The Impact of Economic Crisis on Chronic Patients’ Self-Rated Health, Health Expenditures and Health Services Utilization

Abstract

Abstract:There is evidence that the economic crisis in Greece has substantially affected patients and health care services, with chronic patients forming a particularly vulnerable group. The aim of this study was to investigate whether and in what way the current economic environment has affected patients with selected chronic conditions. A cross sectional study was carried out with a sample size of 1200 patients suffering from hypertension, diabetes and chronic obstructive pulmonary disease (COPD). Following a large family income decrease (35.4%) in the last 3 years, chronic patients reported decreased spending for various expenditure categories in order to maintain their ability to finance their health care needs. Among the disease groups studied, statistically significant differences were found for self-rated heath (SRH), out-of pocket health expenditures, health services utilization and the perceived need for physician services. Although need for physician visits for issues related to the chronic condition has largely been reported as met, this was achieved by increased out-of-pocket expenditures and large family budget cuts for essential household goods and services. Austerity measures and reduction of public health expenditure by the state appear to have led to high private expenditures and to de jure or de facto insurance coverage loss for primary care services.

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

“…With regard to COPD patients' treatment adherence, high rates of non-compliance have been documented, as the majority lower the doses of their medication because they are struggling to afford the cost [13,39,41,[100][101][102], while 46% of patients forget or consciously stop medicating properly [13,39,41,[100][101][102]. Remarkably, despite the fact that health seems to be the last expenditure category for which chronic patients would be willing to decrease spending, one in five patients are forced to reduce spending for their health conditions [102].…”

“…Remarkably, despite the fact that health seems to be the last expenditure category for which chronic patients would be willing to decrease spending, one in five patients are forced to reduce spending for their health conditions [102]. More convincingly, according to SKROUMPELOS et al [102], patients with COPD report a significant decrease in spending for physician visits (17.5%), examinations (14.7%) and COPD drugs (5.8%) during the crisis.…”

“…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].…”

“…The economic burden of the disease increases not only with increasing disease severity and exacerbations, but is also substantially augmented by hospitalisations and especially admissions to ICUs [41,102]. Greek data during the crisis show that almost half of patients with moderate-to-severe exacerbations required hospitalisation [106,107].…”

Out-of-Pocket Payments and Subjective Unmet Need of Healthcare

“…External shocks to an economy, leading to a deterioration of the general economic situation, may worsen the problem of SUN, even if the rules with respect to OOP payments do not change. A recent example can be found in the effects of the financial crisis in Greece [19,20]. This leads to the obvious but important policy conclusion that a policy meant to reduce access problems in healthcare should not be restricted to interventions in the insurance system itself but should incorporate broader social policy measures.…”