Can the country afford to turn to private healthcare?

It was recently said that Greece’s health system is now the most privatized among the Organization for Economic Cooperation and Development’s 30 developed countries. And this could mean a lot in a country whose constitution stipulates that «the state should take care of citizens’ health.» In the USA, for instance, where the constitution provides for exactly the opposite, i.e. that health is the personal responsibility of citizens, public allocations for health – only for the aged and the very poor – as a percentage of the overall spending on health, stands at marginally higher levels than in Greece. To take it further, compared to the rest of Europe, health in Greece seems more like a «paradox.» Private spending, either officially permitted or done against the law, is growing to a greater degree than the GDP and now meets over 50 percent of the overall spending on health. On the other hand, public expenditure on health has shifted toward social security funds. But these, as their capacity to meet growing demand is diminishing, produce deficits and are incurring huge debts to health providers. As the state’s ability to fund social services drops, there is less and less state funding to the supply side. Such underfunding has helped public health infrastructure remain in the same state it was 25 year ago. Public health sector employees – professionals, medical practitioners and others – feel neglected and are turning for a living to private facilities, which have been enjoying steady inflows of fresh capital. Ten years ago, the major source of private capital was the stock exchange. Now, such private funds, often imported, are simply looking for high-return investments. And they surely find such options. In 1976, there were around 900 smaller private clinics operating around the country but not even one major private hospital. In 2006, private clinics numbered less than 200, with a number of major private hospitals (owned by three or four big groups), claiming an extensive portion of private health turnover. Advances in science In the 32 years since 1976, we have seen dramatic changes in technology and medical science, which have considerably enhanced therapeutic potential. The private sector responded promptly, initially entering the diagnostic segment and later turning to providing treatment services. Private health services are now expanding into other, neglected areas, such as rehabilitation, primary healthcare and home care. In the period 1995 to 2004, private investment in health rose an incredible 1,400 percent. The state, on the other hand, simply keeps falling behind. In the past decade, this was primarily the result of the state’s long-established sloth and its habitual ineffectiveness in managing all kinds of organized service provision systems. To date, it seems that the state’s backing off is a much more intentional move, though still not acknowledged. Ceding public duties to private hands is being done gradually, pursuant – sadly, one could say – to the latter’s business plans. An increasing number of public-private partnerships, exemplified by a rumored concession of primary healthcare to the private sector, are just some of the signs pointing to the privatization of the National Health System. A question that still needs to be answered is whether Greek society is willing to consciously turn over its health to private hands. Lykourgos Liaropoulos is a professor in health economics at the University of Athens.