MAY 2019.
By Grigoris Sarafianos, President of the Panhellenic Union of Private Clinics and Member of the Board of Directors of the European Union of Private Clinics (UEHP)
A new legislative framework, denationalization through acquisitions, the positions of the political parties in view of the elections, and changes to the form of care as we move towards 2025.
The New Legislative Framework
The Institutions’ demand in the framework of the fourth evaluation for a new legislative framework for the operation of private clinics, merging together the various Presidential Decrees and Laws into a single new law for the purpose of unified treatment, led to the voting of Law 4600/2019, which establishes new rules, especially for clinics to be created in the future, in a framework that is completely bureaucratic and strictly limits new investments, to the extent that based on a quick definition of costs, it can be calculated that no amortization and profit creation of any sort is achievable.
Such limitations and insubstantial time-consuming bureaucratic procedures even for the simplest issues, which do not aim to upgrade the level of health care services offered to patients, suit regimes with a controlled economy.
Fortunately for the currently operating clinics, care was taken for only 24 articles to apply, since the application of the rest is impossible, when the vast majority operate within the urban fabric of cities, any intervention in buildings is impossible and costly, and in fact, yields no return in periods of tight budgets.
The ultimate result is the opposite of what was expected, and in a sentence, instead of 3 Presidential Decrees as until now, clinics now operate with the 3 Presidential Decrees, but with a new law added!
Denationalization through Acquisitions
A few months after the end of the memorandum era for Greece, with everyone expecting the start of a new era, we see that the health care sector has also been affected by the consequences of the decade-long recession, regression, and the dramatic changes in the business climate.
The end of operations of dozens of clinics, approximately forty, acquisitions of private hospitals of well-known groups, in fact with a low level of financial dependence on the National Organization for Health Care Services, and offers and moves made to purchase other groups, and competition procedures for others comprise a backdrop that will be completely different by the end of the year, compared to two years ago and of course, before the start of the economic crisis.
And the questions emerge reasonably.
Why is there such interest on the part of foreign funds in investing in Greece and in particular in the health sector? Do they see it as a sector that will return to profitability immediately? Will increased value be recorded by the treatment center buildings? Will there be an excessive concentration of the sector and therefore, a redistribution of the pie among few operators? How will that happen, however, when the National Organization for Health Care Services is functioning in a framework of closed budgets, which are unrealistic compared to the real needs of the population, with private insurance companies covering a small percentage, approximately 12% with its health care programs, with a population that declares itself unable to pay privately to cover its hospitalization expenses?
Of course, the need for health care will continuously increase.
Although one of the consequences of the economic crisis is the reduction of life expectancy by two years, at the same time, the low birth rate, increased unemployment, the aging population, expensive new treatments, expensive new diagnostic tests, and the high cost of new medication create a negative balance for the finances of health care. This problem, the need to increase spending on health care, is something that we face not only in Greece, but in every European country.
The Positions of the Political Parties in View of the Elections
In a pre-election year like this one, which are the positions of the European and Greek political parties on health care?
All the parties talk about free public health care, kowtowing to voters, when of course they know what the condition of public health care is, especially in our country, and when the cost of public health care is a multiple of the cost in the private sector.
Everyone in Greece and Europe should understand the valuable complementary role of the private sector in all national health care systems and entrench free access and choice for patients in the member states of the European Union to the doctor and hospital that they trust in order to deal with the problems that they face, without waiting lists, and with costs that are accessible for their means but also much lower for the social security system.
Health is valuable, and at the European Union there should be a minimum unified policy, and the Commissioner for Health should be exclusively responsible for health care and not also other areas.
Changes to the Form of Health Care Moving Towards 2025
However, health care is evolving rapidly, medical technology is moving ahead at a very fast pace and discovering new innovative diagnostic and treatment machinery whose purchasing cost is prohibitive for the conditions in Greece, taking into consideration the low values of reimbursement for medical treatment and the financial means of both insurance funds and patients.
Still, we will need to develop, we will need our health care units to involve, and to invest, in order to cover the ground lost during the last decade, in our efforts, but also in our vision to provide health care services that are suitable for a developed country in Europe like our country, but also with a high level of responsibility towards our patients and fellow humans.
In order for this to become reality, we will need to readjust our health care budgets in accordance with patients’ choices. If health care services cost more in the public sector and the state cannot at the same time act as a successful entrepreneur by taking risks, it is not a bad thing to consider public-private sector partnerships, with the concession of the operation of clinics of National Health Care System hospitals or even entire hospitals to the private sector. The state will be rid of loss-generating activities, so that it can exercise social policy without interruptions, and citizens will enjoy high-quality, efficient, safe, and immediate services, when they need them and not months later, when it may be too late for their lives.
Let’s leave ideology and political cost and see which solution is more affordable for the state and is in citizens’ interest to a greater extent, and let’s proceed forward.
Health care has a cost, and we have never designed a national patient-centered strategy over the long term.
Let’s implement reforms in this sector.
Health care services in the private sector, with a lower cost and incomparable levels of quality and service, and the obligation for the state to limit itself to inspecting the operation of the facilities in terms of the safety of services, and not bureaucratic issues by consistently raising obstacles.
After all, health care is changing its form, moving towards new standards of continuous and individualized care. The way that we provide our services is changing along with it, creating new conditions of treatment and individual care.
By 2025, technology is expected to change everything that we know about health care to this date radically, in terms of patients, private insurance, and even public health.
Information technology, machine learning, nanotechnology, and electronic systems will play a significant role in restructuring the sector.
Artificial intelligence, robotics, nanorobotics, the Bionic movement, brain – computer connections, virtual reality, and 3D-printed medicine have entered our daily life, and we will need to examine and study the impact of this technology on our businesses and invest in adapting them to the future, in order to continue to be competitive and profitable in the new environment that is taking shape.
In 2025, “digital assistants” will perform medical diagnoses, will measure vital signs, will implement doctors’ orders, and will communicate with patients through computer-based vision and voices, with automated learning and the use of digital data.
We are experiencing the new revolution of technology. We need to be aware of this and adjust the way that our businesses in this sector and workers operate.
We should not lose the opportunity for this technological reform that coincides with leaving behind the memorandums and attempts to chart a course for growth.
And let’s not forget that health care should remain in Greek hands and not be sold out to foreign funds with investment capital of unknown origin and only profit-seeking objectives.
