Greece’s health system faces collapse

By Robert Stevens
13 October 2011

The austerity measures being forced onto the Greek population by the ruling social democratic PASOK government are literally killing people.

In an October 10 letter to The Lancet, the world’s leading general medical journal, “Health effects of financial crisis: omens of a Greek tragedy”, six researchers, Alexander Kentikeleni, Marina Karanikolos, Irene Papanicola, Sanjay Basu, Martin McKee, David Stuckler described how the health service is being ripped apart.

Many adults have been thrown out of work and into debt, while a whole generation of youth are unable to find any stable, decent employment. This is leading to an increase in deaths.

The letter explained, “15 years of consecutive growth in the Greek economy have been reversed” by strict conditions attached to loans from the International Monetary Fund and “Eurozone partners”.

The “drastic curtailing of government spending” has seen adult unemployment rise from 6.6 percent in May, 2008, to 16.6 percent in May, 2011, they point out. Youth unemployment rose from 18.6 percent to a staggering 40.1 percent.

Debt grew between 2007 and 2010 from 105.4 percent to 142.8 percent of gross domestic product. This is compared with the average change in the EU-15 (the 15 countries that were EU members before May 1, 2004) from 66.2 percent to 85.1 percent of GDP.

The authors point out, “Compared with 2007—i.e., before the crisis—2009 saw a significant increase in people reporting that they did not go to a doctor or dentist despite feeling that it was necessary”.

This 15 percent increase in people not going to a doctor or dentist was mostly due “to long waiting times,” the letter notes.

“There were about 40 percent cuts in hospital budgets, understaffing, reported occasional shortage of medical supplies, and bribes given to medical staff to jump queues in overstretched hospitals,” they write. “We noted a significant rise [14 percent] in the prevalence of people reporting that their health was bad or very bad.”

Noting a corresponding 25 to 30 percent decline in admissions to private hospitals, due to “pressure on personal budgets and registered losses after the onset of the crisis”, they explain: “Although people were less likely to visit GPs and outpatient facilities, there was a rise in admissions to public hospitals of 24 percent in 2010 compared with 2009, and of 8 percent in the first half of 2011 compared with the same period of 2010”.

This is despite the decline in the number of people able to obtain sickness benefits owing to budget cuts. Further reductions to access and the level of benefits “are to be expected once austerity measures are fully implemented,” they add.

The letter explains that 25 percent of callers to the national suicide helpline “faced financial difficulties in 2010 and reports in the media indicate that the inability to repay high levels of personal debt might be a key factor in the increase in suicides.”

The number of suicides has escalated by 17 percent in 2009 compared with 2007 and unofficial 2010 data quoted in parliament mention a 25 percent rise compared with 2009.

The letter draws attention to a report from the Minister of Health recording a 40 percent rise in suicides in the first half of 2011, compared with the same period in 2010.

The austerity programme is devastating all aspects of public health. The letter states, “Budget cuts in 2009 and 2010 have resulted in the loss of a third of the country’s street-work programmes; one survey of 275 drug users in Athens in October, 2010, found that 85 percent were not on a drug-rehabilitation programme.”

They warn, “New infections of HIV were expected to increase by 52 percent in 2011, with half due to intravenous drug use.”

The removal of access to public health provision has resulted in a phenomenon never before seen in Western Europe—that of NGOs providing standard medical services to the general population.

Previously, street clinics run by NGOs “mainly catered to immigrants, but the Greek chapter of Médecins du Monde estimates that the proportion of Greeks seeking medical attention from their street clinics rose from 3-4 percent before the crisis to about 30 percent.”

In conclusion the researchers state, “Overall, the picture of health in Greece is concerning. It reminds us that, in an effort to finance debts, ordinary people are paying the ultimate price: losing access to care and preventive services, facing higher risks of HIV and sexually transmitted diseases, and in the worst cases losing their lives.”

Apostolos Veizis, the head of programmes for Medecins Sans Frontieres Greece, told the EUObserver web site, “Wherever we work, we are working not only to respond to emergencies, but also to potential unwillingness on the part of authorities to provide access to healthcare”.

He added, “With the growth of the economic crisis, we are seeing symptoms of a wider problem. Now pensioners, the unemployed, the homeless, HIV and TB patients are also going without healthcare… We are seeing the budgets of some health service areas such as social support and the treatment of certain diseases being hit by cuts of up to 80 percent”.

Major pharmaceutical corporations have imposed an embargo on Greek public hospitals. Last year, two leading drug companies withdrew supplies after the government announced it would slash the price of all medicines by 25 percent as a component of 1.2 billion euros in budget cuts. Danish pharmaceutical company Novo Nordisk—the world’s leading supplier of state-of-the-art insulin for diabetics—announced it would withdraw its supplies. Another Danish firm, Leo Pharma, gave the Greek government three months’ notice of its intention to stop supplying a number of its medicines.

This crisis was only overcome when PASOK bowed to pressure from the drug companies and restored prices to near their previous levels.

Greece’s debt crisis has drastically worsened over the last year. With the government unable to pay the debt it owes to the pharmaceutical giants, another company, Swiss firm Roche, announced last month that it will stop delivering drugs to indebted hospitals. Public hospitals already cannot provide adequate amounts of life saving medical materials, including vitally needed drugs and blood.

Veizis commented on the sadistic nature of such attacks that are “being imposed by the government without any impact assessment of what will happen.”

This can only get much worse as the number of hospitals, serving a population of 11 million, is cut from 133 to 83. The EUObserver points out, “This will reduce the number of clinical units from 2,000 down to 1,700, limiting to 30,000 the number of functional beds—or 80 percent of estimated needs.”

Nikitis Kanakis, the head of the Medecins du Monde, said that this represented a “deepening humanitarian crisis”. Of 30,000 patients the group has attended to in the last year, some 35 percent are Greek citizens, up from 10 percent in 2010. Of these, nine percent are children.

Kanakis told the EUObserver, “Amongst some children and the elderly, signs of mild malnutrition have begun to appear. This is mostly amongst migrants, but Greek citizens as well. There is a problem also not just with the amount but the quality of the food.”

“What we know is that amongst the new measures for 2012, the troika [European Union, IMF and European Central Bank] has asked that there no longer be exceptions to the €5 fee to visit a hospital. Things will certainly get worse next year,” he added.

During their trip to Athens last week, officials from the troika demanded more austerity, including lowering the minimum wage of €750 and breaking up national collective bargaining contracts. Last year PASOK made the first inroads against collective agreements when it passed legislation allowing employers to bypass the contracts and demand their employees accept lower wages.

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