November 28, 2020

Greeks Reeling From Health Care Cutbacks

Four days earlier, she had run out of insulin and, without insurance and unable to pay for more, she had gone from drugstore to drugstore, pleading for at least enough for a few days. It took her three hours to find a pharmacist who was willing to help.

“I tried a lot of them,” she said, gazing at the floor.

Greece used to have an extensive public health care system that pretty much ensured that everybody was covered for everything. But in the last two years, the nation’s creditors have pushed hard for dramatic cost savings to cut back the deficit. These measures are taking a brutal toll on the system and on the country’s growing numbers of poor and unemployed who cannot afford the new fees and co-payments instituted at public hospitals as part of the far-reaching austerity drive.

At public hospitals, doctors report shortages of all kinds of supplies, from toilet paper to catheters to syringes. Computerized equipment has gone unrepaired and is no longer in use. Nurses are handling four times the patients they should, and wait times for operations — even cancer surgeries — have grown longer.

Access to drugs has also been affected, as some drug manufacturers, owed tens of millions of dollars, are no longer willing to supply Greek hospitals. At the same time pharmacists, afraid that the government might not reimburse them, are asking for cash payments, even from those with insurance.

Many experts say that Greece’s public health system was bloated and corrupt and in dire need of reform. But they say also that the cuts have been so deep and have come so fast, that they have hit like a tsunami.

In just two years, the government has cut spending on health care to $17 billion from $19.5 billion — a 13 percent decrease. And under its agreement with its creditors, Greece must find even more health care savings next year — as much as $915 million, government officials said.

At the same time, public health facilities have seen a 25 to 30 percent increase in patients because so many Greeks can no longer afford to visit private clinics.

Dr. Olatz Ugarte, an anesthesiologist at the Saint Savvas Cancer Hospital in Athens, said that breast cancer patients often have to wait three months now to have tumors removed. “Waiting that long can be life or death for these patients,” she said.

In a recent letter to the medical journal The Lancet, a team of English researchers warned that a “Greek tragedy” could be in the making, pointing to rising suicide and H.I.V. rates and deterioration of services at hospitals under financial pressure. “In an effort to finance debts,” the researchers said, “ordinary people are paying the ultimate price: losing access to care and preventive services, facing higher risks of H.I.V. and sexually transmitted diseases, and in the worst case losing their lives.”

At the Perama clinic, which is run by the international nonprofit Doctors of the World, doctors say they are seeing many families that cannot afford bus fare, let alone the new $6.50 fee at public clinics.

Technically, those Greeks who cannot pay are entitled to free care. But the bureaucracy can be overwhelming. Ms. Ragamb, a former hairdresser whose unemployment benefits and health insurance ran out six months ago, said she was still waiting to get the right papers.

The story did not surprise Dr. Liana Mailli, the pediatrician who was seeing Ms. Ragamb’s son, Elias. The 3-year-old got a diagnosis of diabetes only a few months ago, after he fell into a coma. Dr. Mailli has heard of such bureaucratic troubles from many patients. Even more often, she said, parents have fallen behind in paying their health insurance contributions, or their employers do not pay and so they are no longer covered.

One development that Dr. Mailli said she found particularly disturbing was that a growing number of children had not had their basic vaccinations.

If nothing is done, she said, polio, diphtheria and whooping cough could all return to Greece. “This is such a serious thing,” she said. “But these vaccines are expensive.”

At the start of its debt crisis, Greece was spending about 6 percent of its G.D.P. on health care — about average for Europe. But the system was far from efficient. It includes many small hospitals and a reliance on expensive brand name drugs.

Moreover, there was widespread corruption. Experts say doctors often had lucrative deals with drug manufacturers that led them to vastly overprescribe, and many expected cash payments on the side for timely and attentive care.

Since the debt crisis began in 2009, the government has frozen hiring, cut salaries and focused on tracking prescriptions and new procurement procedures. About 20 doctors have been arrested for corruption.

But little has gone smoothly.

Government officials acknowledge some problems, but say that the system was simply unsustainable. In the next year, they say, adjustments can be made.

“We have had two years of emphasis on the financial, now we will pass to evaluation,” said Nikos Polyzos, the secretary general of the Health Ministry.

But many doctors say the new emphasis on cutting costs has gone too far. In addition to shortages, they say that the supplies they do have are of poor quality. They complain that bugs have been found in new syringes imported from China, sutures fall apart and generic drugs do not seem to do the job. And the hiring freeze has caused such a shortage of nurses, some doctors said, that procedures frequently have to be postponed.

Dimitris Bounias and Nikolas Leontopoulos contributed reporting.

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Breaches Lead to Push to Protect Medical Data

Such lapses, frightening to consumers, could impede the Obama administration’s effort to shift the nation to electronic health care records.

“People need to be assured that their health records are secure and private,” Kathleen Sebelius, secretary of health and human services, said in an interview by phone. “I feel equally strongly that conversion to electronic health records may be one of the most transformative issues in the delivery of health care, lowering medical errors, reducing costs and helping to improve the quality of outcomes.”

So the administration is making new efforts to enforce existing rules about medical privacy and security. But some health care experts wonder if the current rules are enough or whether stronger laws are needed, for example making it a crime for someone to use information obtained improperly.

“The consequences of breaches matter,” conceded Dr. Farzad Mostashari, a former New York public hospitals official who recently became the Obama administration’s national coordinator for health information technology. “People say they are afraid that if their private information becomes known, they may not be able to get health insurance.”

In the last two years, personal medical records of at least 7.8 million people have been improperly exposed, according to the government data. One particularly egregious case involved information about 1.7 million patients, staff members, contractors and suppliers of Bronx hospitals and clinics operated by the Health and Hospitals Corporation, the New York public health agency. Their electronic files were stolen from an unlocked van belonging to a record management company.

The affected patients got the disquieting news that their medical and personal information, like Social Security numbers, had been violated when their health care providers notified them under federal rules.

Showing just how lax security can be, the inspector general of the Department of Health and Human Services said two weeks ago that the agency had found dozens of vulnerabilities in systems to protect records of patients at seven large hospitals in New York, California, Illinois, Texas, Massachusetts, Georgia and Missouri. Auditors cited such problems as personal information that was not encrypted and was stored on computers that could be easily used by unauthorized users.

Auditing teams are now inspecting eight more hospitals, said Lori Pilcher, an assistant inspector general at Health and Human Services. The hospitals are not being identified to avoid alerting hackers, she said.

Another big breach was reported in March on the official Web site by Health Net, a California-based insurance company, which notified 1.9 million health plan members that records with their personal information were missing.

Health Net said I.B.M., which was managing its information system, told the insurer that the records could not be found.

“The health care industry is not as vigilant as they should be about protecting private information in a patient’s medical records,” said Representative Joe L. Barton, a Texas Republican who is co-chairman of the Bipartisan Privacy Caucus in the House.

Mr. Barton knows from personal experience. His own records after a heart attack, along with several thousand others from a research project at the National Institutes of Health, were “on a disk in a laptop in somebody’s trunk that disappeared,” he recalled. “I was stunned.”

The Obama administration has levied a string of stringent penalties for egregious violations of patient rights under the most commonly cited law, the Health Insurance Portability and Accountability Act, or HIPAA, of 1996. Health information is supposed to stay private under those rules, but research has shown that it is not that difficult to connect names and addresses to nominally anonymous data with Internet searches and computerized matchups.

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