Some commentators have felt the need to point out that, supposedly, the Swedish health care system charges the equivalent of 33 euros for nonessential appointments. This remark aims to serve as a justification for the introduction of user fees in the Greek health care system. The reasoning behind it goes that, if a ‘highly developed’ society such as the Swedish one charges for medical treatment, then lowly memorandum-bound Greece can do the same, if charges will help to finance the ailing health care system (and bring it up to a par with the Swedish one).
Let us disregard the question of whether or not inter-country rankings in health care carry any meaning, and instead focus on the many holes in the argument, some of which are:
1) It disregards the circumstances under which the decision to introduce user fees in Sweden was taken – this has the effect of presenting economic decisions about health care as value-neutral. However, it may well be that this decision was met with great resistance from the Swedish public. Luckily for those propagating this user fee nonsense, the level of Swedish most Greeks speak only goes so far as to decipher the names of IKEA furniture. The extent of resistance to this decision cannot therefore be known exactly. Unfortunately, however, the Swedish government has a website available (in English), in which the way that the Swedish health care system works is explained in simple terms, and in which the exact fees that someone can be expected to pay for using medical services are laid out.
Τhe Swedes go to great lengths to ensure that equity is maintained, even in the presence of user fees. In contrast, in the Greek system, in which informal payments are the rule and not the exception, it is not uncommon for families to lay in financial turmoil following illness
2) It assumes that the introduction of market mechanisms in health care is directly related to the quality of services offered – however, evidence indicates that user fees are detrimental to public health, in that they reduce the use of preventive health services, such as screening for cancer, diabetes or health disease. In addition, user fees act as a deterrent even for necessary but comparatively ‘small’ procedures, such as monitoring blood pressure, blood glucose and lipid levels, or even some ultrasound examinations during pregnancy. This is especially true in a country with high numbers of uninsured and unemployed, who may not be able to afford paying a fee even before they receive treatment for a known condition. Quality of care is intimately tied with continuity of care and with the correct application of screening and public health programmes. When these are not made available, and when even essential care is placed behind a financial barrier, market mechanisms cannot be said to correlate with quality.
3) It ignores considerations about equity and access in relation to health - the Swedes go to great lengths to ensure that equity is maintained, even in the presence of user fees. For example, there is a maximum ‘ceiling’ that each person can pay for receiving medical treatment per year. Once this ceiling is reached, all subsequent treatments are free of charge. This means that the financial ruin associated with long-term illness can be avoided. In contrast, in the Greek system, in which informal payments are the rule and not the exception, it is not uncommon for families to lay in financial turmoil following illness. This problem will only be exacerbated following the introduction of user fees, on top of informal payments extorted from the chronically sick as a matter of course, in spite of reassurances to the contrary (in Greek).
Therefore, the assumption that the introduction of user fees will increase revenue for the Greek health care system is naive at best, since paying upfront for access deters many from receiving treatment they may need. In addition, the introduction of user fees does not mean that informal payments will not be additionally requested, thereby exacerbating the inequitable state of the Greek health care system as it stands currently. Finally, there are no guarantees as to how the assumed increases in revenue will be spent. It is one thing to struggle to maintain a budget that meets population needs, it is quite another to possess the know-how and moral compass required for spending that budget in a way that respects solidarity concerns and respects, protects and fulfils the human right to health.
