranted variations in practice. There is an over-concentration of healthcare providers in the large cities which host medical schools, leaving the rest of the country with minimum or inadequate healthcare services. Everybody agreed that the healthcare system needed profound reform, but instead of reform what patients experience is the complete abolition of healthcare and social insurance.

We have a saying in Greek that goes: if your head aches, cut it. This is the approach that the Ministry of Health has taken so far in reforming healthcare. Is the minister of health a good accountant? Yes, he is and by the standards of the “big three” (IMF, ECT, EU), he seems to be more efficient than his colleagues in other sectors of the economy.

But, I can see only a population drawn in despair waiting for the inevitable. Today, after just two years of economic decline, there are 500,000 households in which no one earns an income. The number of unemployed exceeds 900,000, according to data from the Labor Institute of GSEE. The economy is crumbling, and the banks have stopped all financing. 14 billion euros have been taken out of Greece in the last month alone. More than 60 billion euros have gone since 2010, according to the Governor of the Bank of Greece. The government has practically stopped working since last summer. There is hardly enough state money for salaries and pensions. Shops and businesses close one after the other, there are whole streets where all the shops are closed.

But did these drastic taxation measures and other healthcare budget cuts have a positive impact on the state deficit? Did they improve the healthcare services offered to Greek taxpayers? Have the health outcomes of Greek people improved in the last two years of drastic taxation increases, and salary, pension and healthcare budget cuts? This recent article in the Lancet, “Health effects of financial crisis: omens of a Greek tragedy” is very explicit on this matter.

Let’s take a concrete look at the economics of a typical Greek household: we assume it to be a family with three children, a mortgage, healthcare expenses, school fees for one child, and cost of living expenses.

The annual income of the family was 32,000 Euros in 2010, and we assume that this family is among the very very lucky to retain this income in 2012 -2013 (they won’t because at the time of writing this article more salary and pension cuts were announced for 2012).  Let’s now see how their taxation will evolve in these three years with the already announced taxation for 2012, but without the additional measures that have just been voted in to the 2012 state budget, nor those that are expected as a result of the new EU loan agreement.

What is unconceivable is that the taxation is higher for families with children. The more children a family has, the higher the taxation, and it is higher percentage wise for those with lower rather than those with higher incomes. Children have become a proof of wealth and they are taxed.

  2010 2011 2012
Income (€) 32,000 32,000 32,000
Tax(€) 390 5,560 6,200
Income after tax(€) 31,610 26,440 25,800

As well as taxes this family will have to pay from the income above (that will be further reduced by new taxation and salary cuts in 2012) social insurance contributions, healthcare beyond the minimum offered by EOPYY (the new umbrella organization under which all social insurance funds are mandatorily hosted), increased utilities, heating costs, transportation, and other living expenses.

The measures taken so far, solely aimed at cutting down healthcare expenditure, will only broaden healthcare disparities, and will increase the gap between those who can afford high quality, reliable private healthcare, and those unemployed or at subsistence level for whom the only resort will be a public hospital.

The list of new reductions in healthcare benefits grows every day. Those with insurance and the population in general are not informed what these measures will really mean for their access to the public healthcare system, their health outcomes, or the impact of these measures on their already substantially reduced income. The financial possibility that large population groups had until now to use private healthcare for emergency cases or for the treatment of serious diseases is gone forever, due to the drastic taxation imposed, and the concurrent salaries, and pensions cuts.

Greeks live under continuous uncertainty about the future, with depression becoming a national disease. Daily changes, and the reduction or abolition of their long established and directly contributed social insurance benefits, and their eligibility for healthcare services create anxiety, anger, and confusion. Hospitals are working without basic supplies, low quality disposables that tear off before being used, a lack of basic foods in hospital kitchens, and expensive hospital equipment that is broken and not maintained. Patients have to bring their medicine to hospital themselves. Doctors are working unpaid overtime. There are very long waiting times to get a medical appointment, or to schedule an operation. The e-prescription application often crashes, and is not able to cope with even the small number of people who use it. This is now the reality for healthcare professionals and patients in Greece.

Kathi Apostolidis is a public affairs consultant, Athens.