Malaria and HIV Spike as Greece Cuts Healthcare Spending

The nasty downside of austerity.

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A pharmacist arranges drugs in a pharmacy in Athens on March 1, 2012. (John Kolesidis/Reuters)

One day in late March, European finance and health ministry officials met at the OECD's Paris office to discuss how healthcare systems are faring in times of austerity.

On the second day of the two-day conference, Greek finance ministry official Evdoxia Andrianopoulou read from a series of brown-colored PowerPoint slides riddled with details of attrition and savings. Greece's cuts were deep, of the sort commonly seen in a corporate turnaround - but rarely on a government's balance sheet, and almost never to healthcare expenses.

The takeaway from the meeting - according to two people who attended it - was that Greek officials knew that these huge cuts would result in the curtailing of essential services for their people. But the officials were working under the stress of having to meet a financial target set by their tri-party group of creditors: the European Commission, the International Monetary Fund, and the European Central Bank. And so they delivered.

According to an Austrian finance ministry official who attended the meeting, participants in the room "were in a state of shock" after Andrianopoulou concluded her talk. Another attendee who asked that he not be quoted said "a pin-drop silence" filled the room.

Meanwhile, across the Channel in London, academics were preparing to release a study in "The Lancet" on the healthcare crisis that has followed deep budget cuts in Southern Europe.

One of that work's principal researchers, David Stuckler of Oxford University, warned that not just Greece, but also Spain and Portugal, faced a potential healthcare disaster due to their own steep budget cuts.

Yet of the three crisis-stricken countries, Greece seems to have suffered the most.

"Greece is an example of perhaps the worst case of austerity leading to public health disasters," Mr. Stuckler explained in a telephone interview.

"After mosquito spraying programs were cut, we've seen a return of malaria, which the country has kept under control for the past four decades. New HIV infections have jumped more than 200 percent," he noted.

Malaria returned because municipal governments lacked the funds to spray against mosquitoes. HIV spiked because government needle exchange programs ran out of clean syringes for heroin addicts. By Stuckler's estimate, the average Greek junkie requires 200 clean needles in a given year.

"But now they're only getting three a year each," Stuckler said.

Athenian drug addicts sharing needles or malaria-carrying mosquitoes biting Spartans have put Greece in the media spotlight over the past few months. But a decidedly less headline-grabbing fact is this: cuts taken over the last two years could look even worse a few years from now.

"The thing about healthcare systems," the OECD's Ankit Kumar explained in a telephone interview, "Is you cut the money today, and start to see the cuts' impact at least three to four years from now. You know that people aren't getting their medications. But it takes a couple of years before this manifests itself in high levers or sickness, fewer people being able to work, and more people facing shorter lives. Given the consequences of what has happened in Greece, these outcomes are just going to get worse and worse."

Some experts have suggested that Greece's budgetary ax fell unduly hard on its healthcare sector, which was slated to grow at around 4 percent annually, but which has instead been jolted by a series of wage freezes, firings, and drug rationing programs. Economists around the world warned of the cuts' consequences - but it was the Greeks themselves who opted for deep gashes to their healthcare system.

"IMF doesn't say 'you have to cut 10 percent of your economy, but you can't close hospitals or schools.' Where the cuts are made remains a country's sovereign right," Kumar explained.

This spring has been an important time for healthcare research in Europe because data now confirm -- as if there were any doubt -- that in healthcare, too, the gulf between Europe's north and its south has continued to widen.

Last year, while Greece went about adjusting to its new slimmed-down healthcare reality, German's ministry of health contacted the OECD for its help in studying the exact opposite problem. German healthcare costs were ballooning, but only a third of the growth could be linked to Germans becoming sicker or aging.

The OECD's research on Germany was published this spring, at nearly the same time that the full picture of Greece's healthcare tragedy came into form.

OECD researchers compared Germany to its peers, and came to a simple conclusion: German doctors seem to be prescribing treatments, operations, and hospital stays more often than might be medically necessary. That this is occurring while Germany's neighbors just a two-hour plane ride away in Athens face the worse healthcare and societal crisis in their history only underscores the much publicized idea that Europe is growing apart.

One statistic was especially telling: the OECD average for hospital beds per 1,000 patients sits at 4.9; in the case of Germany, it's 8.3. France has 6.4, while the U.S. has 3.1.

"The difference in the medical science between the United States, Germany, and France is not so great that it can justify 70 percent higher numbers in Germany than the OECD average," Kumar said.

Kumar and his co-author, Michael Schoenstein, theorized that because Germany has more hospitals than it needs, doctors and hospitals appear to be steering patients towards more expensive in-patient procedures and then tacking on multiple night hospital stays in order to fill hospital beds and submit payments to Germany's essentially unlimited system of insurance reimbursements.

"These are big institutions that want to be busy," Kumar said. "After investing millions, and in some cases billions of dollars, into the infrastructure, no one wants to have these institutions running at 60 percent. They know that if hospitals aren't full, someone's going to point the finger and say 'hold on a second, you're running at 60 percent capacity regularly, why do you have all of these empty beds, we need to get rid of that.'"


The OECD lacks clear data on how many Greeks have been denied medical care during the country's economic crisis. But anecdotal reports have shown that people are being deprived care.

The New York Times reported that "breast cancer patients often have to wait three months now to have tumors removed" and that at least 2,000 patients in need of bypass surgery haven't been scheduled for procedures.

Could the solution to Greeks' healthcare crisis be to send patients north to Germany's hospitals? With Europe's common market, citizens' freedom of movement, couldn't Greeks just fly north for treatment?

"Yes, EU citizens can travel to other EU countries for treatment," OECD's Michael Schoenstein explained, "But for planned treatments like cancer treatments, they need prior approval from their healthcare insurers at home. It's theoretically possible, but practically very difficult."