Healthcare in crisis-hit Greece under threat

A new round of cuts in debt-hit Greece's troubled health sector could cause irreversible damage to the country's already struggling public healthcare, insiders warn. Under its EU-IMF deal, which is keeping its economy alive with bailout loans, Greece has pledged to redeploy 25,000 civil servants and axe 4,000 state jobs by the end of the year. As part of this process, eight hospitals in Athens and Thessaloniki are currently being downsized and turned into health centres, with 1,618 of their staff transferred elsewhere. Public healthcare is free in Greece but the system has been mismanaged for decades, leading to chronic corruption and overspending on drugs and hospital supplies that is only gradually coming to light. After the economic crisis erupted, authorities sought to get a better control over health spending. Last year, the government introduced an online prescription system to control the costly malpractice of bogus handwritten prescriptions, which had enabled corrupt doctors and pharmacists to make money at the expense of healthcare funds for years. Now, the health ministry says it wants to boost bigger hospitals that suffer from shortages by moving staff from smaller ones where demand did not justify the operational cost. "We are carrying out a major restructuring of the health sector to provide better health services to the Greek people," Health Minister Adonis Georgiadis said at a press conference in August. Georgiadis, a former far-right politician appointed to the post in June, promised there would be no job cuts. But many healthcare staff still fear the overhaul will drastically reduce hospital beds and downgrade public healthcare in general. Hospital doctors will join a two-day strike by civil servants this week in protest at the cuts. "We already had staff shortages and the new employees we are supposed to receive are just a drop in the ocean compared to our needs," said Ilias Sioras, a cardiologist at Evangelismos hospital in Athens, one of Greece's biggest. "How can they say health services will improve when people can't get treated?" asked Maria Ikonomaki, a lab worker in the Amalia Fleming hospital in northern Athens that is slated to become a rehabilitation centre instead. "We treat one million people every year and last year another hospital in our area shut down," she said. "The way (these changes) are carried out shows (the government) is more concerned about redeploying staff than improving services," another Amalia Fleming hospital doctor who preferred anonymity told AFP. Public health spending dropped by 25 percent between 2009 and 2012, after having increased by nearly 6 percent per year in real terms the previous decade. Outlays on medicine alone were cut by one-third between 2010 and 2011 to 3.75 billion euros. That pushed Greece to slightly below the average of 9.3 percent of gross domestic product spent on health care in the 34 advanced economies in the OECD in 2011, coming in at 9.1 percent. The cost-cutting effort has increased out of pocket healthcare expenses for many Greeks, as certain drugs are no longer subsidised by state-run health insurance funds. And if the state is indeed scaling back health services, the vacuum will be inevitably filled by private clinics at a much higher cost, doctors warn. "There are needs to be covered and much demand for health services -- when the state just leaves, what are we supposed to think?" said Haralambos Farantos, a surgeon at Patissia hospital, situated in a densely-populated central Athens neighbourhood. "If you are to create one big hospital, you should at least place it in the same area where the small one used to be," he argued. Kyriakos Souliotis, an assistant professor of health policy at the University of the Peloponnese, warned that the cuts could destabilise Greece's health system altogether at a time of high unemployment and rising poverty. "Nobody can deny the past excesses in public health expenditure," Souliotis told AFP. "But the current management is the extreme, exaggerated opposite -- fiscal targets in the health sector are so tight now, that we are in danger of not being able to sufficiently meet certain expenses," he said. Greece is in its sixth year of continuous recession and has a staggering 27-percent unemployment rate. With so many people out of work, the monthly insurance contributions that are the lifeblood of the public healthcare funds are also drying up. "Structural reforms were necessary, but an economic crisis is a bad time for change," Souliotis added. Under pressure from its creditors, Greece has had to carry out reforms that other European countries implemented over a decade in just two years, he noted. "According to the targets, pharmaceutical expenses, for instance, have to be covered by one percent of Greece's GDP. Now that the GDP has shrunk by 25 percent, this is not enough," Souliotis said.