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Anastasia Balezdrova

Healthcare is one of the sectors that have been hit by the economic crisis in southern Europe. Budget cuts have reduced the funds for healthcare, worsening the quality of the services in public hospitals. At the same time, in countries such as Greece, the high rate of unemployment and the slowdown of the reform of the social security funds have left outside the system hundreds of thousands of citizens who have no health insurance.

In such conditions, it is expected that the private sector will take the initiative to cover a solid portion of the insurance. This was one of the main topics discussed at the meeting of the Council of the European Union of Private Hospitals that took place in Athens.

President of the federation, which represents private healthcare in 20 European countries Erich Sieber, explained that the healthcare systems and the rate and manner of private sector participation in them are different in different countries.

"In countries such as Austria and Germany we use the ICD10 system. It is a points system and the basis of the payment at a later stage. In Austria, we have a common budget for the current year. Payments are made on a monthly basis and, at the end of the year, we make a balance and pay the difference.

The budgets are not regulated as they depend on the contributions of insured persons in the funds as well as on the funding of each province. Citizens also pay for their treatment, but the price for them is low, unless they decide to be admitted to a luxury clinic, where they pay additional costs. The price is 11 euro per day for a regular room, but if a relative wants to accompany the patient, he or she pays 15 euro. The price increases depending on the treatment but the rate that is paid by the insurance fund increases in parallel as well."

He explained that the system is not uniform in all Austrian provinces. "Where the budget is closed, this only applies to basic healthcare and not to the additional therapies and services. On the one hand, the system operates on the basis of criteria that are the same for all, and on the other, the budget of a large hospital that has doctors from all specialties is different from the budget of a smaller hospital that has doctors from all specialties, but offers fewer services."

President of the Association of Private Hospitals in Spain Cristina Contel presented the problems in private healthcare that were caused by the austerity measures applied in her country.

"The main problem is that public hospitals began to provide private health services but the cost of the salaries of doctors, equipment and everything else is paid by citizens. In fact, what they do is unfair competition because they receive funding from the state budget and from taxes. This is a huge problem for private hospitals in Spain, because under these conditions, we are not able to compete with public hospitals.

Another problem is the constant inspections by the tax authorities on various occasions. These frequent inspections of private hospitals cost a lot of money and threaten our budgets.

She said in Catalonia 30% of citizens are insured in both the public and the private healthcare system. The majority of the Spanish citizens have recently turned towards private healthcare, and the prices of the services rendered by private hospitals remain at 2006 levels. "This is a problem for us because we have more patients, which means more work to earn less money."

It is worth noting that in Spain, 63% of citizens have private health insurance and private hospitals do not work with patients insured in the public healthcare system.

Private hospitals in another crisis-hit European country, Portugal, are not funded by the public sector in any way and are supported by their activities. The citizens are obliged to pay for public insurance, which is calculated on the basis of their income. According to the director general of the Portuguese association of private hospitals, the sector is seriously affected by the crisis.

"The austerity measures were implemented in the public system, but this had increased the cost of healthcare in general. Before the crisis, the citizens of Portugal visited public hospitals and paid 10 euro to be rendered different health services. Following the imposition of the measures, that price has significantly increased, so that today it does not matter for those citizens who have a private insurance whether they will visit a public or private hospital. Except that they wait longer at public hospitals, and the procedures there are cumbersome and bureaucratic. In general, we can say that the measures were positive for our sector. For example, I have one of the best private insurances and pay 90 euro per month. Seeing a doctor in a private hospital costs me 12.50 euro."

According to him, in recent years, due to the crisis the government has reduced the prices paid to private hospitals for the services provided to those insured in the public system. "This has resulted in their refusal to treat the insured in the public system. Anyway, they are not obliged to do so under the contracts signed. This has increased the number of people waiting for operations without knowing when this will happen." According to him, even before the crisis, private hospitals were providing their services at lower prices for those insured in the public system.