Six years after economic crisis hit Greece, a new agreement between the government and its debtors offers a glimmer of hope for the country's ravaged health services.
Greece's initial bailout by the European Union, European Central Bank and International Monetary Fund stipulated extensive austerity measures and structural reforms for the health sector. Many people saw their health insurance entitlements reduced and health provision cut, at a time when it was most needed as unemployment soared and incomes dropped. Many struggled to afford adequate food or to properly heat their homes.
As a result there were large increases in unmet medical needs, a marked worsening of mental health, and a sharp deterioration in the health status of vulnerable groups, particularly drug users and migrants. As of now, nearly a quarter of the Greek population lacks health insurance.
Last month, a new coalition government formed under Alexis Tsipras, leader of left-wing party Syriza, promised to put an end to this situation and wage a war against what his party terms a "humanitarian crisis".
This week, after a round of intense negotiations with European institutions and the IMF, Tsipras's government was granted breathing space to put its programme into action. Pending the approval of parliaments in six EU member states, Greece's creditors agreed to extend financial assistance for a further four months.
So how might Tsipras ease the health crisis? In its interim promises to creditors, the government committed to "control health expenditure and improve the provision and quality of medical services, while granting universal access". It has rightly emphasised the importance of expanding access to healthcare as a means to end the health crisis. The details have yet to be spelled out, but one thing it can do is learn from the legacy of recent failed policies.
The previous government introduced two programmes to try to improve access to healthcare, but both fell short. First, a health voucher scheme was intended to provide access to a limited number of medical services for 230,000 uninsured citizens for two years beginning in 2013. Yet, by March 2014 a maximum of just 23,000 vouchers were issued. The reason? The scope of services covered was too limited and eligibility criteria overly strict.
A second – more promising – legislative reform began in the summer of 2014 to grant uninsured people access to primary, in-hospital and pharmaceutical care. However, the initial evidence suggests that this too failed to deliver, because of poor advertising, inadequate organisation, and stigmatising and bureaucratic means testing. And those intended to benefit were not exempt from high payments for any medicines they might need.
To tackle health inequities requires universal provision, as a recent major report for the World Health Organization made clear.
Aside from health system policies, the government has also pledged to invest in active labour market programmes and provide targeted assistance to those in absolute poverty – all without harming public finances. It hopes the funds will come from curbing tax evasion, fighting corruption, and improving fiscal management, all persistent weaknesses in the Greek economy.
Beyond Greece, the broader issues raised by Syriza's stand – defending the welfare state and putting an end to austerity – resonate elsewhere in Europe. Notably, Italian prime minister Matteo Renzi and the newly powerful Podemos party in Spain have challenged the EU policy of hardline austerity in response to the European crises and have called for growth-oriented policies in their countries that include public investment in health and social protection.
Yet, in the context of continuing economic difficulties in southern Europe and no apparent change of heart in Germany or other strong European economies on the mantra of imposed austerity, challenging the status quo will be difficult. The outcome of the Spanish elections, due before the end of the year, will set the stage for how the Eurozone moves ahead on such issues.
For now, the new Greek government has been given valuable policy space to implement its attempts to invigorate the economy and bolster social protection. Recent signs of a budding economic recovery and the government's pro-welfare state rhetoric suggest a possible end to Greece's health crisis is finally in sight.
After half a decade of declining health status and defunding the health system, overcoming the catastrophic legacy of austerity will require years of persistent and systematic effort. Ensuring universal access to health services would be a first step in the right direction.
This article was published today in the New Scientist.
All the best,
Alexander E. Kentikelenis
Research Associate in Sociology and Political Economy
Department of Sociology
University of Cambridge
King's College 562
Cambridge, CB2 1ST
+44 (0)759 3212319