Postcard From The Edge: Inside The Dramatic Collapse Of Greece's Healthcare System

Doctors are left "playing God," having to choose which patient will get the costly treatment.

Postcard From The Edge: Inside The Dramatic Collapse Of Greece's Healthcare System
Benoît Vitkine

THESSALONIKI - It was in 2009 – what feels like ages ago now - that the Organization for Economic Cooperation and Development (OECD) reported that the Greek healthcare system was "rather efficient."

Around that very same time, doctors in Thessaloniki successfully cured “Mrs. I.” from melanoma. When her cancer came back three years later, they did not even try. “Mr. I.” asked to remain anonymous when telling his wife's story.

"Doctors prescribed a treatment, but since it was potentially quite expensive, it had to be approved by a commission of doctors and hospital administration officials," he explained. "They denied treatment. One of the members of the commission took me aside and told me, ‘We had to make a choice and we are going to keep this money to heal children. Your wife is 62, let her die at home.’”

This is an extreme and isolated case, but in every one of Thessaloniki’s 13 hospitals, in Greece’s second largest city, doctors are “playing God,” as Leta Zotaki, head of the radiology service of Kilkis Hospital in the north of the city, puts it. "When we start running out of x-ray films, we have to decide who needs to be examined first; we trade with other hospitals or ask the patients to pay for the film,” explains this trade unionist, who saw her 4,000 euro salary cut by half, and whose night shift hours have not been paid since May.

Some nurses have put up a note on the door of one of the hospital rooms: "When visiting your relatives, don’t bring chocolates, buy them toilet paper,” the note reads. There is a shortage of everything: latex gloves, cold pads, reagents for blood tests and catheters. The only upshot is the fact that public hospital workers have not yet been laid off yet – like they have in other public service sectors. But the doctors who are leaving – who have either retired, or left for private hospitals or abroad – are not being replaced: in Kilkis, the number of doctors has gone from 160 to 125.

Even before the crisis broke out, the national health system was already facing a structural deficit. Every two or three years, the State would bail it out. But since 2009, in order to satisfy the conditions imposed by the “troika” (EU, IMF, ECB) and in an attempt to balance the country’s finances, public spending allocated to the healthcare system has seen a 32% drop. The situation has gotten worse as the unemployment rate has increased (+25% in November) meaning the number of contributors has fallen.

Public healthcare, which had already undergone a 40% budget cut between 2007 and 2009, entered the crisis in a very fragile state. In order to balance its budget, patients were asked to pay a new five-euro fee for every consultation (which was raised to 25 euros in the new budget voted this Fall), and a variable financial contribution to medical fees. On top of which Greeks sometimes have to pay a fakelaki, a bribe that goes directly in the doctor’s pocket and allows them to jump the queue.

Unemployed people are losing their medical coverage a year after losing their jobs, and must now pay for medical expenses themselves. In most cases, they don’t go to the doctor and wait for the situation to worsen so they can go directly to a public hospital emergency room. ER admissions have been multiplied by three. Intensive care units are also overwhelmed: between 30 and 40 people are denied access to these units everyday, according to the trade unions.

Makeshift clinics

The alternative, for patients who can’t afford medical care, is quite pathetic. In Thessaloniki, the alternative is an apartment located on Ionos-Dragoumi Street, which has been turned into an emergency consulting room by the Doctors of the World NGO. About 50 people are waiting in the queue – which trails down the staircase – to be examined by exhausted volunteer doctors, who cure diseases, order prescription drugs, vaccinate children, and sometimes have to play the role of psychologists and social workers.

"Ten years ago, we opened this center to treat immigrants," explains Sofia Garane, the young manager of this local chapter of Doctors of the World. "With the crisis, the number of patients is 10 times higher and Greeks now represent the majority of our patients.” Despina Ioanidou, 48, who has been unemployed for eight years, often comes to get drugs for her back pain and depression. "I have just enough money to pay for electricity and food, so how could I afford to see a doctor or even go to hospital?" she asks.

Doctors from this makeshift clinic are seeing new diseases, which are due to child malnutrition. Everywhere in the country, old diseases, such as malaria and tuberculosis, are making a comeback

Totally bankrupt, the Greek healthcare system is on the verge of collapsing. The drug distribution sector is just as bad. Payments are delayed and health insurers owe around one billion euros to laboratories and chemists. A majority of chemists, who know that they won’t be reimbursed by health insurers, refuse to dispense drugs on credit. Now patients either have to pay for prescription drugs up front -- like Panagiota C., who spent 100 euros on coagulant drugs and waited six months to get her money back -- or start looking for a public hospital that stocks the drugs. According to the Pan-Hellenic Pharmaceutical Association (PFS), 300 prescription drugs have become nearly impossible to get – a situation that is particularly worrying for heart disease and cancer patients. Pharmaceutical companies are threatening to stop supplying the drugs altogether. In early November, pharmaceutical group Merck announced that it would stop supplying anti-cancer drug Erbitux to hospitals with delayed payments.

Prescription drugs are part of the solution, according to Stavros Baroutis, an administrative official at the Agios-Dimitrious hospital in downtown Thessaloniki. By increasing the number of generic drugs from zero to 47% in his hospital, he has managed the limit the loss, and cut “only” 80 beds. “The fact that we did not use generics before the crisis shows the shortcomings of our healthcare system,” he says, listing “abuses:” there is no flexibility regarding the shutdown of services or the decrease in beds; costly equipment is left rotting in the hospital’s basement; absence of medical files; tests done two or three times; too many doctors and too much waste…

"This crisis could have been an opportunity to rethink the system," explains Baroutis, walking swiftly through the poorly lit corridors of his hospital. "But the cuts are so violent; the purge is done in such a way that we are killing the system without reforming it."

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Air Next: How A Crypto Scam Collapsed On A Single Spelling Mistake

It is today a proven fraud, nailed by the French stock market watchdog: Air Next resorted to a full range of dubious practices to raise money for a blockchain-powered e-commerce app. But the simplest of errors exposed the scam and limited the damage to investors. A cautionary tale for the crypto economy.

Sky is the crypto limit

Laurence Boisseau

PARIS — Air Next promised to use blockchain technology to revolutionize passenger transport. Should we have read something into its name? In fact, the company was talking a lot of hot air from the start. Air Next turned out to be a scam, with a fake website, false identities, fake criminal records, counterfeited bank certificates, aggressive marketing … real crooks. Thirty-five employees recruited over the summer ranked among its victims, not to mention the few investors who put money in the business.

Maud (not her real name) had always dreamed of working in a start-up. In July, she spotted an ad on Linkedin and was interviewed by videoconference — hardly unusual in the era of COVID and teleworking. She was hired very quickly and signed a permanent work contract. She resigned from her old job, happy to get started on a new adventure.

Others like Maud fell for the bait. At least ten senior managers, coming from major airlines, airports, large French and American corporations, a former police officer … all firmly believed in this project. Some quit their jobs to join; some French expats even made their way back to France.

Share capital of one billion 

The story began last February, when Air Next registered with the Paris Commercial Court. The new company stated it was developing an application that would allow the purchase of airline tickets by using cryptocurrency, at unbeatable prices and with an automatic guarantee in case of cancellation or delay, via a "smart contract" system (a computer protocol that facilitates, verifies and oversees the handling of a contract).

The firm declared a share capital of one billion euros, with offices under construction at 50, Avenue des Champs Elysées, and a president, Philippe Vincent ... which was probably a usurped identity.

Last summer, Air Next started recruiting. The company also wanted to raise money to have the assets on hand to allow passenger compensation. It organized a fundraiser using an ICO, or "Initial Coin Offering", via the issuance of digital tokens, transacted in cryptocurrencies through the blockchain.

While nothing obliged him to do so, the company owner went as far as setting up a file with the AMF, France's stock market regulator which oversees this type of transaction. Seeking the market regulator stamp is optional, but when issued, it gives guarantees to those buying tokens.

screenshot of the typo that revealed the Air Next scam

The infamous typo that brought the Air Next scam down

compta online

Raising Initial Coin Offering 

Then, on Sept. 30, the AMF issued an alert, by way of a press release, on the risks of fraud associated with the ICO, as it suspected some documents to be forgeries. A few hours before that, Air Next had just brought forward by several days the date of its tokens pre-sale.

For employees of the new company, it was a brutal wake-up call. They quickly understood that they had been duped, that they'd bet on the proverbial house of cards. On the investor side, the CEO didn't get beyond an initial fundraising of 150,000 euros. He was hoping to raise millions, but despite his failure, he didn't lose confidence. Challenged by one of his employees on Telegram, he admitted that "many documents provided were false", that "an error cost the life of this project."

What was the "error" he was referring to? A typo in the name of the would-be bank backing the startup. A very small one, at the bottom of the page of the false bank certificate, where the name "Edmond de Rothschild" is misspelled "Edemond".

Finding culprits 

Before the AMF's public alert, websites specializing in crypto-assets had already noted certain inconsistencies. The company had declared a share capital of 1 billion euros, which is an enormous amount. Air Next's CEO also boasted about having discovered bitcoin at a time when only a few geeks knew about cryptocurrency.

Employees and investors filed a complaint. Failing to find the general manager, Julien Leclerc — which might also be a fake name — they started looking for other culprits. They believe that if the Paris Commercial Court hadn't registered the company, no one would have been defrauded.

Beyond the handful of victims, this case is a plea for the implementation of more secure procedures, in an increasingly digital world, particularly following the pandemic. The much touted ICO market is itself a victim, and may find it hard to recover.

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