Greek hospitals struggle with onerous capital controls

ATHENS — It’s close to 90 degrees on the streets of the chaotic Greek capital, but in the lobby of the Henry Dunant Hospital, a sleek private facility just off the Panormou metro stop, it’s cool and quiet. A neat line of white coats snakes behind the ATM as one doctor uses one bank card after another to sneak past the daily 60 euro ($67) withdrawal limit.

Two floors underground, in the smoky office of the hospital employees’ union, doctors and technicians wait for patients. But they also are on tenterhooks for the latest news on Prime Minister Alexis Tsipras’ negotiations with Greece’s creditors in Brussels.

Greece’s health care sector — heavily dependent on imported supplies and financially anemic after many years of crisis — is now running on fumes as capital controls persist and the country anxiously awaits the determination of its fate in the eurozone.

The bank closures and withdrawal limits set in place on Monday were a tough hit to the industry, said Gregory Sarafianos, the president of Pan Hellenic Union of Private Clinics, as clinics and hospitals were already operating with a limited amount of money and hospital goods. Now, he said, suppliers have started demanding cash payments. But clinics and distributors are unable to deliver, under measures that severely limit amounts that may be used to purchase products from abroad.

According to Sarafianos, some of the 161 clinics in his union are just weeks away from running out of some equipment. While there are no reports yet of medical supplies being exhausted, basics like bedsheets and syringes and crucial things such as cancer medications and heart stents — are running low. All nonemergency procedures and treatments are being postponed.

In theory, the government’s special Committee for the Approval of Banking Transactions will help purchases made in the public or social interest, such as medical and pharmaceutical expenses, circumvent restrictions. Yet it’s unclear if this exemption has aided doctors or hospitals.

Minister of Health Panagiotis Kouroumplis denied any pharmaceutical or medical supply shortages in an interview with Al Jazeera and called media reports of emptying pharmacy shelves and slipping insulin stocks “exaggerated.” He also said there is a financial cushion on the way; on Wednesday night in a late vote, parliament approved granting 160 million euros to medical importing companies to top up supplies. But the aid is contingent on a eurozone deal being signed by Sunday.

Some medical facilities are reporting business as usual this week. At the 400-bed Henry Dunant Hospital, formerly the Hellenic Red Cross Hospital, in the Panormou district of Athens, employees said they have not experienced any supply interruptions. Hospital officials there did not respond to a request for comment. In an emailed statement, a representative of the Hygeia Group, which owns three private hospitals in Greece, said it should have no supply issues for “the foreseeable future.”

Evangelos Voumvoulakis, CEO of the General Hospital of Attica, a public hospital in the Athens suburb of Kifissia, said it has enough inventory for six weeks and that suppliers were willing to be paid in bank transfers.

Still, it’s unclear how long the indebted Greek health system can hobble on. According to the European Federation of Pharmaceutical Industries and Associations, the country owed over $1.2 billion to international drug makers as of May.

“I don’t know how long our current situation with suppliers will last,” Voumvoulakis said.

After five years of crisis, the health industry — on both the public and the private side — has been hollowed out. Greece now spends about 5 percent of its GDP on public health care, down from 9.3 percent in 2012, which was then the average for Organization for Economic Co-operation and Development member states. Tales abound of months-long waits for treatment and, now, unconfirmed rumors of food shortages at public hospitals.

Private clinics and hospitals have been hit indirectly by years of austerity as state insurers have cut payouts while patients’ ability to pay insurance premiums or out-of-pocket sums has withered, along with ever-shrinking salaries and rising unemployment. Many facilities have been providing services for free when patients cannot pay, and according to the Pan Hellenic Union, there are about 1 million medical workers in the private sector currently working without a salary.

“We cannot tell the patient to give cash in order to have surgery or be hospitalized,” Sarafianos said. “We are men of enterprise, but first of all, we are people.”

He estimates that the state insurance agency, known as EOPYY, owes about 700 million euros to private clinics for services provided to state-insured patients since 2013. For the past two years, EOPYY has paid only 50 percent of invoices from private clinics as part of a rebate clawback program designed to preserve the state budget. The last payment from the agency, said Sarafianos, was four months ago.

The recent bite of capital controls has only added to the long-term liquidity pressures on the industry.

“For about 14 months, we had no salary here, so we are used to it,” Panayiotis Kirantzis, the president of the employee union at Henry Dunant Hospital, said of the capital controls. While workers at the private hospital are now being paid monthly, about two years ago, all employees there went without a salary for five to 14 months. “We have nothing left to lose.” 

Moving forward depends on the outcome of Greece’s last-ditch efforts this week to stay in the eurozone. “We are waiting to see what happens,” said Kirantzis. “We are worried, but no one is panicked.”

Kouroumplis said he “believes strongly” that a deal will come through by Sunday, adding that “a Europe without Greece would be like a body without a soul.”

He was optimistic that health care would be spared further cuts in any new deal. “I cannot even imagine that [eurozone authorities] would even dare to ask for more reductions in health expenses,” he said.

But with the possibility of a “Grexit” now looking more likely than ever, it’s unclear how the country’s health sector will continue to cope.

“Of course [exiting the euro] would be a great shock,” said Kouroumplis, “but this shock might motivate many strengths of the Greek people.”

Kirantzis and his union said they have already agreed to a plan B if there is no deal this week. “If bad things come to Greece, we will work here for free, 24 hours a day for the people,” he said.

Sarafianos, however, kept a realistic perspective. Without an agreement by Sunday, he said, “we will see a huge health crisis in not only the private sector but also the public sector.” 

But five years of severe economic downturn has taken its toll. He added, “We are just waiting to return to normal life.”