Low official wages created a temptation for physicians, who would attract fee-paying patients by falsely categorising them as pregnant women who are exempt from the normal requirement to help pay for their drugs.
Corruption remains widespread, according to doctors, pharmacists and medical suppliers, with direct bribing by suppliers.
“The fakellaki system [envelopes containing cash bribes] is still operating at big hospitals in Athens, run by the heads of procurement,” says one Greek executive working for a foreign medical supplier.
Another executive says pharmacists sometimes seek reimbursement by falsely claiming medicines for fictitious or dead patients. Health insurance funds do not require verification that costly medicines are essential, resulting in fraud estimated at up to €1bn a year.
Patent-protected drugs have been sold to the Greek health system in high volumes at prices which are relatively low by EU standards. One consequence was more than €850m last year in “parallel exports” of medicines bought cheaply by Greek pharmacists and resold abroad. The government responded in recent months by banning foreign sales of some medicines after domestic supplies ran out.
Once patents have expired, the lack of any requirement for Greek doctors to prescribe cheaper, generic versions means patented drugs still represent nearly 80 per cent of total prescriptions in Greece, compared with less than 30 per cent in Germany. Yet generics were traditionally sold at relatively high prices, with very low discounts to patented drugs. Even after recent reforms, they are typically only a third cheaper, compared with lower rates of nearly 90 per cent less in the UK.
Vassili Kontozamanis, a former Greek drug regulator, calls for greater efforts to boost generic prescribing at lower prices, but he cautions that such moves are meeting resistance from the country’s powerful generic drug industry, which employs more than 15,000 people.
Recent government reforms have included non-binding prescription guidelines, and cuts in drug prices amounting to €1bn, with the aim of reducing the state’s medicines bill to 1 per cent of GDP by the end of this year. But reforms at state hospitals are making only modest progress amid strong opposition from medical staff.
Sunday, February 12, 2012
Athens struggles to rein in medical excess - FT.com