❙ Access to healthcare ❙ in Greece 1. Access to healthcare for authorised residents The National Health System was established in 1983. It relies on a mandatory health insurance which is based on work (with employer/employee contributions, which are income-related). Thus the health services are funded by individual contributions (insurance-based) but also by state subsidies (tax-based). The system is decentralised and divided between primary healthcare centres, district and regional hospitals. Greece has engaged in substantial reforms of its National Health System in order to tackle the economic and social difficulties that the country is facing. One striking measure which has been taken is the reduction by 40% of the financing of the public hospitals. Access to healthcare is free at the point of access for insured nationals and authorised residents. However, there is still a co-payment of 25% of drug costs. Furthermore, since 2011 and austerity measures there is a €5 entrance fee for hospitals and healthcare centres, and every medical intervention subsequent to the consultation must be paid for (e.g. €30 for a blood test). People on a low income (below €300 / month) can also receive a “welfare card” which allows them to access healthcare services for free (even medicines) provided they have identity documents.
2. Access to healthcare for asylum seekers Asylum seekers have the same rights as nationals and authorised residents in terms of access to healthcare, provided that they are able to prove their status. In practice, this condition is difficult to meet for asylum seekers, due to the difficulties faced by the migrants in lodging an asylum claim in Greece.
HIV and other serious infectious diseases are considered by law to be an emergency and therefore everyone can access treatment. However, the Directive of 2 May 2012 provides that HIV treatment for undocumented migrants is accessible only until the patient’s health has been “stabilised”. This provision poses a real problem because nothing in the law or other regulations defines clearly the concept of “stabilisation”. Once again, the decision is left to the discretion of the medical professionals. Finally, the Directive of 2 May 2012 (amending the Law 3386/2005, §84) states clearly that public services, public corporate bodies, local authorities and social security institutions do not have to provide services to undocumented third-country nationals. There is an exception for hospitals, child care facilities and clinics in cases of emergency. State of health has become a legal ground for the detention of undocumented persons or asylum seekers if the authorities deem that these people represent a risk to public health. Indeed, an amendment to the Presidential Decree 114/2010 states that asylum seekers and undocumented migrants can be detained if they represent a risk to public health because they are suffering from infectious diseases or belong to vulnerable groups particularly exposed to the risk of infectious disease (this “risk” is assessed depending on their country of origin, intravenous drug use, prostitution activities). According to the law, the risk may also exist if people are living in conditions that do not guarantee minimum hygiene standards. People who are identified as a “risk” (which means they are suspected of being infected) can be forced to undergo mandatory screening. In addition, since 2012 the risk to public health represented by undocumented migrants or asylum seekers has become a reason for deportation from Greece.
According to the new Directive of 2 May 2012, there will be no change in access to healthcare for minors, meaning they continue to have free access to healthcare services, regardless of their status.
Undocumented migrants can only access healthcare services in cases of emergency or if there is a risk to the patient’s life. A circular from 18 August 2011 states that patients who come to the hospital are first examined by doctors who then decide whether or not the state of health of the undocumented migrant constitutes an emergency. The decision is then at the discretion of the medical professionals whether or not access to healthcare is granted.
© Alessandro Grassani
3. Access to healthcare for undocumented migrants
Patients getting medecines from the MdM Athens’ pharmacy
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Legislation update in seven countries (BE, DE, FR, EL, NL, ES, UK)