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Anastasia Balezdrova

Greek doctors are determined to oppose measures that the Ministry of Health is preparing to take. After their dynamic protests in spring they are ready not to let the ministry to push health care reforms in the middle of summer and are preparing for protests. In an interview for GRReporter Medical Association chairwoman in Piraeus Varvara Anemodoura told why she has taken the initiative to mobilize the medical community and stressed that changes in health care cannot be conducted only with financial criteria. 

In a letter to the Panhellenic Medical Association you indicate that the Greek health care is about to return to the 50s of last century. Explain what you mean. 

This is related to the fact that the Ministry takes measures based only on financial criteria. They calculate the cost of health services according to the amounts that were valid before 5, 10, 20 years. Compared with them the current prices are high and the Ministry wants to reduce prices. 

But health care is developing dynamically and cannot be measured based on how much a thing costs, because here we do not take into account the quantity but the quality. A simple example will illustrate what I mean. 20 years ago we treated fracture by immobilizing the patient for 2-3 months until healed. After that, of course, he was limping but his treatment did not cost anything. Then they discovered the cast. Let us say that its worth was one drachma. The patient remained immobilized in bed for less time. Then they discovered nails. We stabilized the foot with them but of course their price was naturally higher than that of the cast. The patient was out of bed faster, but after a certain period of time we had to take them out. This also had a certain value. Now we moved to hip fracture repair. The very next day after surgery the physiotherapist raises the patient on his feet. After 15 days he can walk normally. But this intervention has a different price. 

But how should we look at things? Should we compare the present method of fracture treatment, which is worth a thousand or two thousand euros with the old one, which is not worth anything? The quality of medical services is different. For the patient, for his family and for his job as well. If materials used for hip fracture repair are more expensive then the state should undertake proper evaluation. They should organize tenders and find the best prices rather than blame the doctors that they use expensive materials. 

The same goes for medications. They issued the so-called "negative list", which means that doctors prescribe medicines described therein, but health funds do not pay for them. Currently, vasodilators and drugs for coughing, acne, diarrhea, constipation, hemorrhoids, and drugs such as Viagra are not on this list. I understand that they can be used not only where they are needed, but there are people who really need them. There are young men with diabetes, multiple sclerosis or cancer of the reproductive organs that have problems with erection and it is likely that this type of medication will help them with this problem. In this case, can we speak of luxury? Of course, I am against prescribing this medicine to a 80-year-old man, he does not need it. 

They start talking about getting rid of medical tests. Today we have available the PET-scan. We know it is expensive. But what if the patient really needs to be examined? The development of medical services has changed. We are not prepared to accept the reduction of medical care in any way. 

Did the Panhellenic Council adopt your initiative to hold a general meeting? 

Not yet, but we expect a positive response. We made some decisions during the extraordinary meeting in early March of this year. But ever since then much has changed, and the government has been submitting draft laws and taking action. We must urgently review our decisions in today's conditions. I do not believe that the Panhellenic Council will not respond. If, however, until Thursday or no later than Friday they do not respond positively to the call for a meeting of the General Assembly or at least of the chairs of medical associations, it is very possible we will take action ourselves. I am in contact with the presidents of many medical councils in the country, who are joining our request. Unions from Thessaloniki, Larissa, Athens and others have the same opinion as us. 

How do you comment on the measures announced by the Minister of Health, such as the mergers of hospital managements? 

First, I must say that he takes these measures in our absence. Second, for their participation in any meeting of the board they receive 30 euros. Is this the biggest problem for healthcare? I am sure that if the Minister had made a proposal to the board members of hospitals to give up that amount, they would do so. 

But I do not think, however, the issue lays there. Last week, the minister started talking about mergers of hospital authorities. I do not believe his claim that the merger will help to conduct tenders for delivery of materials and drugs on better prices. We have a proposal on the resolution of this issue. It is not needed for every hospital administration to conduct its separate tender. It will be enough for the Ministry to hold a tender for the supply all the materials for all Greek hospitals. Which is preferable: one or 82 tenders? And on which one will you be able to win a better price? 

Their aim is to reduce the number of hospitals. And since local communities have responded to this possibility, the Ministry started with the merger of the management and is going to move to the second measure, which is the closure of hospitals and turning them into medical centers. This is a big mistake. 

What are your suggestions on this issue? 

First let me clarify that hospitals are designed for medical advice from second and third instance. Unfortunately a large proportion of hospitals operate in this wrong way. Second, the Ministry must comply with the morphology of the landscape of the country. Greece consists of islands and mountains. It is not like Denmark, which is a flat country and now is representing us as a model, having abandoned the example of Britain. For example, in the hospital on the island of Kalymnos, which serves a large area, needed are physicians from all specialties in order to be able to take all safety measures. It is not possible to send a gynecologist, without providing an anesthesiologist and obstetrician. It is also not possible to have only one doctor in each specialty, and for him to be on duty 360 days per year and not to be able to leave the island for some time. If this hospital is closed, where will patients go? To hospital in Rhodes or in Athens? Or have they built helicopters sites to allow rapid transfer of patients?

According to us, the country should ensure safe medical services to citizens, as far as the medical staff is concerned and also the level of medical equipment. 

Unfortunately the managements of the Ministries of health, employment and finances do not take into account the proposals of the medical unions, which they provide for free, but they believe their paid advisers. And I want to emphasize that doctor unions are not trade unions, but scientific bodies - entities of the administrative law. We are determined to protect the professional and scientific activities of physicians and especially the medical services for citizens. 

What is your response to accusations that some doctors do not perform their professional duties properly? 

We do not say that there are no such doctors. They exist and we ourselves make them step down. But here I would like to say that the Minister should take into consideration our proposals to impose sanctions, rather than cases to be reconsidered and reviewed. And finally, provide us with the information on these offenders so we can participate in the "punishment" of those colleagues of ours, who first harm us and then the state. 

Are there still cases where doctors take "envelopes" with money from their patients? 

The "envelope" is a simple speculation. If the state wanted to break this phenomenon it could have easily done it with a simple campaign among the citizens as we did with the campaign "if you want an envelope, give an empty one". The state must convince people that our hospitals are very good and that people can trust the doctors who work in them. But the state will also have to put the condition that when a citizen must undergo a surgery, it will be done by the surgeon who is on duty rather than a specific one. When a patient seeks the services of a particular doctor, this immediately creates a private connection between them? 

Salaries of doctors are another reason. The government pays higher salaries of judicial functionaries, as this ensures their independence and the issue of equitable solutions. Is it possible with a salary of 1200, 1300 or 1600 euros to provide excellent medical staff? Why shouldn’t doctors be well paid? Once the state knows that salaries are low, is it now aware what this can lead to? A good professional must be paid well, in order to be sure he will work only for you. 

This applies to all physicians, including those who serve in public health funds. Did you know that time set by the state to initially check-up on a patient is ten minutes? This creates a breeding ground for other relationships. When a person leaves their health in the hands of the doctor, of course, they will seek ways to get better service. Our proposal is to give at least 20 minutes for each check-up. 

According to you what is the reason that so many drugs are sold in Greece? 

The reason for this is because usually patients first get their medicines from pharmacies and then they go to doctors to give them the prescription. We are for electronic prescriptions, but not in today's conditions. Currently each health fund has its own list and each doctor must enter separately with a different password. The problem will be solved by the introduction of a unified electronic system. Also, all doctors who have a permit to exercise the medical profession in Greece should be allowed to issue prescriptions to all citizens, whether they have a contract with their health fund or not. Who will pay for the visit - the patient himself or the fund, this may be subject to a contract, but the right to issue prescriptions comes from the right to exercise the medical profession. 

Are you planning a protest action and what form will it take? 

Of course, we intend to take a protest action. This is why we proposed to hold a meeting on PanHellenic level. If PanHellenic fails to do so, we as Physician unions will make a decision on how to response. In any case we do not intend to let things continue to evolve in their present form. 

Does this mean that doctors may lead protests in September? 

Even sooner than September. Only two weeks ago an amendment was voted which states that by September 15 the Minister must issue a law not to change the possibility of setting up medical practices by physicians and medical companies with at least 51 percent of owners being physicians. Few days ago the Ministry came up with a new document, according to which the Finance Ministry will submit an amendment to Parliament which will change the amendment of the Ministry of Health and will allow people who have nothing to do with the medical profession to open a medical diagnostic or centers, provided they have the money to do so. This is why we sent a letter to the Prime Minister, all parties and MPs, so they can comment on this issue. We have no intention of letting this happen.