Hospitals bear brunt of primary healthcare for the uninsured

Greeks are adept at finding ways around obstacles to their access to the health services. Despite the cost in terms of time (many hours spent waiting to see a doctor from their own social security fund or going to a clinic far from home), they will take recourse to private doctors insofar as income permits. Those who are not insured for primary healthcare and lack the necessary resources head straight to the hospital. Despite official statistics which depict almost all Greeks with health insurance coverage, the ESDY study revealed that a large section of the population lacks proper, substantial insurance for primary healthcare doctors and other services. The research team sent a special questionnaire to over 4,000 households that contained the basic question: «The different health services available to you are written on this paper. Please note how many times you have used one of these health services over the last 30 days.» The basic conclusions which emerged from the survey are: – People over 45 years old, as well as people with health worries, go to general doctors more frequently. The number of visits, however, drop as income and educational level rises. – The absence of insurance for hospital treatment increases the number of visits to pharmacies, which function as a kind of substitute. Again, those with a higher educational level and income make fewer visits to chemists. – Visits made to pharmacies increase significantly after the age of 45, with women making them more frequently than men. – Hospital admissions show no statistically significant differences between women and men. But there is a much higher incidence of hospital admissions among older people and people with health concerns, though this drops as educational level rises. Hospital admissions are high for people without insurance for primary healthcare. – People with a lower educational level and/or lower income visit general practitioners and pharmacies more often, but not dentists. «The study has shown,» said Kyriopoulos, «that demographic and socioeconomic factors, that is, the social context in which the individual acts, determine the degree of use of the health services. «As expected, those suffering from poor health go to the hospital. What’s interesting is that people not insured for primary healthcare also have recourse to hospitals. From our study, it emerged that about 16 percent of the population stated they did not have insurance coverage. This is partly a question of formalities, and partly a much deeper question. «Some are not insured due to long-term unemployment or because they have not yet entered the labor market or because they are migrants, or other reasons. This category also includes people who may have some kind of relationship with a social security fund but do not use insurance coverage because it’s inconvenient or insufficient. From some funds, it is difficult to get services; in fact, the services they offer are theoretical. «The insured have recourse to hospitals in lieu of primary healthcare. However, the former play a very different role and are much more expensive. But if the uninsured went to a doctor’s, they would have to pay. They prefer to go to hospital, where various social welfare and solidarity stipulations means they don’t.» About 10 percent of the population of Greece, 1 million people that is, are admitted to the hospital every year. «The real figure for annual admissions is lower,» said Kyriopoulos. «In many cases, chronic sufferers or the elderly may be admitted more than once a year. The total number includes the uninsured needing primary healthcare. What this means is that there is another factor, apart from sex, age and state of health, that plays an important role: cost in time and money. And this is what politicians have to take into account. «What all this shows,» Kyriopoulos continued, «is that people will take devious ways to deal with health problems. That those with a low income will use medical services more means poverty and health concerns. «To sum up, the state of their income is related to the state of their health. This is why they go to general practitioners. There are no differences when it comes to specialists; the middle strata appear to use them just as much as the poorer classes.»