What the US can learn from Greece's healthcare system

Greece's government-run healthcare system has been a significant contributor to its debilitating national debt, though it is often overlooked compared to its over-inflated pension program.

Spiraling overutilization of medical services, spending waste and corruption among physicians and administrators, though much more severe than that of the U.S., can serve as a wakeup call as our own policymakers and politicians seek to modify healthcare reform, according to a recent op-ed by Marty Makary, MD, in the New York Times.

Greece's healthcare spending soared between 2000 and 2007, during which time the government launched a wave of new programs. Just before the financial crisis of 2008, healthcare spending accounted for nearly 10 percent of Greece's gross domestic product — a high proportion by European standards, according to Dr. Makary, a professor of surgery and health policy at the Johns Hopkins School fo Medicine in Baltimore. This increased spending, combined with a lack of accountability, set the foundation for a culture of overtreatment and overspending.

At the same time, population health priorities dwindled. Although approximately 32 percent of Greek adults use tobacco, the highest rate reported by the 34 nations of the Organization for Economic Cooperation and Development, anti-smoking efforts were cut down.

On the other hand, medical disability claims were easily obtained, and if an individual should be denied, he or she could still acquire them through connections. Additionally, the Greek healthcare system typically paid three- or four-times more for drugs than other European nations, Adonis Georgiadis, the Greek health minister, told The Washington Post last year. Pharmaceutical spending represented a quarter of Greece's total healthcare spending in 2014, according to the O.E.C.D.

Medical professionals and administrators also contributed to the problem. According to the Dr. Makary, physicians who faced disciplinary problems in other European nations flocked to Greece, while corrupt administrators and physicians often accepted kickbacks from medical device manufacturers and pharmaceutical companies. Patients were also responsible for "envelope" payments — large supplementary payments made directly to surgeons — as the government turned a blind eye, Dr. Makary wrote. 

Much of the money going into the Greek healthcare system remains unaccounted for, according to Dr. Makary. A 2013 survey on Greeks' view of corruption in their healthcare system by the European Commission found 75 percent believe bribery and abuse of power for personal gain are pervasive. The E.C.'s report concluded limited transparency was the root cause, with the central government filling in (with loans) the deficits.

Instead of focusing efforts on the urgent need for healthcare reform, Greece's various bailout plans have included austerity programs with arbitrary spending restrictions, which exacerbate already limited access, weaken patient safety efforts and fueled a mass exodus of physicians and other healthcare providers from the country, according to Dr. Makary.

Greece's spending spree slowed down following the global financial crisis in 2008, and in 2009, its 131 medical centers were reduced to 82. Overall healthcare spending was cut by 25 percent, according to the O.E.C.D., but the damage to the system was substantial.

In a petition that is reminiscent of the debate over the Affordable Care Act, Greek physicians are arguing that the only way to control healthcare costs is for the nation's leaders to ask how to fix the broken system, not merely for new ways to finance it.

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