Hospitals equipped and staffed but not organized

The National Health System (ESY) is a prime example of the misfortunes that permeate the public sector. Long lines and total chaos during the night shifts at large hospitals and extremely long waiting times even for emergency tests and operating theaters infuriate Greeks, who resort all the more often – if they can afford it – to private clinics. This is not because Greek public hospitals lack equipment and sufficient staff. Simply deciding to schedule afternoon shifts for hospitals and daily shifts for emergency departments at public hospitals could make a shining example of this European health system. The hospitals have enough money and good doctors, and most have enough equipment. Night rosters Three major hospitals in Attica have to meet the emergency health needs of a densely populated city. Given the lack of a well-organized primary healthcare system, these hospitals will receive anyone, including minor cases, who have to wait while the more serious cases take priority. «Last Sunday, when Evangelismos Hospital was on duty, 1,638 people came to the hospital,» Andreas Kartapanis, the hospital’s manager, told Kathimerini. «On that day, we dealt with a lot of traffic accident victims, and I should mention that this is the only hospital with an injuries unit.» Kartapanis says that serious problems requiring a solution include the night-duty system, the lack of personnel (chiefly of nursing, technical and administrative staff), and balancing the duty roster among hospitals. As he explains, hospitals doing the same shift do not have the same arrangement of clinics and departments, so emergency cases needing the assistance of particular specialists all end up at one hospital. The state of hospitals on night duty can be seen by the number of gurneys in use, though there are some hospitals that use gurneys while others have empty beds. The Health Ministry is currently processing statistics about the general flow of cases in hospitals so as to come up with measures to give large duty hospitals a breather. Waiting time is not only a problem on night shifts but also for chronic cases and especially for examinations and surgery. A recent survey showed that one in four Greeks sees waiting time as the most serious public healthcare problem in Greece. Some hospitals seem more attractive than others, whether due to their reputation, equipment or staff. As Yiannis Kyriopoulos, professor of health economics at the National Public Health School, told Kathimerini: «Use of public health services depends largely on the attractiveness of the hospitals, which depends on two elements: high technology and ‘big name’ doctors. Given that other obstacles, such as distance and the cost of getting to those hospitals, have been minimized in recent years, patients crowd into the most attractive hospitals, causing bottlenecks.» Queue jumpers Crowding increases waiting times and makes Greeks willing to pay for time and quality either in the private sector or under the table in the public sector, by paying to jump the queue. In Greece, health expenditure amounts to 9.4 percent of GDP, and 45 percent of that sum, or 6 billion euros, is for private healthcare. «For many years, that suited politicians,» says Kyriopoulos, «because the responsibility and political cost flowed on to the health professionals and the public. That then prevented them from adopting a system with clear rules, a system that would set obstacles of time and money in inverse proportion to need, so that the greater the need, the fewer the obstacles. «Hospitals have heavy loads because there is no system for substituting services that are costly in time and money for cheaper but equally effective ones, such as primary healthcare services. What is needed is a multifactor support service for consumers and support for their negotiating position in the market.» Double shifts A radical solution that would bring about instant benefits would be for hospitals to work double shifts. This was one of the government’s basic election promises, and according to statements by Health Minister Nikitas Kaklamanis, a bill to be presented to Parliament in September will abolish private afternoon clinics in hospitals and make hospitals work a second shift, during which insured patients can see hospital doctors. Their insurer will pay the cost of visits, doctors’ procedures and medical examinations. In an attempt to shorten waiting lists for surgical procedures, there is talk of a second shift for operating theaters at hospitals that have the necessary equipment and staff. As Kartapanis points out, double shifts for laboratories and operating theaters will bring in money to ESY. «Many patients who are treated stay in the hospital waiting for an operation or examination. The average cost of one day’s stay in Evangelismos, not counting wages, is around 270 euros. «Imagine what savings ESY could make by reducing the average stay by one day.»