Intended for healthcare professionals


Rise in user fees in Greece could reduce access to healthcare, charity warns

BMJ 2011; 342 doi: (Published 11 January 2011) Cite this as: BMJ 2011;342:d200
  1. John Zarocostas
  1. 1Geneva

Concern is growing in Greece that the rise in user fees announced by the minister of health last week could reduce access of many cash strapped and vulnerable groups to public hospitals and primary care clinics.

“Measures like this are no way to facilitate access to health,” said Rebecca Papadopoulos, head of Médecins Sans Frontières in Greece. “The population is already in crisis because of the tough austerity measures.”

On 4 January Andreas Loverdos, the minister of health and social solidarity, announced that the charge for morning visits to outpatient units of public hospitals and health centres would rise to €5 (£4.2; $6.5) from €3, with immediate effect.

However, the directive stipulates that some people will be exempted from the fee, including people needing urgent care, severely disabled people, people with AIDS, asylum seekers and political refugees, and very poor welfare recipients.

Mr Loverdos also announced that public hospitals and clinics would have to ensure that at least 50% of the drugs they buy in future are generic rather than branded, up from about 30% at present.

The government estimates that lower drug prices and renegotiation of prices with suppliers will result in savings of about €1.4bn for the heavily indebted nation.

Reform of the health sector to generate efficiency gains and transparency, including strengthened procurement practices, was part of the conditions imposed by the International Monetary Fund and the European Central Bank for bailing out Greece with a €110bn loan.

The terms, agreed by Greece last May, also stipulate that Greece’s public healthcare system, “where there have been major expenditure overruns, will be overhauled through management accounting and financing systems.”

Ms Papadopoulos and Ilias Sioras, a cardiologist and president of the workers’ union at the Evangelismos Hospital, Athens, said that many in the health sector objected to the fee rises and that some hospitals are refusing to implement the new measures.

Critics point to experience in African countries that rises in user fees greatly reduce access to healthcare.

Ms Papadopoulos said that many people in Greece were facing cuts in income of up to 30%, which meant that they had to contend with “many new barriers either to access public hospitals or to medicines.”

Mr Loverdos, in an interview with the radio station Real FM on 7 January, said that a key objective was to make the cuts “without denying services.” He also noted that Greece spent about 10% its of gross domestic product on public and private healthcare but that the quality of its healthcare service didn’t reflect that amount of spending. He also indicated that he intends to press ahead with reforms of the Greek hospital system in the coming months.


Cite this as: BMJ 2011;342:d200

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