Health in crisis: The problem of access to the Greek health system

by Konstantina Briola,

The Greek Health System presents a series of problems that endanger the very existence of the system itself, while at the same time deteriorating the objectives of the health system and the health of the citizens. Some of these pathogens are wastage within the health system, creation of health budget deficits, provision of uncoordinated services, lack of quality assurance institutions, etc. Below, we will analyze the issues of geographical misalignment of health resources and waiting lists (along with waiting times).

Access to health services

Access to health services is considered a social good. However, it can be argued that the NHS in Greece is governed by over-regulation, poor management, low cost-effectiveness and inability to provide universal access. Regional disparities have been a very important issue in recent years. The height and evolution of regional disparities are of great importance both to theory and to politics.

Geographical access

One of the factors that increase the inequality in access to health services is the geographical specificity of our country. Residents of remote areas, small and isolated islands have problems accessing specialist doctors and specialized laboratory centers. Citizens, especially those with health problems, are forced to move to urban centers where appropriate services are available. This means that access to health care depends on the place of residence of the person in need of health care.

Indeed, the NHS is unable to address the issues of decentralization, equality, and quality of health services. Greece is the country in EE-15 with the largest proportion of the population that was unable to undergo a medical examination because of geographical distance from the health service. This is largely due to the fact that there are no effective allocation mechanisms based on the needs of the population.

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Diagram 1. Health inequalities, EU, 2009 – Unmet needs for medical examination due to unequal geographical access to services (%)

Note: Republished from C. Papatheodorou and A. Moisidou, 2011, Chart 9, p.36. ©ΙΝΕ ΓΣΕΕ

Inequalities in the provision of health services between regions and in urban and rural areas are often reported in ESPN country reports. In France, for example, 23% of the continent’s population finds it difficult to find a GP within a thirty-minute drive from his home. The shortages of doctors in disadvantaged areas have become more serious in recent years and may pose significant challenges in the field of human resources in the near future.

A key feature of the structure of the Greek healthcare system is the uneven regional distribution of infrastructure, human and financial resources. This is due to the fact that health resources in Greece have, in the past, been allocated on the basis of political expediency and bureaucratic procedures.

The geomorphology of Greece – which includes several mountain villages and many islands with sparsely populated areas – combined with the lack of sufficient incentives for staffing – does not facilitate a satisfactory expansion of health care. The situation in 2001 and 2011 is presented in Figures 1, 2 and 3. These show that significant inequalities persist in total hospitals, total hospital beds, and neuropsychiatric clinics per 100,000 population. These inequalities in the distribution of health resources make it doubtful whether all health areas are capable of meeting the health needs of their populations. For example, the existing inequalities in the capacity and availability of oncology beds between different geographical areas affecting equal access to effective cancer care, favoring large urban areas and especially the regions of Attica (ie the cities of Athens and Piraeus) and Thessaloniki.

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Figure 1. Total hospitals per 100,000 inhabitants per geographical area, 2001 & 2011
Note: Republished from C. Economou, 2015, Figure 11, p. 45. © WHO
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Figure 2. Total hospital beds per 100,000 inhabitants per geographical area, 2001 & 2011
Note: Republished from C. Economou, 2015, Figure 12, p. 46. © WHO
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Figure 3. Neuropsychiatric hospital beds per 100,000 population per geographic area, 2001 & 2011
Note: Republished from C. Economou, 2015, Figure 14, p. 47. © WHO

From the above, it can be argued that two of the main barriers to access the healthcare system in Greece are the uneven geographical distribution of services and the shortage of staff, especially in public health centers in rural areas. These factors tend to increase both costs and travel times for those living in rural/remote areas, widening inequalities in access to healthcare for the population.

Waiting lists

Admittedly, waiting lists are a problem and a challenge for all EU countries, and over time it is expected to grow as a problem. Indeed through the austerity measures imposed on Greece by the outbreak of the crisis, the budget of the public hospital dropped by 26% between 2009 and 2011. Data on the health impact of these cuts are rare, but the workload of staff has increased and waiting lists have increased equally according to some studies.

To investigate unmet needs for medical examination due to the waiting list, we must divide the population into quintiles. As shown in Chart 2, large waiting lists affect the poorest social strata (ie those in the top 10) compared to the richest strata (ie those in the top 5) because they do not have the option of private coverage of health costs.

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Diagram 2. Health inequalities, 2009 – Unmet waiting list for medical examination (%), in Greece and EU (15), per quintile of population-based on an income equivalent
Note: Republished from C. Papatheodorou and A. Moisidou, 2011, Chart 10, p. © ΙΝΕ ΓΣΕΕ

At this point, it would be useful to refer to the difference between the waiting time and the waiting list. Although, waiting times and waiting lists are similar concepts, the difference is that while the waiting list predicts that patients will be treated at some point, the waiting time is determined by the amount of time required to treat all patients on the waiting list, through current and future therapies. For example, waiting lists in England steadily increasing since the 1950s, on the contrary, waiting times were quite stable for long periods. From the patients’ point of view, what matters is the waiting time, not the length of the list.

Waiting times are an important health policy issue in many OECD countries. Policymakers around the world face significant challenges in reducing waiting times. However, the available data on comparative waiting times are very limited. Only 15 of the 23 countries monitor and publish national waiting time statistics (Sweden, Denmark, Finland, Norway, England, Scotland, Wales, Northern Ireland, Ireland, Portugal, Spain, Netherlands, Canada, New Zealand). The countries without national statistics on waiting times are Austria, Belgium, France, Germany, Greece, Italy, and Luxembourg. Some countries that do not have national control still measure waiting periods at the regional level, such as in Italy.

Epilogue

Access to health services is considered a social good. However, issues such as geographical access and waiting lists (along with waiting times) pose obstacles to equal access for citizens. One of the factors that increase the inequality in access to health services is the geographical specificity of our country. Residents in remote areas have problems accessing specialist doctors and specialized laboratory centers. Uneven geographical distribution of services and lack of staff are found in public health centers in rural areas. As for waiting lists, with the outbreak of the crisis, the public hospital budget was reduced. This has resulted in reduced existing hospital staff, increased workloads, and increased waiting lists.

The key to a successful NHS is to be able to ensure the equity, quality of health services it offers. Governments, in a Europe of recession and budget cuts, are called upon to meet the growing needs of the population. In order to make such an effort viable, it is, therefore, necessary to establish a long-term policy plan.

References

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