Economic crisis, health and

Transcription

1 Economic crisis, health and health systems Marina Karanikolos response in Greece Reseach Fellow ECOHOST, LSHTM

2 Health System in Greece Health System Review (2010) precrisis NHS (ESY) coexists with SHI model and private sector Private expenditure accounts for 40% of THE (3rd largest in EU) Serious inefficiencies, including: High degree of centralization; Lack of planning and coordinantion

3 Memorandum of Understanding (March 2012) Troika and MoU for Greece: PHE at 6% of GDP 2 bln savings in pharmaceuticals between 2010 and 2012 (through pricing mechanisms and prescribing monitoring) 25% decrease in expenditure for joint purchase of medical services and goods (by end 2011)

4 Memorandum of Understanding (March 2012) Some things happened or underway: Introduction of DGRs Some progress in eprescribing and monitoring Pharmaceuticals expenditure decreased... but...

5 Pharmaceutical policies Lowering of drug prices pushed wholesalers to sell abroad to increase profits SHI fund owes pharmacists ( 400 million) who are unable to pay suppliers 500 commonly used drugs are in short supply. Among them, there are drugs for hypertension, gastroenterological disorders, cancer, kidney diseases, and pain killers. Karamanoli E. (2012), the Lancet Vol 379:9813, p 302

6 Pharmaceutical policies General moratorium As a temporary measure to protect the public health and to avoid shortages of drugs associated with the entry into force of the new prices on pharmaceuticals, EOF makes recommendations to all stakeholders for general temporary suspension of exports and intracommunity

7 Pharmaceutical policies

8 Health services and access 40% cuts in hospital budgets Shortage of staff and medical supplies 24% rise in admissions to public hospitals; 2530% fall in admissions to private hospitals

9 Health outcomes 15% increase in bad selfreported health ( ) Increase in infant mortality and stillbirths in 2010 and 2011 (Eurostat; Vlachadis & Kornarou, BMJ 2013;346:f1061 (Kentikelenis A, et al. 2011) Increase in heart attacks since 2008 (Makaris, ACC European Observatory on Health Systems and Policies Conference 10/03/2013)

10 Mental health 120% increase in MH service use over 3 years (Anagnostopoulos & Soumaki, 2013) 2.5 times increase in major depression between 2008 and 2011 (Economou et al, 2012)

11 Mental health State funding for MH decreased by 20% in 2011 and further 55% in Large number of MH service provides (community centres, psychosocial rehabilitation units, highly specialised establishments) have suspended operation

12 Infectious diseases Crisis undermines health system's capacity for infections prevention and control Danis et al., 2013)

13 Infectious diseases HIV outbreak coincides with budgetary cuts in the health system (especially the field of drug treatment and harm reduction), the deteriorating socio economic environment of the Athens city centre, and changes in injecting behaviours among IDUs. HIV outbreak among injecting drug users in Greece An updated report to the EMCDDA 2012

14 Infectious diseases NGOs are filling in the gaps in health service provision:

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