“Troika”-Mandated Austerity and the Emerging Health Care Crisis in Greece: An Open Letter to the Greek Government
To the Prime Minister of Greece and President of New Democracy Party, Mr. Antonis Samaras
To the President of PASOK, Mr. Evangelos Venizelos
To the President of the Democratic Left, Mr. Fotis Kouvelis,
To the Minister of Health, Mr. Andreas Lykouretzos,
This letter is an attempt by Greek scholars and physicians to express their concern regarding the current, dire state of Health Care services in Greece.
Our country has fallen into a dismal state, and it is constantly challenged by extrinsic and intrinsic pressures, while the economic and social climate deteriorates further day by day. The Greek government, in total obedience to the irrational demands of the Troika, focuses on the obligations of the citizens towards the state, and seems to forget or ignore its own obligations towards its citizens. The Government has imposed a brutal and self-defeating fiscal austerity; in a confiscatory manner, it tries to collect extra revenue from an already impoverished and afflicted populace, while it neglects its main role, as specified by the Constitution: The Protection of the Rights and the Welfare of the Citizen Body.
In three short years, governments comprised of the current coalition parties have managed to reduce the country’s GDP by 25%, leading Greece to the deepest and longest-lasting economic depression in the history of the modern Western world. During the same period of time, the public debt expanded from 109% GDP to 170% GDP, unemployment rose from 8% to 27%, and youth unemployment now holds the world record at 58%. Incomes have been reduced by more than 40%, leading to a record number of families and individuals living below the poverty line. It is worth noting that the famous “haircut” (PSI), presented by the Government as a notable achievement, ultimately increased the public debt, while raiding the reserves of pension funds, reserves that were gathered painstakingly by the contributions of workers and pensioners.
One of the sectors that has been most hard-hit is Health Care. The Public Health system in Greece is now collapsing at all fronts. Having signed a memorandum of understanding with the unelected and unaccountable troika to reduce public health expenditures from 9.8% GDP (pre-crisis) to 6% GDP (the shrunken post-crisis GDP), the Greek government has instituted a number of measures which seriously undermine the health of the population. Removing health coverage from thousands of unemployed is definitely guaranteed to increase mortality in this segment of the population.
This policy of subservience to the Τroika’s demands has led to the closure or downgrading of Hospital units. For example, the hospital of the town of Kymi “Georgios Papanikolaou”, the hospital of the city of Thebes and many others in the provinces and in metropolitan centers have seen their medical personnel reduced, the staff remained unpaid for long periods of time, their medical equipment in progressive deterioration, and laboratories with increasing shortages in all kinds of consumables (syringes, bandages, reagents etc.). Patients now have to pay for consumables, for medical tests, and for surgeries. This is all on top of what they already paid through their insurance funds. Those who suffer from chronic diseases, such as chronic obstructive pulmonary disease, are forced to pay a 25% deductible for the cost of their medication, while prior to the crisis this deductible stood at 5%. Cancer and kidney failure patients suffer not only due to the increased costs of specialized treatments, but also the general rundown of these facilities, loss of key personnel and dramatic shortages in medications; unable to receive treatment at home anymore, they have to travel far away for dear life, and wait in endless queues in the corridors of bureaucratic health-insurance offices and/or hospital clinics. Patients in mental health units, such as Dromokaitio, face every day the alienation and indifference of a state that fails to support them. The staff and the resources in most psychiatric clinics are decreasing rapidly, while the number of patients is increasing (as this crisis is taking its toll). Psychiatric hospitals in Greece can no longer perform at the level required to provide even basic treatment to patients diagnosed with serious mental illnesses.
Furthermore, the establishment of a “standard rate” for surgeries is forcing patients to pay in advance approximately 20% of the value of materials and services. This “standard rate” makes both emergency and elective surgeries virtually unapproachable for a broad segment of the population. For example, on the basis of the newly introduced pricing, the cost for a hip replacement surgery at a public hospital approximates €1000; this cost is further increased by the remuneration of the surgeon, the anesthesiologist and other essential staff. Thus, the cost of this common surgery is currently unaffordable by an elderly patient with a basic pension of less than €600; such retirees would be unable to secure the funds, having to prioritize purchasing of basic foodstuffs, paying for rent and utilities, securing funds for heating, acquiring their regular medication, and affording sundry living expenses (and often this small pension supports an additional family member).
Beyond these specific destructive measures, one can easily figure out the impact on public health of the consecutive decreases in pensions and the confiscatory tax measures. Many poor pensioners have no choice but to forgo basic, life-saving drugs and healthcare monitoring, in order to afford just food and heating (the Government’s devastating policies in heating fuel are duly noted here). The pricing of basic goods has increased (not only by inflation but also by the drastic increases in VAT for even basic items), while incomes have been drastically reduced. The imposed increase of 500% or above on deductibles for drugs and doctor visits are simply making it impossible for many pensioners to maintain their assigned treatment. Certainly, the consequences here, especially for persons with serious and chronic diseases, are increased morbidity and mortality.
This rapid decline in the quality of care administered is complemented by the hemorrhaging of highly trained individuals; more than 4,000 highly trained Greek doctors have emigrated abroad because of their frustration with the degradation of the system and the successive cuts in wages, overtime remuneration and benefits. It is worth noting that the National Health System (ESY) in our country has operated efficiently, provided exceptional services and constituted an important achievement of our society prior to the onset of the crisis. It was the hard work of the doctors, the nurses, the pharmacists, the laboratory scientists and technicians, the administrators and the ancillary personnel of ESY that advanced the status of the public health in the country. This system is now bereft of basic resources, besieged at every level and plundered with your consent. Its members are fleeing in increasing numbers.
In this context, we call on the Greek government to keep and defend the value of health. There should be no cuts on funds required for the normal operation of the hospitals in Greece, both for those located in major metropolitan centers and for those in the islands and other remote areas of our country. We ask that you do not downgrade regional hospitals to just health centers. Such health centers will provide limited services and result in the collapse of public health in the provinces. Do not let these regional/provincial hospitals remain understaffed, manned simply by general practitioners or pathologists, bereft of key specialized personnel; your policies will degrade terminally what has been the key strength of these regional hospitals, a strength that contributed significantly to the improvement of public health in Greece in the last few decades. If your policies were fully enabled, key specialized personnel would only be found in large, crowded hospital conglomerates in metropolitan centers. Such a policy would force Greeks who need special attention, to travel farther and farther from home in order to secure proper care (thus further increasing the already unbearable costs), assuming that they can even afford it, a dangerous assumption in this current economic climate. The additional costs and the absence of timely specialized care would undoubtedly lead to increased morbidity and mortality in the provinces. A welfare state that respects its institutions and history, and cares about its continued existence in the future, should not even contemplate such drastic cuts in public health. Such actions can be expected by foreign-installed, occupation governments, not by a government of Greeks for Greeks.
Thus, we request the following actions by the Greek government:
- The proper staffing, maintenance, and modernization of existing hospitals in the country, especially in the provinces and the islands.
- The restoration of proper medical coverage of population groups, the collective health of which is specifically under threat by the current economic crisis. These groups include the long-term unemployed, the working poor, low-income pensioners, and others. For these population groups, you must introduce a substantial rollback of the increases in the cost of health care that you have instituted.
- The creation of policies and incentives that will assist in the proper geographic allocation of physicians and nursing personnel of all specialties in order to avoid needless and counterproductive concentration of qualified personnel (often unemployed) in metropolitan centers.
- The proper remuneration of physicians, nurses, laboratory scientists and technicians to avoid further depletion of these key personnel through emigration. The drastic cuts in wages, salaries and overtime pay must be rolled back. Otherwise, the exodus of qualified personnel will turn into a stampede, with disastrous consequences for public health
- The introduction of policies that will assist in the ready availability of pharmaceuticals, consumables, laboratory supplies, and devices. The government should forgo unconvincing public releases about primary surpluses and regularly pay suppliers and pharmaceutical companies the full amount owed.
As the government of Greece, you have the responsibility for our country’s survival and the welfare of its citizens. You have no right to obtain credit by degrading the health of your compatriots and by sending to an early grave the most vulnerable among us. You are obliged to say NO to the demands of the unelected members of the “troika”, when obedience to these demands has devastating consequences for our country. If saying NO to Troika’s destructive demands means exiting the Euro Zone, then you must do so. Many of us believed in a united Europe, but the Euro Zone proved to be only a means of exploitation of the weaker nations by the stronger ones. The consequences of our continued participation in the common currency have become obvious by now. Along with the impoverishment of our country, you have made us forget not only the meaning of the word “pride”, but also the meaning of “dignity”. Despite the ongoing crisis, record unemployment, the rapid decline in GDP, the dramatic increase in poverty and hunger, the deteriorating health of the population, the sharp decline in birth rates, the wave of suicides and total loss of hope, you cling tenaciously to your policies of supplication and subjugation, while continuing to sell off public property and public companies at rock bottom prices.
The disastrous policies that undermine even the basic health of the Greek population must come to an end. As Greeks, we are able to survive the crisis and rebuild. However, to do so, having our physical health is a prerequisite.
- Medical and support staff of the Metropolitan Social Clinic of Elliniko, GREECE.
- Akritas Alkis, Professor, CS / KU, USA.
- Albrecht-Πηλιούνη Ευφροσύνη, Ph.D., International Programs, Foy Hall 316, Auburn University, Auburn, AL 36849, USA.
- Almpoura Efstratia, MSc Developmental Psychologist, IED-Paris8, Vincennes-Saint Denis, Paris, & Harvard ES, Cambridge MA, Athens, GREECE.
- Anastassopoulou Ioanna, Professor, School of Chemical Engineering, Department of Material Science and Engineering, Athens, GREECE.
- Andreatos Antonios, Professor, Department of Computer Science, Department of Air Science, Air Force Academy, Athens, GREECE.
- Antikas Theodoros, Ph.D., GREECE.
- Apostolaki Aggeliki, MSc Psychologist, A.U.TH. Faculty of Philosophy, Department of Psychology, Thessaloniki, GREECE.
- Argyrokastritis Ioannis, Associate Professor, Agricultural University of Athens, GREECE.
- Argyropoulos Giannis, PhD, AT&T Labs
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- Valaskakis Kimon, Ph.D., Ambassador of Canada (Ret), Professor of Economics (Emeritus), University of Montreal, CANADA.
- Vallianatos Evangelos, Ph.D., Associate Professor, Pitzer College, USA.
- Vartholomaios Tasos, MD, PhD, MFHom, GMC, UK, Registered Consultant Pathologist, Member of the Faculty of Homeopathy,UK
- Vartholomaiou-McLean Athina, Ph.D., Professor, Sociology, Anthropology and Social Work, Central MI University 48859, USA.
- Vichas George, Cardiologist, Head of the medical team of the Greek Metropolitan Social Clinic of Elliniko, GREECE
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- Vogiatzis Alexander, Former Associate Professor, University of Macedonia, GREECE.
- Burriel Angela R., Professor, Veterinary Microbiology, University of Thessaly, GREECE.
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- Gatzoulis Nina, Languages, Literature and Cultures University of New Hampshire, USA.
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- Dokos Socrates, Ph.D., Associate Professor, Graduate School of Biomedical Engineering, University of New South Wales, Sydney 2052, AUSTRALIA.
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- Koutselini Mairi, Professor, University of Cyprus, CYPRUS.
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- Moraitis L. Nicholas, Professor of International Relations – Comparative Politics, University of California, Berkeley.
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- Anna Tsirka, pediatric cardiology, Assistant Professor, Tufts University School of Medicine
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- Katerina T. Franzi, Associate Professor of Informatics, Department of Mediterranean Studies, University of the Aegean
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