Medium-term impact of the economic crisis on mortality, health-related behaviours and access to healthcare in Greece

Abstract

Previous studies on the health consequences of the crisis in Greece investigated short-term impacts on selected outcomes. This study examined the impact of the crisis on a key set of health indicators with longer follow up than previous studies. We conducted interrupted time series (ITS) analysis to compare trends in standardised mortality by cause before and during the crisis. We examined changes in fruit and vegetable consumption, smoking, physical activity, obesity, out-of-pocket payments and unmet needs for healthcare using national household data from the “Hellas Health” surveys. Standardised mortality rates for suicides (p < 0.001) and infant mortality (p = 0.003) increased during the crisis compared to pre-existing trends, while mortality from respiratory diseases (p = 0.053) and transport accidents (p = 0.067) decreased. The prevalence of smoking (42.6% to 36.5%; RR = 0.86) and sedentary lifestyle (43.4% to 29.0%; RR = 0.69) declined. The prevalence of unmet need for healthcare significantly increased from 10.0% to 21.9% (RR = 2.10) and the proportion of people paying out-of-pocket for healthcare from 34.4% to 58.7% (RR = 1.69) between 2010 and 2015. The impact of the economic crisis in Greece on health was more nuanced than previous reports suggest. Effective strategies to mitigate the adverse health impacts of economic crises need to be better understood and implemented.

Impact of the financial crisis on COPD burden: Greece as a case study

“…Interestingly, a positive correlation has been reported between COPD diagnosis and private care settings [35], probably due to the lack of equipment and/or specialised pulmonologists in the Greek public healthcare system [92]. In 2011 there were reports of a 40% reduction in public hospital budgets, while between 2009 and 2014 total health expenditure fell from 10.1% of the gross domestic product to 6%, a decrease of >25% [92][93][94][95].…”

“…Furthermore, from 2009 onwards, public pharmaceutical expenditure followed a downward trend, from approximately €5.3 billion in 2009 to approximately €2 billion in 2014, notably by cutting the prices paid for drugs and promoting the increased use of generics [14,[93][94][95]. At the same time, average out-of-pocket expenditure almost doubled between 2010 and 2015, mostly attributed to increased cost-sharing rates for prescription drugs and healthcare services, either as user fees for public services or increasing use of private services [14,[93][94][95]. This suggests that unmet healthcare needs increased after the enactment of austerity measures in Greece, mainly due to patients' difficulty in covering the costs of medical care [98].…”

“…Patients omitting taking their drugs were found to have 11.5% more exacerbations and 14.1% more hospitalisations annually, and they were more likely to be admitted to an intensive care unit (ICU) [41]. Another phenomenon is the challenge of changing prescribed drugs to generics, otherwise patients have to bear the cost on their own [13,87,95,102,105]. Hence, serious adverse events lead to higher costs due to disease complications [13,106,107].…”

“…Thus, in the vulnerable post-diagnosis phase, aftercare and follow-up aim to stabilise treatment effects and prevent relapse or re-admission. Barriers to healthcare access have emerged as one of the main negative consequences of austerity, as the proportion of Greek adults who reported unmet healthcare needs more than doubled in just 5 years, with 12.2% of respondents citing cost as the main reason for not receiving treatment or diagnostic tests [14,15,95]. Furthermore, from 2009 onwards, public pharmaceutical expenditure followed a downward trend, from approximately €5.3 billion in 2009 to approximately €2 billion in 2014, notably by cutting the prices paid for drugs and promoting the increased use of generics [14,[93][94][95].…”

“…Barriers to healthcare access have emerged as one of the main negative consequences of austerity, as the proportion of Greek adults who reported unmet healthcare needs more than doubled in just 5 years, with 12.2% of respondents citing cost as the main reason for not receiving treatment or diagnostic tests [14,15,95]. Furthermore, from 2009 onwards, public pharmaceutical expenditure followed a downward trend, from approximately €5.3 billion in 2009 to approximately €2 billion in 2014, notably by cutting the prices paid for drugs and promoting the increased use of generics [14,[93][94][95]. At the same time, average out-of-pocket expenditure almost doubled between 2010 and 2015, mostly attributed to increased cost-sharing rates for prescription drugs and healthcare services, either as user fees for public services or increasing use of private services [14,[93][94][95].…”