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Challenged by austerity measures, Greek health care system undergoes restructuring
While private practices struggle to survive, reduced budgets make public hospitals unable to cope with patient overload.
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Despite a variety of problems, including a fragmented organization and a complex system of bureaucracy, the Greek health system was classified as “relatively efficient in international comparison” in the 2009 report of the Organisation for Economic Co-operation and Development. In 2000, the World Health Organization ranked the Greek health care system as the 14th best in overall assessment and the 11th best in quality services worldwide, above the U.K. and Germany. Ophthalmology, thanks to a long history of research and innovation, offered particularly high standards of care and had built a solid network of public and private hospitals, as well as independent clinical practices.
Over the last 2 years, however, the global economic downturn and the government debt crisis have hit hard on the system, imposing harsh across-the-board austerity measures.
“Health funding has been greatly reduced, and we are undergoing a huge restructuring process, aimed at improving efficiency and reducing expenses,” Ioannis Panagopoulos, MD, president of the Hellenic Society of Intraocular Implant and Refractive Surgery, said.
Ioannis Panagopoulos
“Working conditions are now extremely hard, especially for young ophthalmologists,” he said. “A large number of doctors are struggling to survive in a difficult working environment. Salaries in public hospitals are much lower than the EU average, and social security doesn’t cover many expenses for the patients. Private insurance companies have reduced doctor fees and patient coverage over the last year.”
Public and private care in trouble
Following the European tradition of providing universal access to health care, the Greek national health system, ECY, was established in 1983. Cataract surgeries and other ophthalmic procedures are performed under ECY coverage in public and private hospitals. The Ministry of Health recently issued a new law that also allows ophthalmic procedures to be done in private medical centers that have the proper organization and equipment. In this case, patients are covered by private insurance or pay out of pocket. Refractive procedures are solely performed in private medical centers.
“Traditionally, Greek people seek a personal relationship with their doctor, and whenever they can, they prefer to pay for private care and have a doctor of their own choice,” Panagopoulos said.
However, the economic crisis has created new, unprecedented conditions that have affected health care in general, including ophthalmology. The public health system is working on restricted budgets and dealing with an overload of patients because people are unable to cover their private medical costs.
“The overload in public hospitals is causing a series of complications, such as delays in services such as cataract surgery. There are long waiting lists, and the demand is exceeding the offer in terms of time and available resources. On the other hand, medical professionals in the private sector are experiencing a decrease in surgical volume and consequently in their income,” Panagopoulos said.
He said he is concerned about the consequences of the situation, which heavily affects the quality of medical services. The patients, he said, are those who suffer the most.
Greece has the largest doctor-to-population ratio of any country in the Organization for Economic Cooperation and Development. There are approximately 2,000 ophthalmologists, and 75% of them are men. There is a concentration of ophthalmologists in urban centers due to the overall distribution of the population. With 4.2 million inhabitants, Athens and its suburbs house nearly half of the country’s population. Consequently, approximately 950 ophthalmologists practice in the capital.
However, the needs of the population have been well covered in all areas of the country, even the most remote areas, by a solid network of public and private health care services, Panagopoulos said. University clinics offer primary, secondary and advanced health care and are present in every area, from the northern border to the island of Crete in the south. Ophthalmologists are well trained, most are exposed to the international literature, and an increasing number of young doctors do their residency or fellowship programs in another European country or the United States.
“As ophthalmologists, we have a long tradition in high-level medical services and have always been in the forefront of research and production of new knowledge. It is not coincidence that the LASIK procedure was first introduced in Greece by the innovative research of Prof. Ioannis Pallikaris. Greece has developed over the years an important role in every field in ophthalmology due to the effort of many excellent specialists,” Panagopoulos said.
Present concerns
There is concern that the present situation may corrode the basis of the Greek health system. A range of proposals for reform has been issued by the Ministry of Health to ensure efficiency within the International Monetary Fund key loan conditions that public health expenditures must not exceed 6% of the gross domestic product.
“We are undergoing major changes in policies regarding medical insurance schemes, data collection on hospital activity and expenditure, hospital budgets, physicians salaries, medical prescriptions, reference prices for drugs and pharmacies regulations. Implementation, however, has been complicated by the current economic climate,” Panagopoulos said.
In his opinion, it will take time before the system finds a new balance and difficulties start to decrease.
“The drop in the demand for cataract surgery in the private sector, as well as for refractive procedures, is a trend that will continue as we move in further recession. The only response we can give now to allow private practices to survive is lowering the price of the procedures and maintaining high quality,” he said.
As far as the public sector is concerned, Panagopoulos said he hopes that the current reforms will offer the opportunity for improvement and lead to cost-effective reorganization of health care.
In November 2012, the European Union and the International Monetary Fund finally agreed to revitalize the rescue program for Greece by releasing a new tranche of bailout loans and cutting €40 billion from its debt. Although this decision provided much-needed relief, Greece is still far from being able to get back on a path of independent economic growth
“However, our country wishes to stay in the European Union and the eurozone and whatever solution can only be worked out within these arrangements. Many countries, especially the southern European countries, have similar problems, but eventually a solution will be found to the benefit of all,” Panagopoulos said. – by Michela Cimberle