Greek Crisis Fallout Is an Opportunity for Health: Greece's Health Reform-Born of the 2008 Economic Crisis-May Fall Short of Expectations. Aris Sissouras Tells Menelaos Tsafalios Why
Tsafalios, Menelaos, Bulletin of the World Health Organization
Q: How has the economic crisis affected health in Greece?
A: The prevalence of clinical depression and of suicide has increased over the last three years. Also, the prevalence of HIV infection is increasing, perhaps because injection drug use has grown and programmes supporting people who are dependent on such drugs have been slashed. Access to the health services has been reduced and pressure on the public services is greater. People can no longer afford private health care and are going to public hospitals. Hospital admissions have been increased by 28% to 2.2 million in 2013 from 1.6 million admissions in 2009. Many people with health problems, who lack the money, are not seeking health care at all. In addition to poor access, an increase in co-payments for medicines and the imposition of other user chargers have compounded these problems. Hospital budgets are continually being cut, resulting in shortages of medical materials, particularly laboratory materials, undermining the quality of care. People's health and the health system have both suffered.
Q: What is being done to protect people from financial ruin and make health services more accessible?
A: Unemployment is increasing every year and, today, 27% of the adult population, nearly 1.5 million people, is unemployed. About 18% of the overall population (11 million) no longer has health insurance coverage, as people who become unemployed now lose this after one to two years. This has grave social implications. To address the problem, the government is issuing health vouchers for certain groups, such as low-income families and the disabled. Local governments and the Greek Orthodox Church are also trying to establish "solidarity centres" that would provide basic health services and medicines to those in need. In addition, nongovernmental organizations, which used to attend to immigrant populations, are now providing free health services to Greeks as well.
Q: Was the reform long overdue or is it a desperate attempt to address the current budget deficit?
A: Our current health policy and any changes to the health sector are determined mainly by the crisis and, in many ways, dictated by the memoranda of the Troika [representatives of Greece's official lenders: the EU, the European Central Bank and the International Monetary Fund]. The fact is that Greece has taken out loans and that obliges us to fulfil certain conditions.
Q: Given the anti-Troika demonstrations in Greece in recent years, does it help that the terms of your country's health sector reform are dictated from abroad?
A: While there is unease about this situation in Greece, a large part of our society recognizes that the health-care system had reached the point of unsustainability and was in urgent need of reform. Many people are understandably inclined to be negative and say that our health policy is being manipulated by outside forces. But, while the broader terms are being dictated by the Troika --i.e. by how much certain spending should be cut--we have a certain degree of freedom to decide how to implement these cuts and certain policies that were long overdue are now being implemented.
Q: If all the cuts stipulated by the Troika are made, can the Greek health system function properly, within the budget foreseen by the memoranda?
A: No, not at the moment, because the health system lacks the structural elements needed to allocate and control the money in a more efficient and rational way. It's a paradox. On the one hand, we accept that there was a lot of 'fat' in the health sector, which had to be eliminated, i.e. a lot of unnecessary expenditure that had no effect on the quality of health care. But, on the other hand, these cuts have brought health services and outcomes to a lower level than before, because the structural changes that should have been in place have not been instituted. It's a vicious circle of the need and will for reform on the one hand and the inability of the system to proceed with the required changes, on the other hand. …