ANALYSIS:Cancer patients are waiting months to have tumours removed, and a growing number of children have not had their basic vaccinations
THE FREE clinic in Perama, a suburb of the Greek port of Piraeus, opened about a year ago to serve illegal immigrants. But these days, it is mostly caring for Greeks such as Vassiliki Ragamb, sitting in the waiting room hoping to get insulin for her young diabetic son.
Four days earlier, she had run out of insulin and, without insurance and unable to pay for more, she had gone from pharmacy to pharmacy, pleading for at least enough for a few days. It took her three hours to find a pharmacist who was willing to help. “I tried a lot of them,” she says, gazing at the floor.
Greece used to have an extensive public healthcare system that pretty much ensured that everybody was covered for everything. But in the last two years, cost-saving measures have taken a brutal toll on the system and on the country’s growing numbers of poor and unemployed who cannot afford the new fees and co-payments instituted at public hospitals as part of the far-reaching austerity drive.
At public hospitals, doctors report shortages of all kinds of supplies, from toilet paper to catheters to syringes. Computerised equipment has gone unrepaired and is no longer in use. Nurses are handling four times the number of patients they should, and waiting times for operations – including cancer surgeries – have grown longer.
Access to drugs has also been affected, as some drug manufacturers, owed tens of millions of euro, are no longer willing to supply Greek hospitals. At the same time pharmacists, afraid that the government might not reimburse them, are asking for cash payments, even from those with insurance.
Many experts say Greece’s public health system was bloated and corrupt and in dire need of reform. But they say also that the cuts have been so deep, and have come so fast, that they have hit like a tsunami. In two years, the government has cut spending on healthcare from nearly €15 billion to €13 billion. And under its agreement with its creditors, Greece must find even more healthcare savings next year – as much as €700 million, government officials say.
At the same time, public health facilities have seen a 25 to 30 per cent increase in patients because so many Greeks can no longer afford to visit private clinics. Dr Olatz Ugarte, an anaesthesiologist at the St Savvas Cancer Hospital in Athens, says breast cancer patients often have to wait three months now to have tumours removed. “Waiting that long can be life or death for these patients,” she says.
In a recent letter to the medical journal, the Lancet, a team of English researchers warned that a “Greek tragedy” could be in the making, pointing to rising suicide and HIV rates and deterioration of services at hospitals under financial pressure.
“In an effort to finance debts,” the researchers said, “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 case losing their lives.”
At the Perama clinic, which is run by the international non-profit organisation Doctors of the World, doctors say they are seeing many families who cannot afford the bus fare, let alone the new €5 fee at public clinics. Technically, those Greeks who cannot pay are entitled to free care. But the bureaucracy can be overwhelming. At the Perama clinic, Vassiliki Ragamb, a former hairdresser whose unemployment benefits and health insurance ran out six months ago, says she is still waiting to get the right papers.
The story does not surprise Dr Liana Mailli, the paediatrician who is seeing Ragamb’s son, Elias. The three-year-old got a diagnosis of diabetes only a few months ago, after he fell into a coma.
Mailli has heard of such bureaucratic troubles from many patients. Even more often, she says, parents have fallen behind in paying their health insurance contributions, or their employers do not pay and so they are no longer covered.
One development that Mailli says she finds particularly disturbing is that a growing number of children had not had their basic vaccinations. If nothing is done, she says, polio, diphtheria and whooping cough could all return to Greece. “This is such a serious thing,” she says. “But these vaccines are expensive.”
At the start of its debt crisis, Greece was spending about 6 per cent of its GDP on healthcare – about average for Europe. But the system was far from efficient. It includes many small hospitals and a reliance on expensive brand-name drugs. Moreover, there was widespread corruption. Experts say doctors often had lucrative deals with drug manufacturers that led them to vastly over-prescribe, and many expected cash payments on the side for timely and attentive care.
Since the debt crisis began in 2009, the government has frozen recruitment, cut salaries and focused on tracking prescriptions and new procurement procedures. About 20 doctors have been arrested for corruption. But little has gone smoothly. Government officials acknowledge some problems, but say that the system was simply unsustainable. In the next year, they say, adjustments can be made.
“We have had two years of emphasis on the financial, now we will pass to evaluation,” says Nikos Polyzos, the secretary general of the health ministry.
But many doctors say the new emphasis on cutting costs has gone too far. In addition to shortages, they say that the supplies they do have are of poor quality.
They complain that bugs have been found in new syringes imported from China, sutures fall apart and generic drugs don’t seem to do the job. And the recruitment freeze has caused such a shortage of nurses, some doctors said, that procedures frequently have to be postponed.
“The whole system is a mess right now,” says Dr Elias Sioras, a cardiologist and a union activist at the Evangelismos Hospital in Athens. He says that 11,000 patients used to have bypass surgery in public hospitals each year, but that number fell to 9,000 last year.
“The way I see it, at least 2,000 people needed a bypass and didn’t get it,” he says. “I have no idea where they are. They could be dead.”
Some experts, including Lykourgos Liaropoulos, a health economist at the University of Athens who helped the government design many of its cost-saving measures, say the hospitals were probably performing too many bypass procedures. But even he questioned the virtual recruitment freeze on nurses.
“It’s one of the areas where the troika got it wrong,” he says, referring to Greece’s creditors – the International Monetary Fund, the European Commission and the European Central Bank.
Access to drugs has also become a problem for many patients. Some pharmaceutical companies – owed millions, or unhappy with the new, lower rates the government plans to pay – have stopped supplying the hospitals. These include the Swiss pharmaceutical giant Roche, which makes cancer drugs that are not available elsewhere.
The president of the Athens pharmacists association, Konstantinos Lourantos, says few pharmacists can afford to wait for reimbursements, especially for cancer drugs, which can cost €5,000 a month.
He says he told one client to see if any hospital pharmacies had the drug on hand. But the man later told him he had gone to six hospitals without success. "I have no idea what happened to him," Lourantos says. – (Dimitris Bounias and Nikolas Leontopoulos contributed to this article; the New York Times)