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.
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.
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."