Friday, December 04, 2015

Austerity takes its toll on Greek health-care

5 years of austerity takes its toll on Greek health-care. Corridors overflowing with patients; doctors trying to take care of them under intense physical and psychological pressure; shortages of drugs, medical supplies, and equipment; nurses in the intensive care unit struggling to meet the needs of the five or six patients they each have under their care. This is the typical picture in Greek public hospitals in 2015 while private insurers restrict their drug coverage, leaving people with serious illnesses, such as cancer, struggling to meet the costs of the medicine they need. Shortages are the order of the day.

Public hospitals treat many of the 2·5 million people who are uninsured, including refugees. However, funding of public hospitals has been cut by more than 50% since 2009. Public health spending is expected to shrink to 4% of GDP by the end of 2015, compared with an European Union average of 6·9%. According to the Panhellenic Medical Association, public hospitals are in need of 6000 more doctors and 4000 additional paramedics. “Personnel in public hospitals get older and older, because young doctors and nurses leave for foreign countries in search of a better salary”, says Michael Vlastarakos, president of the Panhellenic Medical Association. Senior registrars in the public sector are paid €1700 per month, and consultants no more than €2300 a month.

“The number of patients in outpatient clinics, but also in the emergency rooms of public hospitals, has doubled since the beginning of the crisis. Medical staff numbers are insufficient, because new hiring has been suspended. The staff often become exhausted, creating precarious conditions, especially during long night shifts in the big public hospitals”, says Georgios Hillas, consultant in respiratory medicine in the department of critical care and pulmonary services at the University of Athens Medical School. “Patient overload is even greater because public hospitals provide health services for humanitarian reasons to uninsured people and to foreigners”, he adds.

The head of nursing staff at a major public hospital in Athens, who wished to remain anonymous, told The Lancet that there is only one nurse per shift for as many as 60 patients. When the hospital is on call 24-hours (hospitals in Greece are rotated to be on call), there are 16 nurses for 1600 patients, and one nurse for five patients in the intensive care unit. “In the last 2 years, 2000 new hires were scheduled, but none took place. There are also shortages in drugs and medical equipment, which result in low quality health services”, she said.

The private health-care sector has also suffered in the years since 2010. The profits of private hospitals and clinics have been substantially reduced, not least because of liquidity problems of the social insurance funds and the long delays in payment by private insurance companies. The decline in profits has led to staff cutbacks and to an increase in part-time employees, who are paid low salaries.

“Unemployment among doctors is very high”, says John Striftis, an internist who works in a private hospital in Athens. “So to make a living in many cases they have to work long hours, covering as many shifts as they can. This gradually results in loss of motivation for their personal scientific improvement, and for the provision of the best medical care to their patients. Long working hours and low salaries mean less time for reading, research, and developing one's scientific knowledge. There is less participation in international conferences.”

Nor is it only the hospitals that are making cutbacks; so are patients themselves. “In many cases, patients choose to stop their treatment, or replace the prescribed medication by cheaper alternatives. Sometimes they ask for the cheapest treatment instead of the best. In addition, preventive check-ups and vaccination of high-risk groups, such as old people and children has been greatly reduced”, says Striftis.

The financial squeeze that the crisis imposed on the health-care sector has also affected pharmacies. According to the latest official statistics, the government owes pharmacies €0·5 billion. In Greece, insured people only pay a percentage of their prescription costs; the rest is paid by social security services. But the financial crisis has meant social insurance services no longer have enough money to cover drug expenses. There is also a major shortage in vaccines and medicine. In June, when capital controls were imposed, several vaccines that are included in the national vaccination programme were in short supply. “Medicine in Greece is very cheap and multinational pharmaceutical companies prefer to ship them off to other countries in order to make higher profits”, says Constantinos Lourantos, president of the Panhellenic Pharmaceutical Association. Lourantos points out that, in official statements, drug companies claim that they don't have enough stock. “It is not unusual for me to order 20 anticoagulant injections and, even though I pay cash, they send me ten, claiming that there is no stock”, a pharmacist, who owns a store in downtown Athens and wished to remain anonymous, told The Lancet. “This results in pharmacists and patients trying to find the medication prescribed all over Athens”, she added.

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