[Ip-health] Washington Post: Greece's prescription for a health-care crisis

Thiru Balasubramaniam thiru at keionline.org
Mon Feb 24 03:19:02 PST 2014

Greece's prescription for a health-care crisisBy Anthony
, Published: February 22 | Updated: Sunday, February 23, 2:59 AM

ATHENS -- President Obama's health-care plan is, in fits and starts,
attempting to extend coverage to millions of uninsured Americans. But here
at the epicenter of Europe's economic crisis, Nikos Solomos is the face of
a continent where debt-laden nations are drifting away from a privileged
era in public health.

Like most Greeks, Solomos, 60, and his wife, Amalia, 52, paid into a state
insurance fund for years, granting them access to medical care for little
or no cost. After their pickle business went bankrupt, they could not
afford their premiums and descended into the cascading ranks of the
uninsured. Fueled by massive unemployment, a five-year recession and deep
budget cuts, the number of uninsured has soared from less than 500,000 in
2008 to at least 2.3 million -- or almost one in five Greeks -- today.

Then, after a lifetime of good health, came bad news. In 2011, Nikos was
diagnosed with intestinal cancer, and the Solomoses sold off farm equipment
and property to cover medical costs that quickly raced above $68,000. Last
week, his situation went from bad to worse: A private doctor charged him
$204 to read his medical tests and explain that the cancer had metastasized
to his liver.

Steadying himself with a strong coffee at an Athens cafe shortly after
receiving the diagnosis, the elegant man with perfectly combed
salt-and-pepper hair looked tired and held his wife's hand. Her eyes were
red from crying. The cancer, he said, was beatable. But the bills weren't.

"The operation alone is 12,000 euros ($16,200)," he said. "We just don't
have it. It's funny. I saw President Obama on television the other day,
talking about how the United States, a country known for being cold to its
citizens, was trying to help the uninsured. Here, we have the opposite. The
state used to take care of you. But if you are sick in Greece now, you have
an expiration date."

Europe, economists say, is turning a corner. After a four-year debt crisis
that left a large swath of the region on financial life support, there are
finally signs of a pulse in even some of the region's most moribund

But a look across the still-bleak landscape, from Greece to Spain, Ireland
to Portugal, suggests a painful aftermath, where the plight of millions of
Europeans is worsening even as the financial crisis passes. One of the
biggest problems now is in an area that Europeans have long prided
themselves: public health.

While core nations such as France and Germany are resisting higher
co-payments or cuts in state-funded health care, public health is being hit
in the most troubled corners of the European Union.

In Spain, the government has suspended free care for illegal immigrants,
begun charging seniors for a portion of their prescriptions, cut aid to the
mentally ill and moved to raise co-payments for medications, prosthetics
and some emergency services. In Ireland, state assistance to the disabled
has been slashed, and new rounds of cuts this year will remove some
medications from the list of drugs covered by public health care while new
reviews are being launched to determine whether those receiving free care
are truly eligible.

Nowhere, however, has the impact been as dramatic as in Greece. Bloated,
inefficient and plagued by corruption, the massive public-health system
became a top target for cuts, with total health spending slashed by more
than 25 percent since 2009, and more cuts are on the way this year.

Critics say those cuts have been made with an ax instead of a scalpel,
leading to shortages and gaps in care at public hospitals and a growing
crisis of the uninsured.

Stung by cutbacks in needle-
exchange programs for intra-venous drug users, HIV rates have soared, Greek
health officials say, forcing the government to relaunch moth-balled
programs last year.

Doctors, meanwhile, say worsening living conditions and limited access to
primary care for hundreds of thousands of people have led to a resurgence
of tuberculosis. Last week, Greek doctors took to the streets of Athens to
protest changes that would allow public hospitals to fire physicians who
also have private practices. As the government struggles to meet budget
targets, at least 8,000 -public-health workers are set to be furloughed,
with a significant number likely to face layoffs.

At Gennimatas General Hospital, one of Athens's largest, attending
physician Elena Karabatzaki said that the hospital can't afford to repair
broken medical equipment, forcing patients to wait a week or more for
procedures such as MRIs and CAT scans. The hospital is facing periodic
shortages of antibiotics and other medications. Meanwhile, emergency care
is under strain from a deluge of uninsured patients with minor problems
using the hospital for primary care -- as well as patients who have waited
too long to seek medical assistance and are now arriving in acute condition.

A four-year hiring freeze for doctors and nurses has left the hospital
desperately short-staffed. "For things like feeding and bathing patients,
we now depend on relatives," she said.

Last week, Angeliki Pogrotopoulos, 72, was racing up and down the halls at
Gennimatas as she cared for her 92-year old sister, Alexandra Stathakou,
who had had a stroke. To cover for staff shortages, she has been feeding
and bathing Stathakou, as well as buying adult diapers for her at a
pharmacy since the hospital has run out. She also pays $68 per shift for a
private nursing assistant to watch over her sister at night.

"It's a disaster," Pogrotopoulos said. "The hospital staff is wonderful,
but there are too few of them now and too many shortages."

*A strain on clinics*

The biggest challenge is a massive increase in the uninsured.

Greece offers state-subsidized insurance for the equivalent of several
hundred dollars per month. But an unemployment rate that tops 27 percent
has left hundreds of thousands without the means to pay. At the same time,
eligibility for free indigent care has been tightened, while co-payments
for those with insurance have increased.

Many of the sick and uninsured rely on free clinics such as the
Metropolitan Community Center, operating in a former barracks of an
abandoned U.S. military base in South Athens. On a recent afternoon,
volunteer cardiologists, gynecologists and other specialists took shifts
seeing uninsured patients. At 5 p.m. every weekday, aides dole out donated
prescription drugs, offering free insulin for diabetics, pills for heart
patients and antibiotics for ill babies.

Doctors are also acting as advocates for the uninsured. George Vihas, one
of the clinic's founders, said that staff had to intervene last week on
behalf of an uninsured woman who had given birth and whose hospital had
refused to release her newborn until payment was made. The clinic is also
attempting to secure free or discounted medication and treatments for
uninsured cancer patients on a case-by-case basis.

"But it doesn't always work," he said. "Sometimes, they come to us in poor
condition because they've been unable to see a doctor, and even then it
takes time to find a solution. We've lost dozens of patients who could have
-- who should have -- been helped."

Greek Health Minister Adonis Georgiadis said that the government is
attempting to aid the uninsured, creating a $17.6 million fund for the most
acute cases, using money seized in a crackdown on tax evasion. He hopes the
fund will be dramatically boosted by the end of the year.

But Greeks, he said, must also understand that the public-heath system was
broken before the crisis by years by mismanagement and corruption. The
state was sometimes paying three to four times more than other European
countries for certain prescription drugs, with middle men, doctors and
pharmacies pocketing the difference. If hospitals are facing shortages, he
said, it is because they are having a hard time adhering to more reasonable

Georgiadis said that emergency cases are still being treated at public
hospitals irrespective of insurance status. "But," he said, "illnesses like
cancer are not considered urgent, unless you are in the final stages."

That is exactly what troubles Solomos, the uninsured cancer patient.

"What am I supposed to do?" he said.

*Elinda Labropoulou contributed to this report.*

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