“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)