The reorganization of the Greece's health system, under German direction, is advancing. "A final timetable is to be presented in the second half of this year," declared the German Health Ministry (BMG). The German government sees deficits also in the lack of an "effective cost management," but most of all in the lack of "competitive elements." In a "Memorandum of Understanding" (MoU), the BMG and the Task Force for Greece (TFGR) have reached an agreement with the Greek government on the introduction of the highly criticized German-modeled so-called case flat-rates. The criticisms stem from the fact that patients are not being treated in response to their medical needs but on the basis of economic efficiency. The massive consequences the austerity measures are having on the public health in Greece are becoming more evident. A growing number of Greek citizens are losing their health insurance, due to unemployment and therefore must pay medical costs themselves. The shortage of medical aid, for example, has caused an increase of 40 percent in the child mortality rate since 2009. Diseases such as malaria or AIDS are spreading more rapidly. The German government continues to insist on its austerity course in spite of these ramifications.
"Efficiency and Effectiveness"
Within the framework of the EU austerity dictates, Germany took the lead in the reorganization of the Greek health system back in March 2010. "The German Ministry of Health is in support of the Greek government's measures to increase the efficiency and effectiveness of long-term health care, by substantial and effective transformations in the organization of its health system," declared the State Secretary in the Ministry of Health, Stefan Kapferer in February 2011, on the occasion of the signing of the corresponding "Declaration of Intent."[1] The concrete measures had been specified by the German Ministry of Health and the Task Force for Greece (TFGR) in the April 2012 "Memorandum of Understanding" (MoU) with the Greek government. These measures include the introduction of case flat-rates, a change in hospital management structures, the reorganization of the National Organization for Healthcare Provision insurance (EOPYY) and new pricing models for medicine. The German GIZ development aid agency was given the responsibility of the final elaboration of these plans, which thereby opens "new markets in industrialized countries."[2] The German government bought supplementary expertise at the "KSB Clinic Consulting Group" and the "B and K Informatik and Consulting" company.
Profit-Oriented Therapy
According to the German government the Greek health sector is lacking an "effective cost management," but above all it lacks "elements of competitiveness."[3] The introduction of German-modeled case flat-rates is considered a fundamental instrument for overcoming these alleged deficits. By using a remuneration system oriented on the type of illness rather than on the length of hospital stay, the government coalition expects "major advantages" - even though criticisms of this model have been growing for a long time. Doctors have been criticizing that the false incentives, on the one hand, could lead to unnecessary, but lucrative treatments, and, on the other, to premature discontinuation of treatments in less profitable therapies. In addition, no studies have proven that costs are reduced through a reorientation on "Diagnosis Related Groups" DRGs. The German government is not promising overnight effects through DRGs. These would presuppose the implementation of modern, efficiency-oriented hospital management structures, which would be time consuming. "In this situation, short-term, tangible successes are not to be expected," according to a government answer to a parliamentary interpellation in the German Bundestag.[4]
Cut the Health Budget by One-Third
These proposed transformations are being implemented within the framework of the austerity measures being enforced by Berlin. According to the stipulations handed down by the Troika, Greece's health expenditures should not surpass six percent of the country's gross national product - in Germany these expenditures were at 11.3 percent in 2011. Since, as a result of the austerity policy imposed on that country, the Greek GNP has been on the decline for years, the expenditures for the health system are sinking drastically. By 2012, these expenditures were reduced to around 9.5 billion Euros, from 14 billion Euros in 2009.[5] The Greek government has already shut down 46 of its 130 hospitals and cut the budget by 40 percent for those remaining. This has added thousands more to the unemployed created by the devastation of the health sector. The newly founded EOPYY health insurance organization has had its finances cut. This has created billions in debts and is unable to pay the costs of medicine and treatments. Therefore patients must themselves pay, along with approx. 30 percent of their fellow citizens, who had lost their health insurance due to unemployment.
Humanitarian Crisis
In 2012, Greece's Minister of Health, at the time, Andreas Lykourentzos, characterized the negotiations with the Troika as the most difficult period of his incumbency. "The public health system can't be amputated," he warned following the talks.[6] In fact, the imposed austerity measures had a devastating effect on his country's health situation. Sick leaves have already a tendency to increase in times of economic crisis; the austerity policy, therefore, makes the situation even worse. Dr. Giorgos Vichas, speaks of a "humanitarian crisis."[7] Since 2008, the child mortality rate has risen by 40 percent. The number of HIV positive drug users has risen from 10 - 15 in 2007 to 314 in the first eight months of 2012 alone - mainly due to the drastic cutbacks in preventive programs. Malaria and tuberculosis, the West Nile and dengue fevers are continuing to spread. Doctors' initiatives, appealing for donations of medicine and treating patients free of charge are attempting to mitigate the most serious emergencies, but they cannot substantially better the medical situation.
Deadly Shock Therapy
"The interaction between austerity policy, economic shock treatments and deficient social protective measures seems to ultimately lead to an escalation of the health and social crises in Europe," concluded a study by several scholars published in the renowned "The Lancet" medical journal,[8] Epidemiologists, David Stuckler and Sanjay Basu drew the same conclusion in their book "The Body Economic - Why Austerity Kills." This is why the "European Health Alliance" has appealed for a political about face in an open letter to the European Commission. Associations in Germany, for example "Medico International" and the "Association of Democratic Doctors" are protesting against the austerity dictate and its catastrophic consequences.
Expenditures Still too High
The German government does not seem to be impressed by these initiatives. For example, activities to insure a better health insurance protection, surpassing the program set with the TFGR in the "Memorandum of Understanding," are not being planned. "The German government is concentrating its active support on the focal themes set out in the MoU with the Greek government and the TFGR," explains the Chancellery.[9] In the meantime, the Troika has imposed even more drastic cut backs. Following its last "inspection," at the beginning of this month, it has forced the Greek government to agree to take concrete steps - not, for example, to mitigate the dramatic consequences of austerity on the country's health situation - but rather to bring under "control" the still "too high expenditures in the areas of health."[10]
