Our health system needs help
For the patient, hospitals represent a frightening «no man’s land» between health and illness, between life and death. For Greece itself, hospitals are the criterion by which we can judge whether the state is serious about the welfare of its citizens. The National Health System functions well, but unfortunately not well enough to prevent a mass exodus toward the expensive private system that has been set up. Why? The excellent treatment provided in the public health system is due mainly to heroic efforts of the great majority of doctors and nursing staff. We know no one (rich or poor, Greek or foreign) will be left untreated. Notwithstanding its problems, the system provides a safety net that many wealthier countries can envy. But staff shortages, organizational shortfalls (which inflict chaos on both staff and patients) and frequent cases of bribery undermine all the good efforts. Patients suffer unnecessarily, their companions are exhausted by all the work they have to do to help them, and citizens feel that they are at the mercy of a system they do not understand and which shreds their personality and their dignity. It is not that the state and the citizens themselves don’t spend a huge amount on healthcare. According to the latest statistics from the Organization for Economic Cooperation and Development, in 2003 Greece spent 9.9 percent of its GDP on health. This is equal to the percentage spent by Canada and, surprisingly, more than that spent by countries such as Denmark (9 percent), Finland (7.4 percent), Britain (7.7 percent) and the Netherlands (9.8 percent). The only countries that spend a greater percentage of their GDP on health are the United States (15 percent), Switzerland (11.5 percent), Germany (11.1 percent), Iceland (10.5 percent), Norway (10.3 percent) and France (10.1 percent). In Greece, though, we spend a disproportionately large amount on private healthcare – namely 47.1 percent of the total, whereas the EU average is 22.8 percent. In other words, Greece, with its National Health System, is close to the United States, where 55.1 percent of healthcare spending goes to the private sector. Greece’s Foundation for Economic and Industrial Research (IOBE) reported last year that in 2003, total healthcare costs in Greece amounted to 14.8 billion euros, of which 7.8 billion was spent on public health and the other 7 billion in the private sector. But if we spend so much on public health, why do so many people turn to private clinics and doctors? There are a number of reasons for this, but the underlying cause is the shortage of staff in the public system. The National Health System employs about 13,000 doctors, who are assisted by 9,000 people who are training to be specialists and who leave when their training is complete. For years, doctors have complained that another 5,000 doctors need to be hired. The shortages lead to the staff exhaustion and patients’ hardship. Both sides then have to put up with long queues and short tempers. Still, thanks to the efforts of the doctors, the work gets done. The real problem for both patients and doctors is the serious shortage of nurses. For years, the urgent hiring of some 6,000 new nurses has been delayed (proving that the rigid procedure for state-sector hiring has become a curse rather than a means to combat cronyism). Family members are therefore forced to spend all day and night at a patient’s bedside in crowded wards (with all the risks that this raises for their own health and that of the patients). Or they have to hire, at great expense, «exclusive nurses.» That is why, when they can, people choose private clinics, where they know that at least they will avoid the overcrowding and lack of nurses of the public system. The lack of sufficient staff also explains the lack of organization and the insecurity that compels patients to want to pay doctors for special care, even when such payment is not directly requested. If the system were running smoothly, very few would probably feel the need to buy a doctor’s or nurse’s commitment. (And the fact that wages are low is not a factor here, as the many doctors who accept no payment from patients get the same wages as those who seek bribes). Given these conditions, it appears that the simple solution of hiring more staff is not done because that would add costs to the public health system and, secondly, it would inevitably cause the robust private health sector to wither. But if the state really did care about its citizens – whether they be doctors, nurses or patients – it would know what to do.
