Since 2008 the European Union has struggled to overcome the local effects of a global recession. With financial instability has come spending cuts to public services in many countries, including health care. Although there are more and more positive signs pointing to an economic upturn for many European countries, some nations are still struggling to regain the financial foothold they once had: and in no country is this more true than Greece.
After joining the Euro in 2001, salaries increased and public spending was on the rise – unfortunately, so was tax evasion and illicit government borrowing. When Greece found itself unable to cope with a massive nation-wide debt, the country was bailed out financially by other members of the European Union – but with the strict understanding that Greece would implement austerity measures in order to get its economy back on track.
Unfortunately, as laid out in the February 2014 edition of The Lancer journal of medicine, these spending cuts in Greece have lead to a health care crisis; a crisis in which 1 million Greeks are without access to health care services.
The Lancet study was conducted by a group of researchers from the London School of Hygiene and Tropical Medicine, as well as Oxford and Cambridge Universities. By examining public health records and surveys along with economic and social policy, these researchers concluded that national austerity measures have put a serious burden on mental and physical health care services, and without targeted action in the near future, the health care environment in Greece will likely worsen.
Firstly, there is the problem of unemployment. The health care system in Greece works under the assumption that every citizen will receive health insurance through their employer, or the employer of a spouse or parent. Of course, unemployment in Greece has been on the rise since the financial collapse in 2008: unemployment rates tripled between 2008 and 2012, from 7.7 percent to 24.3 percent. What’s more, many of the people currently out of work have been without a job for years – nearly 15 percent of the Greek population is enduring long term unemployment.
No job means no employer-sponsored health insurance, and for many people, no job also means no spare money with which to purchase independent coverage.
Along with losing workplace health coverage, Greek citizens have in the past five years also had to face higher-than-average health care prices, again due to government cuts. Hospital spending was cut by a quarter from 2009 to 2011 to meet a required 6 percent cap on government spending, and with more austerity measures implemented in 2012, Greece may see more medical spending cuts in the future.
Such large-scale reductions in health care funding have received criticism both within Greece and abroad. Andreas Loverdos, a former Greek Minister of Health, has been quoted as saying that “the Greek public administration…uses butcher’s knives [to achieve the cuts].” Outside of Greece, a 2012 UN report commented that “the right to health and access to health services is not respected for all children [in Greece]”
Indeed, the health care problems Greece is currently facing have extended in a very noticeable way to children and mothers. Studies show that due to welfare spending cuts by the government, nearly one-third of Greek children are either living in poverty or at risk of doing so in the near future. More expensive health care services and a loss of insurance also appear to be correlated with a country-wide increase in stillbirths, low birth weight babies and infant mortality, possibly due to poor services for pre-natal women.
Health care spending cuts have also lead to a crisis in care for drug offenders. Treatment and prevention programs have lost a good deal of funding, and along with those cuts have come losses to programs that distribute free condoms and clean syringes. According to The Lancet report, it is likely that these service reductions are responsible for Greece’s rising rates of HIV from 2009 to 2012. Especially frightening is the rapidly growing prevalence of HIV amongst intravenous drug users: this group saw 15 new HIV infections in 2009, but in 2012, 484 infections in this population were reported.
Although the most recent Minister of Health (Greece has seen four Ministers of Health in just over a year) Adonis Georgiadis has made efforts to address the country’s HIV problem by approving a law that would allow drug users (as well as immigrants and prostitutes) to be forcibly tested for the disease, critics including the Joint United Nations Programme on HIV/AIDS say that such a policy would discourage at-risk populations from seeking HIV testing and treatment.
Rates of tuberculosis in drug users also appears to be growing, and although the general population of Greece is less at risk of contracting HIV or tuberculosis, it seems they may be at risk from malaria. Greece hasn’t seen a malaria resurgence in over 40 years, but the disease is now emerging in some parts of the country, most likely because many city governments have cut mosquito spraying programs in order to save money and meet austerity requirements.
Greeks who do have health insurance coverage may still find it more difficult than ever to access medical services. Hospital spending cuts have lead to staff reductions and increased waiting times; the personnel who remain are often overworked, especially in rural areas where supplies and staff are in short supply. Many health care costs have also shifted to the patient: outpatient user fees have nearly doubled, and co-pays, inpatient fees and drugs costs are increasing too. In fact, even patients who can afford higher prescription prices may be unable to find the drugs they want. Drug companies saw a profit loss following delayed government reimbursements to hospitals, which has lead to less output from the pharmaceutical industry.
All of these health care cuts are affecting older Greeks the most, according to The Lancet study, although researchers can’t say for sure if this is due to a loss of medical services or the result of a loss of other public services such as transportation. Mental health care, too, has seen larger-than-average damages to its side of the health industry. Many non-profit clinics tasked with offering free community mental services have had to shut down due to a lack of government funding: Greece reduced mental health care spending by 20 percent in 2010 and another 55 percent the year after that. At the same time (and possibly due to the economic downturn) the Greek populace has reported rising levels of depression and attempted suicide in recent years, and suicide rates increased 45 percent between 2007 and 2011.
Greek officials in favor of austerity measures have insisted that government budget cuts will have a long term advantageous affect for all, and that anyone unable to afford health care at the moment should be able to receive services for free. The government has also taken the action of accepting help from the World Health Organization to create further reforms to the health care system, and the European Union lent its financial support in September 2013 toward a new health voucher program that should lead to health care coverage for more than 200,000 Greek citizens. Hopefully, the other 800,000 will soon receive some health benefits, too.