Amidst an overwhelmed, understaffed, and underfunded healthcare system, the government in Greece announced a reform that will supposedly enhance the functioning of the so-called “New National Health System (NHS)”, but which will in fact reduce access to care for patients and limit health workers’ rights.
In reality, the proposed reform is a major Public Private Partnership (PPP) initiative that diminishes the social character of the healthcare system by further promoting its privatization and deregulation. More specifically, the new healthcare bill will significantly expand the role of the private for-profit sector and shift the cost of healthcare provision to its users, or in other words, to the patients. The government insists on adopting neoliberal reforms that have been implemented but have failed and even abandoned in several other countries, such as Great Britain, over the past 20 years.
Public hospitals for private profit
According to the proposed healthcare bill, the reform will “put an end to the perpetual ideological distortion of not deploying the private sector to the advantage of the public” by “covering the shortage of healthcare workers in the NHS through transparent, economically advantageous contractual relationships with the private sector.”
In other words, public hospitals will now be able to hire private doctors under part-time contracts in order to cover gaps in healthcare personnel when needed, especially in regional hospitals. Therefore, the government will once more avoid its responsibility to strengthen the NHS by employing permanent healthcare personnel.
Additionally, surgeons will be given the opportunity to perform operations in public hospitals during the afternoon and evening shifts. The patients, even the insured ones, will have to contribute 30% of the cost of such surgery and completely cover the fee of the surgeon, whereas until now all surgeries that were performed in the public sector were free of charge. Thus, public hospitals will now function as private clinics during the afternoon and evening shifts, and doctors will be able to use public facilities for their own profit. A potential consequence could be the operational degradation of day-time activities in public hospitals, and the minimization of the number of surgeries performed during the day in order to push patients to make their appointments and undergo scheduled surgeries in the afternoon and evening shifts.
Implications for patients
Three years into the COVID-19 pandemic, the Greek NHS continues to function on the brink of collapse. Instead of hiring additional healthcare professionals to cope with the consequences of the COVID-19 disease and its implications for the treatment of other diseases (e.g. cardiovascular disease, cancer), the government further reduced the number of healthcare professionals by suspending the contracts of unvaccinated workers. As a result, patients that cannot afford to turn to the private sector and cover the enormous amounts of money that are required by private clinics are left without treatment.
After the reform, all citizens will be obliged to register with a private family doctor. A referral from the family doctor will be required in order to get treatment from a public hospital or a specialist. Private family doctors will therefore act as “gatekeepers”, with the only exception being emergencies. Yet, a patient will be able to go to a private clinic without obtaining a referral first. This way, patients who are not able to get a referral will be channeled to the private sector, where they will have to cover the cost of their treatment.
Private family doctors will also sign a contract with the public sector and they will be given incentives in order to register 1,000 to 2,000 people as their patients. For their new role, they will be reimbursed per capita, meaning that they will get paid a fixed amount of money for each patient they have registered. This measure might lead to “cream skimming,” a situation where doctors favor the enrollment of younger, healthier individuals who are less likely to get sick – receiving the money, but minimizing the amount of work.
In March, health workers from public hospitals organized a protest in order to express their opposition to the new healthcare bill. The protest started in front of the ministry of health and ended at the Greek parliament where they were met with a strong police force that did not hesitate to use violence.
“We believed that the government would have realized by now the importance of the public health system and would abandon its neoliberal ideologies that support the privatization of the NHS, since, during the pandemic, the private sector acted merely as a spectator,” said the president of the Panhellenic Federation of Public Hospital Workers (POEDIN), Michalis Giannakos. “With the new healthcare bill, the government is trying to shift the cost and the responsibility of healthcare to the public.”
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