A brain operation for 19,260 drs
State and public insurance fund fees for medical visits and procedures have been frozen since 1991 at almost absurdly low levels, despite a steep increase in health costs. A doctor’s visit is rated at 2,200 drachmas, a general blood test 980 drachmas and a blood sugar test at 770 drachmas. Costing is the same for affiliated doctors and private and state hospitals, which receive 4,200 for delivering a child without any surgical procedure, 8,800 drachmas for an operation on a spinal fracture, and 19,260 drachmas for an operation on the brain or spinal cord. Yet data from the National Statistics Service show the health service cost indicator rising by 120 percent from 1 May 1991 to September 30, 2001, and the refunds mentioned above don’t even cover the cost of the materials used. In fact, these fees explain hospital deficits, part of which are covered by the state budget. In the private sector, the cost is passed on to patients, who frequently avoid resorting to their insurance funds. Feeling embarrassed for the doctors, they pay all the fees out of their own pockets. Another common practice, which is a burden on the insurance and not the patient, is the unmonitored, fictitious increase in the number of doctor’s visits and medical tests. In one way or another, everyone is satisfied. The State, which is worried that the introduction of more rational fees will have a generalized effect on inflation; the insurance funds, which secure their own prosperity; and the doctors, who protest, but many of whom get used to the payoffs. The matter would no longer be newsworthy were it not for the fact that the State Council’s decision on an appeal made by the Athens Medical Association (AMA) is still outstanding. AMA President Dinos Economou told Kathimerini that the professional and ethical aspects of the issue were inextricably bound up with the unofficial economy and the deteriorating quality of healthcare. According to AMA statistics, 80 percent of those who visit affiliated private doctors and laboratories are insured with state funds, while only 20 percent are private patients or have private insurance. As Economou explains: «The fee of 2,200 drachmas per visit is subject to deductions, so the net amount is only 1,751 drachmas. This is not a medical fee, it is a tip which humiliates both the doctor and the insured person; it leads to abuses and corruption for which the State is morally responsible. So far all health ministers, including the incumbent, Alekos Papadopoulos, have admitted that these fees are unfair, unjust and unacceptable. But what keeps the fees frozen is the Economy Ministry, which has never yielded to repeated pressure from the Health Ministry for increases.» Health Ministry sources who spoke to Kathimerini acknowledged the problem, pointing out that keeping fees low deprives hospitals of significant funds. But they noted the inability of large insurance funds to curb the phenomena of artificial demand and over-prescribing, which have become commonplace. Though fees remain frozen, at the same time state expenditure on primary healthcare has risen at twice the rate of inflation. The officials say that increasing medical fees to market levels without any effective registration or monitoring mechanism would make expenditure skyrocket. But, they add, a team of health service inspectors and computerization would allow them to tackle the matter and raise fees to more realistic levels. «It’s important for us,» says Economou, «to talk about real fees and a real contribution on the part of the doctor. That is why we, together with the Panhellenic Medical Association, will make a proposal to the ministry and the insurance funds that diagnostic protocols be drafted, making it clear which tests are required for each medical condition and putting an end to abuses. «I don’t know how this can be implemented. The AMA is computerized; TSAY (the health professionals’ fund) isn’t; and TEBE (the fund for the self-employed) needs its own computer system to clear up its own data.» Obsolete medical tests using Third World methods The state list of fees for medical consultations and tests bears no relation to the great strides modern medicine has made over the past decade. The list has not been changed since 1991 and does not include the latest laboratory tests. According to the president of the Panhellenic Professional Union of Pathologists, Dr Leondias Anagnostou, the list does include tests that might better be described as archaic. «For example, pregnancy tests these days are carried out using the latest method which is extremely precise. However, the 1991 presidential decree refers to the Galli Manini method, using a frog, and the Ashein Zondek test, using a rabbit, tests that were in use 40 years ago. «The same applies to infectious diseases. Many modern tests we now use are not included in the presidential decree; therefore the ministry’s expenditure service and the funds do not recognize them. The cost is eventually far greater. The absence of rules and inspection mechanisms results in extreme situations and methods that are potentially hazardous for patients,» he said. «There are some laboratories, which I will not mention by name, that are known to use ‘Third World’ methods. For example, when a doctor calls for the T3, T4, T5H, Free T3, Free T4 thyroid tests, they carry out just one, for example, the T5H, and record results for all five tests based on the one result. Or else they prepare a mixture of solutions from 5 or 10 patients and if negative, they record negative results for all patients. That is not medicine,» he said. «We want to provide support for the small medical practitioner’s laboratory,» said Economou. «Pathologists in the laboratory need to have a deep knowledge of medicine and to be able to advise the clinician. This cannot be done in laboratories used for microbiology, but only by a doctor using a computer and who monitors the results. He or she knows what an increase in a particular value means for the particular patient. Our policy is to preserve the traditional relationship between the pathologist, the clinician and the patient that is slowly being abolished through mass production methods,» he said. Economou observed that there can be no primary healthcare system without the participation of all doctors and the agreement of all political parties. He admits, however, that doctors in private practice also need to be organized and to abide by rules. «The government is using delaying tactics in order to cancel doctors’ contracts, as doctors are now paid per visit and per test,» said Dr Sotirios Rigakis, president of the Union of Non-Hospital Doctors of Attica. «By means of a selection process, doctors will sign annual contracts for a pittance, as happens today with TEBE (the fund for the self-employed).» The Athens Medical Association president had this to add: «We believe that when fees are realistic there is enough for everyone. The State should assign a large part of primary care, by means of collective labor agreements and realistic fees, to medical practices, which could be linked to hospitals.»
