“You have to keep fighting”: maintaining healthcare services and professionalism on the frontline of austerity in Greece

International Journal for Equity in Health, Jul 2016

Background Greece has been severely affected by the 2008 global economic crisis and its health system was, and still is, among the national institutions most shaped by its effects. Methods In 2014, this qualitative study examined these changes through in-depth interviews with 22 frontline healthcare professionals in five different locations in mainland Greece. These interviews with nurses, doctors and pharmacists explored perceptions of austerity and how ideas of professionalism were challenged and revised by these measures. Results Participants reported working conditions characterised by dramatic increases in public hospital admissions alongside decreases in personnel, consumables, materials, and also many hospital closures. Many drew on analogies of war and fighting to describe the effects of healthcare reforms on their working lives and professional conduct. Despite accounts of deteriorating conditions and numerous challenges, healthcare professionals presented themselves as making every effort to meet patients’ needs, while battling to resist guidelines which they perceived diminished their roles to production-line operatives. Conclusions Participants considered it their duty to defend their professional ethos and serve patients without compromising standards, even if this meant liberal interpretation and implementation of regulations. These professionals regarded themselves on the frontline of healthcare provision but also the frontline defence in a war on their professional standards from austerity.

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“You have to keep fighting”: maintaining healthcare services and professionalism on the frontline of austerity in Greece

Kerasidou et al. International Journal for Equity in Health “You have to keep fighting”: maintaining healthcare services and professionalism on the frontline of austerity in Greece Angeliki Kerasidou 0 Patricia Kingori 0 Helena Legido-Quigley 1 2 0 The Ethox Centre, Nuffield Department of Population Health, University of Oxford , Oxford , UK 1 London School of Hygiene and Tropical Medicine , London , UK 2 Saw Swee Hock School of Public Health, National University of Singapore , Singapore, Singapore Background: Greece has been severely affected by the 2008 global economic crisis and its health system was, and still is, among the national institutions most shaped by its effects. Methods: In 2014, this qualitative study examined these changes through in-depth interviews with 22 frontline healthcare professionals in five different locations in mainland Greece. These interviews with nurses, doctors and pharmacists explored perceptions of austerity and how ideas of professionalism were challenged and revised by these measures. Results: Participants reported working conditions characterised by dramatic increases in public hospital admissions alongside decreases in personnel, consumables, materials, and also many hospital closures. Many drew on analogies of war and fighting to describe the effects of healthcare reforms on their working lives and professional conduct. Despite accounts of deteriorating conditions and numerous challenges, healthcare professionals presented themselves as making every effort to meet patients' needs, while battling to resist guidelines which they perceived diminished their roles to production-line operatives. Conclusions: Participants considered it their duty to defend their professional ethos and serve patients without compromising standards, even if this meant liberal interpretation and implementation of regulations. These professionals regarded themselves on the frontline of healthcare provision but also the frontline defence in a war on their professional standards from austerity. Austerity; Greece; Healthcare; Professionalism; Medical professionalism; Healthcare system reforms; Qualitative Background Background to austerity in Greece Greece is one of the European countries that have been severely affected by the 2008 global economic crisis. By 2010, the Greek deficit was calculated at 16 % of gross domestic product (GDP) and in May of the same year, Greece received its first bailout loan of €110 million from the European Commission, the European Central Bank and the International Monetary Fund, now known collectively as Troika. A second bailout of €130 million followed in February 2012. A third loan of up to €86bn to be paid in several instalments was agreed in August 2015. These loans came with strict conditions regarding implementation of austerity measures, structural reforms and privatisation of government assets. The period since 2010 has been characterised by great political and social instability, as successive governments try to implement the measures and structural reforms required by the Troika. Since 2010, Greece have had seven different governments, including an unelected technocratic government (November 2011 to May 2012) and two interim governments, and held national elections four times (May 2012, June 2012, January 2015 and September 2015). Austerity and health The Greek healthcare system was among the national institutions affected by the reforms and austerity measures. Between 2010 and 2014, the healthcare system was restructured twice, aiming at increasing its efficiency and also meeting Troika’s directives, which necessitated the reduction of public spending as a condition for the release of funds. The first restructure came in 2011, which merged the pre-existing social and health insurance funds into a unified central health fund (EOPYY: National Organisation for Healthcare Provision) to decrease the burden on the state [ 1 ]. The Greek healthcare system saw further restructures in 2014, which established a new National Primary Healthcare Network (PEDY) [ 2 ]. One of the Troika directives was that public expenditure on health should not exceed 6 % of GDP [ 3 ]. This measure produced a 30 % reduction in hospital budgets [ 3 ], a 40 % cut in healthcare professionals’ salaries [ 4 ], and a 10–40 % reduction in staff [ 4 ]. In addition, cancer screening programmes [ 5 ], mental health services, prevention and treatment programmes for illicit drug use, and municipal public health services experienced mass closure of services and severe cuts [ 3, 6 ]. The cuts in healthcare spending coincided with deterioration in the Greek populations’ average income due to reductions in salaries, pensions and benefits, and rapid growth in unemployment. Between 2008 and 2013 official unemployment reached 29.4 %, and 51.1 % of young people were unemployed in the last quarter of 2014 [ 7 ]. The severe material deprivation rate, which measures the proportion of (...truncated)


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Angeliki Kerasidou, Patricia Kingori, Helena Legido-Quigley. “You have to keep fighting”: maintaining healthcare services and professionalism on the frontline of austerity in Greece, International Journal for Equity in Health, 2016, pp. 118, 15, DOI: 10.1186/s12939-016-0407-8