Private vs public healthcare
Patients in Greece show a distinct preference for private hospitals when it comes to more expensive treatment, such as surgery, and for non-emergency care. In an interview with Kathimerini, Professor Yiannis Kyriopoulos of the National School of Public Health (ESDY) said that fees at larger clinics have reached «astronomic proportions» due to lack of regulation by the State. A patient is likely to pay over 2,000 euros for 14 hours in intensive care or around 3,000 euros for a medical test, fees that are considered normal for a large, luxury clinic. A public health sector survey, carried out in cooperation with the World Health Organization (WHO), showed that people prefer private hospitals because of their surroundings, the range of choice and the nursing. Kyriopoulos believes that among the greatest disadvantages of state hospitals are the long waits for access to high-technology departments. «These are the shortcomings of the system. People in lower income brackets find it more difficult to get access to these services and have to pay proportionately more,» he said. Hospitals’ reputations Is there a trend toward enlarging the already large private healthcare sector? I would say medium-sized and larger private clinics are experiencing increased demand. However, there do not appear to be any plans for major investments in the hospital sector as long as private health insurance remains at its current levels. Investments, even in major towns outside Athens, are facing serious problems. Increased demand in Athens is due to certain comparative advantages with regard to the quality of non-medical services expected by the public. Although the state hospitals are decidedly more advanced, a large percentage of people in middle and higher income brackets prefer private clinics. We usually link quality with a hotel-type infrastructure. Isn’t the quality of service indirectly linked to the medical result? A hospital’s reputation is the result of a combination of factors and contributes, along with the time factor and fees, to consumers’ decisions. Of course, the medical factor is essential in health services and this is where the public sector is overwhelmingly superior, with the best medical personnel in the country and higher quality technology. In a study of hospital doctors, we found that 53 percent of them have postgraduate degrees and have studied abroad. These factors are important when someone has to make decisions about serious health problems. The private sector provides diagnostic technology, nursing care and treatment for minor or moderate cases. There is a kind of reverse system in operation here. Instead of the users making the choice, it is the clinics that decide which patients to accept. So the higher prices in the private sector are justified? It is obvious and desirable that the private sector’s incentive is profit. The question is whether the prices correspond to what we consider to be acceptable profit. There are several issues that need to be examined regarding the behavior of clinics toward patients and insurance companies. This behavior is linked to the absence of state intervention or state control of prices and quality of services. Major clinics have an oligarchic approach and those who foot the bill are the insurance companies, which are finding it hard to keep their heads above water. If the hospitals improved their infrastructure and updated their financial relations with insurance funds and private insurance companies, then they would attract more patients covered by private funds. Are there cases where unnecessary tests and treatment are carried out? In recent years this phenomenon has been on the wane because of the alternative options open to patients, the development of technology outside hospitals and the high prices charged to patients. I would say that this phenomenon in Greece in recent years has become restricted to the private sector. The way compensation is paid out for services in the private sector results in a plethora of medical tests for which patients pay astronomical fees. In reality, costs in the private sector, taking into account the standard of services and the kind of cases they treat, are much higher than in the public sector. Do you think the State should control prices and the quality of services? Both private and public hospitals should be regularly inspected and evaluated. This is an overall consumer protection policy that should be the vanguard of national health policy in the period to come. All healthcare centers in both the public and private sectors should establish an internal monitoring system, but there should also be outside inspections by teams of experts to make recommendations and, if necessary, impose sanctions. Shouldn’t patients themselves be aware of the capabilities of a department, results of operations, etc., of a hospital to which they are entrusting their health? Of course. Inspections and evaluations allow grades to be awarded, and in my opinion they should be made public so that patients can make their choices accordingly. Is there any such information currently available? Only on an individual and spasmodic basis. There are some very high-quality areas, chiefly within the National Health System. There are very good medical school departments in regional hospitals. In Athens, at the Hippocrateio, the Evangelismos, the Athens State General and Red Cross hospitals, there are clinical departments on a par with hospitals in the rest of Europe and the USA. Are there any criteria that could be used as a basis for putting a ceiling on fees at large private hospitals? Of course there are, but as you are aware, there is a National Health System, which does not operate on the basis of fees; pricing has a very relative value and the set fees have been outdated for some time. This could be done in state hospitals, because access to the National Health System is just about free for everyone. In the state system, things are arranged on the basis of certain rules, but in private hospitals they are based on fees. In such a sensitive sector, however, these should not be set indiscriminately by the supplier. So the State should confront the question of consumer protection here. Of course, fees cannot be curbed too far below market prices as this would result in a black market. For example, ordinary medical consultations are now set at about 6.50 euros, although real fees are way above that.
