Metropolitan Community Clinic at Helliniko: February 2014

Friday, February 28, 2014

Health Reforms Crumble when Based on Lies

Press Release

Health Reforms Crumble when Based on Lies

“Cuckolds and beaten, too! What a destiny” say those wise and savvy street philosophers. That is the only conclusion for anyone carefully following the public debate concerning the abolition of EOPYY (National Organization of Health Providers), and the fate of its doctors, and supplanting it with PEDY (National Primary Healthcare Network). But the Greek Minister of Health is up to his old tricks again: confusing the issue by distortion – about what is happening at EOPYY and generally to the Greek public health system.

We will, once more, lay out the facts and so prove that the Health Minister, Mr. Andonis Georgiadis, is lying systematically and shamelessly – especially about recent past events.

1) He has been repeating lately that he had to shut down the general clinics of EOPYY for a month because the doctors and the support staff were on strike. This is simply a lie. As of 13 September 2013 he had already announced to journalists that the possibility existed that the country may be without primary health care for the insured. The following day he back-tracked, stating “There won’t be a time without primary health care”. Which is it? However you read it, he has been caught with his pants down. Finally, what he had first declared has indeed happened.

2) On Tuesday 18 February 2014 he announced on a morning TV show that already some uninsured patients are accepted in the Greek Public Health system an cited the example of insulin patients who had already received their medicine from the hospitals. But he is still being economical with the truth, because it simply never came to be. The uninsured diabetics are left on their own. Those unable to afford their insulin and required supplies (testing tapes, etc) suffer a slow and torturous death.

3) On the same TV interview he said that all the uninsured patients would be accepted by PEDY, would be allowed to see a doctor and be examined (but not a word about their needed medicines). We have carefully read all of Law 4238 and especially Government Gazette no. 38(17/02/2014) and uninsured patients are not even mentioned.

Specifically, Article 8 states:

The goal of the National Organization of Health Providers is:

a) The purchase of health services for the insured, for pensioners as well as their dependent family members, of insurance carriers as defined by Unified Regulations for Health Provision, (Gov. Gazette no. 90380/25916/3294 (Β΄2456) as amended.

The only suggesting that the newly established PEDY will be available to the uninsured is in Article 1 – specifically:

The services of primary health care will be provided equally to every citizen regardless of their economic, social, employment or insured status, and place of residence, through one, universal decentralized National Primary Health Care Network (P.E.D.Y.) organized and operated in accordance with the provisions stated herein.

There is no reference, anywhere in the law as to what is meant, in practice by UNINSURED patients “regardless of their economic, social, employment or insured status and place of residence” Of course the Minister could mean that the uninsured will qualify for doctors examinations (by the physicians of PEDY) and NOT for lab work or medication. It’s not clear what is meant. But one thing is sure, the uninsured will qualify for piecemeal assistance and that is not of much help (as with the health voucher program).

If you add into the equation the cap on medication that each doctor working with PEDY has to abide by, then things become even more difficult for the insured (let alone the uninsured). Co-pays will be reduced, and more money will be paid out of pocket.

4) We have stressed repeatedly that a large percentage of the uninsured are completely cut off from access to the Greek Public Health System. This is resulting in needless deaths, for the sole reason that patients don’t have the money to pay for treatment. We at MCCH see the results every day with uninsured cancer patients – and others. Even the insured are experiencing cut-backs in the Greek health system, finding it more difficult to acquire medications. The most recently publicized example was the case of a seriously sick child on an island. The local hospital could not supply the medication needed and the Ombudsman stepped in to assist. (source http://www.synigoros.gr/?i=health-andsocial-welfare.el.farmaka.157736 ).

At our clinic we often see (and accept) insured patients with welfare health booklets, who have been “booted out” by public hospitals, because they don’t have the medication to give them. The reason for this is that the public hospitals are consistently under-funded with the result that they can’t supply needed medications to their patients.

All of the above clearly shows the unacceptable situation that the Greek Minister of Health is trying to cover up with lies and misstatements. Every day, the doctors in our clinic deal with the results of these inhumane policies implemented by the Greek public health system. The patients who are completely cut off from the system come to us (and other volunteer community clinics) to find solutions to their problems. The lies of the Minister of Health add cruel insult to the injury of those experiencing these tragedies every day.

What has our vocal Minister of Health got to say to this?

METROPOLITAN COMMUNITY CLINIC AT HELLINIKO

Working Hours
(MONDAY - FRIDAY 10:00 - 20:00) and (SATURDAY 10:00 - 14:00)
CONTACT PHONE NUMBER: +30 210 9631950
ADDRESS: Inside the old American Military Base, 200m away from the Traffic Police of the Municipality of Helleniko, next to the Cultural Center of Helleniko
Post code TK16777, Elliniko, Attiki, Greece
Blog http://mkie-foreign.blogspot.gr/ Email mkiellinikou@gmail.com

Monday, February 17, 2014

Social solidarity or a social Trojan Horse?

Press Release

Social solidarity or a social Trojan Horse?

Unfortunately, political and financial centers have recently been trying to beat down solidarity efforts in the most insidious way. Initially they ignored them, but after realizing that they pose a threat to the established system, they tried mudslinging and imposing "law and order". They accomplished nothing, as society's reaction was direct and immediate. Thus they have started to implement a new plan, much more sinister and insidious, since they are actually turning solidarity itself against the people!

How do they manage that? By a very clever and simple way: They abolish public hospitals and clinics, they fire doctors and nurses and they leave the uninsured without any access to the National Health System, as well as many of those still insured, in such a dire financial condition that they are unable to contribute their share of drugs and tests' cost. At the same time, they create structures naming them “Social Health Clinic”, “Social Pharmacy”, “Social Grocery”, “Social Tutoring”, even “Social Nursing Home”, that do not rely on solidarity, but on temporary EU funds (NSRF) to actually replace (or, to be more precise, to give the impression that they replace) the NHS or other welfare state structures.

In the Health sector, these structures that are essentially municipal clinics - pharmacies etc, accept money from the European Union and some of their staff receive a small pay, while many are working voluntarily. This means that we have structures that offer only a small percentage of what the National Health System is supposed to offer, at a low cost (for the state and the EU) since their staff is either unpaid or receives a pittance. In short, the message that the state is trying to pass is "volunteers will do everything".

The truth is that volunteers (and/or “volunteers”) cannot do everything. Community clinics and pharmacies are EMERGENCY SOLUTIONS that neither intend to nor are able to substitute in the least, structures such as the National Organization for the Provision of Healthcare Services (IKA / EOPYY), let alone secondary health care facilities such as public hospitals or mental institutions.

The massive creation of "social" clinics - pharmacies receiving money from the EU and / or the state, only manages to hide the problem. True, solidarity based community clinics - pharmacies, besides offering health services to suffering people, also highlight the reasons that force people to come to them and of course they demand the existence of NHS, for the simple reason that they know that community clinics can never replace it.

Unfortunately, many Municipalities, Associations, NGOs and others, have been following the trend by creating the above structures. Some make money on the backs of citizens who suffer, but also on the backs of truly voluntary structures like our own clinic (which receives no funding and does not intended to become a permanent structure or an NGO). In fact, they refer patients to us, although they are getting paid for each patient, while we work on a purely voluntary basis -just because they know that we can not leave anyone at the mercy of illness.

We must not let citizens' solidarity become a weapon turned against our own interests. When some have already reached the point of suggesting there's a need for "Social Nursing Homes”, then surely we must all think about the monstrosity that is being created.

Finally, let us wonder how come the Minister of Health is pleased to receive help for the National Health System from Greeks abroad and to distribute it to public hospitals, while at the same time he defends the banks and lenders who claim every last cent, cut from education, health and other social benefits. This is called degradation, not solidarity.

True and False About the Public Health System – and more

Press Release

True and False

About the Public Health System – and more

This pamphlet answering some basic questions about insurance issues should have been done by the Ministries of Health and Labor and Social Security. Instead it was done by a small, newly formed group of volunteers at the Metropolitan Community Clinic at Helleniko formed to look into “the rights of unemployed and uninsured patients”. These few volunteers gave their time to create this informative list that should have existed and been placed in every public building long ago. We would hope that the state could devote some time and effort to assist their fellow citizens impoverished during this economic crisis with simple and inexpensive services, such as this

FALSE: If you are unemployed, you are automatically uninsured as well.

TRUE: There is some protection for the young and those over age 55. Between the ages of 18 – 29 young people who have a card that shows that they have been unemployed can have an IKA (Public Insurance) health booklet which is renewed every six months up to the age of 29. The long-term unemployed (12 months or more), who are above 55 years old and who have 3,000 “stamps” (equivalent to insured days worked) from whatever source can be given a health booklet from IKA to be renewed yearly.
However, for the unemployed aged 29 to 55, it is a different story. On becoming unemployed, an individual must register with the Manpower Employment Organization (OAED), during which he has some unemployment benefits and insurance. If they are unemployed continuously for one year and registered with OAED, they can then apply for insurance for an additional two years from the insurance carrier with whom they have the most work days. Verification from the insurance carrier is required, regarding the number of days worked. A decision from the Greek Ministry of Labor this year will give an additional annual extension to the above form of insurance for those who have already acquired the right to the additional two years. So, someone unemployed from the ages of 29-55 has one year while under OAED, and can then apply for two and perhaps three additional years..

FALSE: All Greek citizens over 67 have a pension for the elderly

TRUE: Greek citizens over the age of 67 can apply for a pension from OGA (the Agricultural Insurance Organization) providing they have no other pension, have lived in Greece for the last 20 years and have an extremely small individual annual income not exceeding 4,320€ or a family income not exceeding 8,640€. It is not a requirement that the applicant was ever employed in the agriculture sector

FALSE: A certificate of financial incapacity (destitution) is issued by the social services of the municipalities to whoever asks for it.

TRUE: Such a document is issued by the social services of the municipalities only at the request of a public service for someone in a destitute condition. The document is issued after investigation into the status of the individual, including checking the tax return.

FALSE: The health booklet of someone who is uninsured is different from the booklet of someone receiving welfare.

TRUE: The two types of health book are exactly the same.

FALSE: A booklet for the uninsured can be obtained by all uninsured citizens.

TRUE: The booklet for the uninsured can be obtained by Greek citizens (or those of Greek origin) who reside legally and permanently in Greece, are uninsured and are in financial need. Foreigners with a residence permit issued for humanitarian reasons (health) recognized political refugees and those who have applied for refugee status which is currently under review by the Ministry of Public Order can also apply. There are also a variety of special categories, such as a) children staying in care units or institutions b) those fleeing civil war and political upheaval and their dependents c) monks and laymen of the Holy Monastery of Sinai and Greek clerics from the various patriarchates d) uninsured single mothers and their children, e) children placed in foster homes f) people admitted to specific state supported rehab centres either as resident patients or outpatients.

The annual family income must be under 6,000 € (with 30% more for a spouse and 20% more for every minor dependent) provided that such income does not come from a source that provides insurance. This designated income can be increased by 50% for those having a disability of 67% and above. It is issued by the municipality and is valid for one year. In exceptional cases, such as emergency hospital admissions, the booklet may be issued after the fact.

FALSE: The certificate of social protection is the same as an unemployment booklet.

TRUE: No, they are not the same. The certificate of social protection is issued only if there is a proven health problem and for very specific categories, such as diaspora Greeks in the process of becoming citizens or foreigners with residence permits given for humanitarian reasons, EU member state residents or foreign born spouses of Greek citizens as well as their children.

FALSE: An unemployed student is uninsured

TRUE: Eligible undergraduate and graduate students of public education institutions are entitled to medical and hospital care under the public health system. This applies to nationals, and foreigners. They have access to the public health system for a period equal to the minimum time for completing their degree plus half. Graduate students of public universities have access to the system during their time of attendance, increased by half.

FALSE: No supporting documents are required to obtain an unemployment card.

TRUE: In order to receive an unemployment card from the Manpower Employment Organization (OAED), one has to present the following 1) The last official receipt of taxable income, or failing that a copy of the last income tax return. 2) A bill from a utility or fixed telephone and a copy of a lease agreement which has been submitted to the relevant tax office. 3) An official ID (Identity card, passport etc). 4) An official document showing the AMKA number (social security number). 5) Residence permit or work permit for unemployed nationals of other countries.

FALSE: Those insured by OGA (Agricultural Insurance Organization) are not required to make insurance contributions.

TRUE: OGA provides medical and hospital care for those directly and indirectly insured. Those insured pay into OGA relative to the years insured and the insurance category to which they belong.

FALSE: The Health Voucher can be obtained by all citizens and they can have cost free access to the public health system.

TRUE: By making an application to a Citizen Service Center one can receive a “health voucher” providing they meet the following conditions: 1) They were once insured, either directly or indirectly, by an institution of EOPYY (National Organization of Health Providers) 2) Their annual individual income does not exceed 12,000 € or 25,000€ for the family. 3) They have either Greek citizenship, citizenship from another member state of the European Union or they are a national from any other country and has a legal resident status.

The Health Voucher provides free access to the health system for medical examinations, visits to doctors or primary care clinics which are contracted to EOPPY or primary care units of the public health system (clinics or hospitals), and for diagnostic tests from diagnostic centers - again contracted to EOPPY or primary care units of the public health system (clinics or hospitals).

The Health Voucher is valid for eight months for a total of three visits. Pregnant women, in addition to the above, can be referred by a physician for a basic package of pre-natal tests each trimester throughout the pregnancy. As above, these exams are for diagnostic centers contracted to EOPPY or primary care units of the public health system (clinics or hospitals). Diagnostic examinations and evaluation for pregnant women will track throughout the pregnancy. If a woman obtains the voucher in her first month of pregnancy, the voucher lasts nine months and the woman is entitled to 7 visits. If services start in the 3^rd month, 6 months and 5 visits, and 3 months and 3 visits after the 6^th month.

FALSE: All the uninsured can self-insure – that is, purchase extra insurance units.

TRUE: Those insured under IKA (Greek Social Security system) before 1993 may apply for additional insurance provided they a) don’t work b) have completed 500 work days within the 5 years preceding the discontinuation of IKA insurance. The application must be submitted within 12 months of the last day insured. For those with 3,000 days or more of insurance, an application can be made at any time.

For those insured after 1 Jan 1993, they must have completed at least 1,500 insurance days, of which 300 are in the last 5 years before submission of the application. The application must be submitted within 12 months of the last day insured.

Contributions are based on the average of the last years salary before the discontinuation of compulsory insurance . For those insured by OAEE (for free-lancers and self employed) in order to self insure, they have to have stopped their activities with OAEE.

FALSE: All immigrants have a “pink card”.

TRUE: The “pink card”, is officially called a “Certificate of Asylum Request”. When an immigrant requests asylum with the proper authorities, he will be given a certificate of asylum request, which will have his/her photo and allow the asylum seeker to stay in Greece. With this card, he has free medical and hospital services through the public health system.

FALSE: If you don’t have an income, you do not need to file a tax return.

TRUE: Each citizen is required to file a tax return. Furthermore, it must be filed electronically – through the internet, even if there is no income.

Tuesday, February 11, 2014

Investing in Future Deficits - A study on the Costs of Treating Patients with Diabetes Mellitus

Press Release

Investing in Future Deficits

A study on the Costs of Treating Patients with Diabetes Mellitus

The Metropolitan Community Clinic at Helliniko has made a study of patients suffering from diabetes mellitus which will be submitted to the Ministry of Health in the next few days. What it shows very clearly is that if uninsured diabetics remain excluded from primary health care now, (which they still are under the new health plan) the cost to the state will be significantly more later. We, as a volunteer clinic, find it impossible to calculate the cost to society and to the medical profession. But we can however prove beyond doubt that by insisting on their present policy of not treating the uninsured the state is heading towards a big deficit in the future – even while proclaiming that they are doing their best for the country’s economy.

What the Ministry should have done instead of referring to “accounting” and “numbers” we did for them in this small study – which proves unequivocally that to include the uninsured in our public health system is not only more humane, but economically is in our interest. These people are excluded from the public health system because there have been no studies on the costs of excluding them. So the insistence on excluding these people from public health can be only one of two things: incompetence or some other hidden reason.

Study of the Uninsured Patients with Diabetes Mellitus

- Patients with Diabetes Mellitus have a double mortality rate when compared to the rest of the population

- Diabetes is the 8^th most fatal illness in countries with a high GDP and the 10^th in countries with a medium or low GDP

- The lack of well organized primary and secondary health services in Greece, the great number of patients who have no access to the little there is, and the very limited system of having patients referred to specialized centers – all this leads to poor and insufficient care and treatment of these patients and to dangers complications of this disease.

- 50% of diabetics are already suffering from cardiovascular complications which will surely deteriorate with time.

- Deterioration and complications are directly related to the proper treatment of the disease in its early stages.

- 6% of the population in Greece as been afflicted by diabetes. So Greece, with a population of 11 million, has 660,000 such patients.

- 30% of the population - that is 3,300,000 individuals are uninsured. That means that, here in Greece, 198,000 have diabetes and are uninsured.

- 20% of diabetics are treated with insulin, so 40,000 of uninsured diabetics are on insulin therapy.

Yearly Cost of Medication per Patient for the Control of Diabetes with Daily Medication

Diabetes Medication	Dosage	Price per package	Number of packages per month	Cost per month	Cost per year

Soloza 2	1X1	€6.64	1	€6.64
Glucophage 850	1X2	€2.16	2	€4.32

				€10.96	131.52

Annual cost for medication per patient for the control of diabetes mellitus with daily medication

Average monthly cost of medication is 10.96 €. Annual cost per patient = 131.52 €

170,000 patients X 131.52 € = 22,358,400 €. If the amount paid by the patient is deducted (10%) the state will spend 20,122,000 €

Average Monthly costs for insulin is 50 €. Cost per year per patient = 600 €

40,000 patients X 600 = 24,000,000 € yearly cost per patient receiving insulin therapy. If the amount paid by the patient is deducted (10%) the state will spend 21,600,000 €

Cost for Glycosylated hemoglobin test: 5 € every 3 months per patient = 20 € x 198,000 = 3,960,000 €

Cost for test strips: 25 € for 2 months. 150 € per patient per year x 198,000 = 29,700,000 €

Yearly cost of Medication for the Control of Diabetes for Uninsured Diabetics

The majority of uninsured diabetics will use medication to control their condition, with an annual cost of 41.722.560 €.

Total cost: 41,722,560 +3,960,000+29,700,000 = 75,382,560 €

Cost of Hospitalization of Uninsured Patients with Diabetes Mellitus

60% of diabetic patients, especially if their condition is severe or uncontrolled, will be hospitalized with at least one of the following complications of diabetes, with an average cost of 2,683 €

Condition/Operation	Cost of Hospitalization

Diabetic Neuropathy	1,500

Coronary Bypass	7,500 (5,000-10,000)

Stent	1,531

Cellulite	1,621

Renal failure	2,934

Septicaemia	2,514

Amputation	3,600

Infections (moderate severity)	1,400

Acute myocardial infarction (heart attack)	2,000

Ulcerated Skin-circulatory problems	2,233

Total	26,833

Average Cost	2,683

The cost of hospitalization for the uninsured will reach:

198.000 x 60% = 118.800 x 2.683 €= 318.740.400 €

Uninsured	60%	Average Hospitalization Cost	Total Cost
198,000	118,000	2,68.€	318,740,400 €

Conversely, if patient’s diabetes is properly controlled, then only 25% of them will be admitted to hospital with complications, and cost of hospitalization is significantly reduced:

198,000 x 25% = 49,500 patients x 2,683 € average hospital cost = 132,808,500 €

Uninsured	25%	Average Hospitalization Cost	Total Cost
198,000	49,500	2,68.€	132,808,500 €

In other words, the savings realized would be

318,740,400 € - 132,808,500 € = 185,931,900 €

Conclusion

Because the hospital must accept patients in need, hospitalization costs will pass to the tax authorities. But the state will never recover these expenses, given that the patients have no way to pay their debt. If the government were to include uninsured patients with diabetes mellitus into the Public Health System, it will save the state 185,931,900 €.

If from this amount, we subtract the cost of necessary medications, exams, test strips, etc, it amounts to 75,382,560 €. The total savings will be a significant 110,549,340 € per year

Therefore, total expenses to the state for patients with diabetes mellitus will reach:

132,808,500 € (expenses for hospitalization 25% of patients) + 75,382,560 € (costs for medications, treatments, tests, films) = 208,191,060 € instead of 318,740,400 € that it now costs for patients outside the system

Notes to the above:

For type 1 diabetes, patient contribution is 0%. We used the figure of 10% for all because we don’t know the number of patients that are type 1. We believe it to be a number too small to significantly alter the result.
The hospitalization costs for uncontrolled diabetics which we estimate as 218,740,400 € does not include the costs of additional hospitalization which these patients often need, a costs which will significantly increase the annual expenses of the state.