Να αυξηθούν οι δημόσιες δαπάνες Υγείας, ναι. Να πετάμε χρήματα όπως να'ναι, όχι.

Υπάρχουν κάποιοι οι οποίοι ζητούν να αυξηθούν ή να παραμείνουν στα ίδια επίπεδα οι ήδη υψηλές τιμές των γενοσήμων και των αιματολογικών εξετάσεων στην Ελλάδα με το επιχείρημα ότι οι δημόσιες δαπάνες μας στην Υγεία ανά κάτοικο, είναι σχετικά χαμηλές.

Η απάντησή μου:

Όταν στην Ελλάδα το 30% των ανθρώπων είναι ανασφάλιστοι, τα γηροκομεία είναι ελάχιστα, οι νοσηλεύτριες στα Νοσοκομεία είναι κακοπληρωμένες και πάρα πολύ λίγες και οι Νευροχειρουργοί χειρουργούν στις εφημερίες τους για περίπου 4 Ευρώ την ώρα (για να δώσω ένα παράδειγμα του πόσο αμοίβεται η κλινική εργασία), επόμενο δεν είναι οι επίσημες δαπάνες Υγείας στην Ελλάδα να είναι χαμηλές; Δυστυχώς, οι επίσημες δαπάνες Υγείας είναι υψηλότατες για το επίπεδο Υγείας που παράγουν στην χώρα μας.

Το ότι οι δημόσιες δαπάνες Υγείας πρέπει να αυξηθούν δεν σημαίνει και το ότι πρέπει να πετάμε χρήματα όπως να' ναι.

Πρέπει να κάνουμε οικονομίες από εκεί που μπορούμε, για να μπορούμε να πληρώνουμε εκεί που πρέπει.

Και πάνω από όλα: Πρέπει να μάθουμε να επιβραβεύουμε πρώτα την αληθινή εργασία, και μετά το εμπόριο. Αλλιώς δημιουργούνται απίστευτες στρεβλώσεις όπως π.χ. ότι οι Μικροβιολόγοι στις Ελληνικές πόλεις είναι πιο πολλοί από τους Γενικούς Ιατρούς.

Δεν είναι δυνατόν ο ΕΟΠΥΥ να πληρώνει 72 εκατομμύρια ευρώ για την κλινική εργασία, 700 εκατομμύρια ευρώ για εξετάσεις και 2 δις για φάρμακα.

01 September 2014: The prices of some usual blood tests in Greece and Sweden. A comparison.

My blog is almost always in Greek. Sometimes though, I write in English because I want my audience to be international. Well, if you wonder why Greece is bankrupt, I think that here you are going to read a part of the answer (in an earlier post in this blog, I dealed with another part of the answer): 

I start again with a short presentation of myself: My name is Argirios Argiriou. I have studied Medicine in Lund, Sweden and I specialized in General Practice in Linkoping Sweden. Since 2005 I work as a private General Practitioner in my hometown Kavala, Greece. I still work though, as a locum doctor in Sweden for some weeks every year, and that helps me to keep in touch with both the Greek and the Swedish clinical reality.

On Juli 16^th 2014 while working as a locum Doctor in Health Center Amal in Sweden, I asked the head of the laboratory department about the prices of the blood tests.

She gave me a written list from 2013 and she told me that these prices remain the same since then. The greek prices have been taken from the site www.e-syntagografisi.gr which is used by the doctors in Greece in order to prescribe tests but even medicines (in order to log in, you must work as a doctor in Greece).

I called the Chief of the Health Center of Amal on September the 1^st 2014 and she told me that the prices ​​remain the same.

On September the 1^st of 2014 when I make this comparison 100 Swedish Crowns (SEK or informally as well represented in Sweden kr) = 10,9 Euro (€).

General Blood Count (Red cells, White cells and Platelets together)

In Sweden it costs 15,51 SEK = 1,69 € (including platelets), while in Greece, if we want to include platelets platelets too, as in Sweden, (platelets in Greece cost separately 1,76 € ) it costs 2,88 + 1,76 = 4,64 €

That is, the General Blood Count is 175% more expensive in Greece than in Sweden.

Ferritin

In Sweden it costs 21,85 SEK = 2,381 € when in Greece it costs 9,51 €.
That is, Ferritin is 299% more expensive in Greece than in Sweden.


Glucose

In Sweden it costs 6,62 SEK = 0,721 € when in Greece it costs 2,26 €.
That is, Glucose is 213% more expensive in Greece than in Sweden.

SGPT = ALAT

In Sweden it costs 6.19 SEK = 0,674 € when in Greece it costs 4,49 €.
That is, SGPT is 566% more expensive in Greece than in Sweden.

ALP

In Sweden it costs 6.04 SEK = 0,658 €, when in Greece it costs 5,02 €.
That is, the ALP is 663% more expensive in Greece than in Sweden.


Creatinine

In Sweden it costs 6,77 SEK = 0,737 €, when in Greece it costs 4,05 €.
That is, Creatinine is 450% more expensive in Greece than in Sweden.

Total Cholesterol

In Sweden it costs 6,18 SEK = 0,673 € when in Greece it costs 2,88 €.
That is, cholesterol is 328% more expensive in Greece than in Sweden.


HDL

In Sweden it costs 15,51 SEK = 1,690 € when in Greece it costs 4,75 €.                                                 That is, the HDL is 181% more expensive in Greece than in Sweden.

Triglycerides

In Sweden it costs 7,49 SEK = 0,816 € when in Greece it costs 4,49 €.
That is, triglycerides is 450% more expensive in Greece than in Sweden.


TSH

In Sweden it costs 16,36 SEK = 1,783 € when in Greece it costs 12,38 €
That is, the TSH is 594% more expensive in Greece than in Sweden.

Free T4

In Sweden it costs 16,45 SEK = 1,793 € when in Greece costs 20,54 €.
That is, the free T4 is 1046% more expensive in Greece than in Sweden.


PSA

In Sweden it costs 28,66 SEK = 3,123 € when in Greece it costs 14 €.
That is, the PSA is 348% more expensive in Greece than in Sweden.

I called some weeks ago, the President of the Union of Swedish Physicians working in the field of Chemical Laboratory Examinations, dr Matias Aldrimer. Dr Aldrimer, told me that, in Sweden, the Primary Health Care (= PHC) as a whole, is a very large customer and it has managed to bring down the prices of the most common laboratory blood tests in PHC. As a compensation the laboratory providers raise the prices of some rare and specialized exams used mostly in hospital settings. The only blood test thought that I could find to be significantly more expensive  in Sweden is that of 17-0H-Progesteron which in Sweden costs 468,23 SEK = 51,037 Euro while in Greece it costs 9,51 Euro. (ie 437% more expensive in Sweden).

In general, however, one can easily see that the prices ​​of blood tests in Greece are much more expensive than in the rich Sweden.

Postscript:

Τhe prices of the blood tests in Sweden are not settled by the state, as in Greece, but the Laboratory Departments of the Hospitals of each county or any private laboratory provider are free to decide their prices. The customers (eg the various Health Care Centers or the various Hospitals ) have the right to choose between the various providers and of course they usually prefer the cheaper one. It even happens that, due to the difference in price, the «customers» send the blood to a laboratory that is located far away (although there may be another laboratory which is located nearer to the customer but it happens to be more expensive).

Those who work in the laboratories of Health Centres and Hospitals are not doctors, (and this contributes too, to make blood tests cheaper in Sweden).  They are called in Swedish "Biomedical Analyst" (Biomedicinska Analytiker) and their education is three years in higher educational institutions. It is not rare though, during the vacation period or in case of sickness, that the Biomedical Analyst is replaced by simple Nurses, who do this job as fine (in Greece it is considered to be a Physician job and should be paid accordingly...) Physicians working in the field of Chemical Laboratory tests (Klinisk Kemi) in Sweden, are few and work mostly as heads of big hospital laboratory departments (eg. a medium sized Hospital has usually 1-2 such doctors). Overall, Doctors having the specialization of Klinisk Kemi are all together around 120 people across the whole Sweden (a country of 9.5 million people). Eg in the county of Dalarna (population over 270,000) there are only two Doctors with this specialty.

In Sweden there are not any small private “Microbiological” laboratory offices, as we know them in Greece, but there are large Medical Laboratory centers. Their clients are not individual citizens as in Greece, but, as I wrote before, their clients are Health Care Centers, Hospitals Clinics or whole Hospitals. The largest private provider in Sweden, is the company Unilabs which is specialized both in blood tests and in Radiology. The second largest private provider is the company Aleris. In the county of Stockholm for example there are essentially three major providers: The (Karolinska University Laboratories which belongs to the state (but essentially it operates as a private company), the private company Unilabs and the private company Aleris.


Dr Argirios Argiriou
General Practioner
Dagkli 4, Kavala, 654 03
Greece.
Telephone: + 30 69 78 68 27 22
www.argiriou.se

Από ποια μέρη του κόσμου προσγειώνονται στο αεροδρόμιο της Καβάλας.

Μια και ζω στην Καβάλα (και μεγαλωμένος στην Χρυσούπολη) και μια και μου αρέσουν τα ταξίδια, με ενδιαφέρει ιδιαίτερα από ποιες χώρες και ποιες εταιρείες πετούν, προς και από, το αεροδρόμιο της Καβάλας το οποίο είναι και δίπλα στην Χρυσούπολη.

Κατ'αρχήν μερικά πράγματα για την διεθνή ονομασία του αεροδρομίου μας:

Kavala International Airport "Alexander the Great" (Greek: Κρατικός Αερολιμένας Καβάλας «Μέγας Αλέξανδρος»,^[1] Kratikós Aeroliménas Kaválas "Mégas Aléxandros") (IATA: KVA, ICAO: LGKV)

Στις 10/08/2014 λοιπόν που έτυχε να βρεθώ στο αεροδρόμιο είδα ότι πετάγαν προς και από το αεροδρόμιο της Καβάλας οι παρακάτω εταιρείες (γράφω σε παρένθεση και την πόλη που η κάθε από αυτές τις εταιρείες, συνδέουν την Καβάλα):

Aegean,
Olympic,
AirBerlin,
German Wings,
NIKI (Austria),
Thompson Airways,
OPENAIR ( St: Petersburg),
Small planet (Poland),
enter air (Poland), FINNAIR (Helsinki)
Monarch (England)  http://www.monarch.co.uk
Travel Service         http://www.travelservice.aero/index.php

Thompson Airways μπορεί να κλείσει κανείς στο 2310 401 822.

Στο διαδίκτυο όμως και άλλες εταιρείες που κατεβαίνουν στην Καβάλα όπως:

Olympic Air, Aeroflot, Air Berlin, Air Malta, Air Slovakia, Austrian Airlines, Britania Airways, Central wings, Excel Aviation Limited, Germanwings, Jat Airways, LTU, Martinair Holland, Mytravel Airways, Nordic NR Regiona, Sas Braathens, Scandinavian Airlines System,Sterling Airways,Transavia, Travel Servis

http://www.callgreece.gr/transport/airports 

Στην παραπάνω ονομασία μπορεί να δει κανείς και τις ονομασίες των άλλων αεροδρομίων της πατρίδος μας.

Και κάτι άλλο πρακτικό. Στο αεροδρόμιο επίσης της Καβάλας υπάρχουν οι παρακάτω εταιρείες που νοικιάζουν αυτοκίνητα:

Sixt
Avis
Advance
Hertz
Europcar

Robin Williams.

"Η αυτοκτονία είναι μια μόνιμη λύση σε προσωρινά προβλήματα»".

29 June 2014: Τhe prices of some generic drugs in Greece and Sweden. A comparison.

My blog is almost always in Greek. This time though, I will write in English because I want my audience to be international. Well, if you wonder why Greece is bankrupt, I think that here you are going to read an important part of the answer:          

A short presentation of myself first: My name is Argirios Argiriou. I have studied Medicine in Lund, Sweden and I specialized in General Practice in Linkoping Sweden. Since 2005 I work as a private General Practitioner in my hometown Kavala, Greece. I still work though, as a locum doctor in Sweden for some weeks every year, and that helps me to keep in touch with both the Greek and the Swedish clinical reality.

The last time I worked as a locum in Sweden was in Amal ( www.amal.se ) which is a municipality with 9000 inhabitants and only one pharmacy while me birthplace in Greece, Hrisoupolis, (http://el.wikipedia.org/wiki/%CE%A7%CF%81%CF%85%CF%83%CE%BF%CF%8D%CF%80%CE%BF%CE%BB%CE%B7_%CE%9A%CE%B1%CE%B2%CE%AC%CE%BB%CE%B1%CF%82 ) with about the same population as Amal, has 10 pharmacies.

On June the 29th, 2014 I did a price comparison between seven different generics in Greece and Sweden.

I got the prices ( Retail Prices ) of the Swedish generics from the online National Formulary of Sweden www.fass.se ( You can see them, all the way down on the pages that open from the following Swedish links. Wherever you see the symbol - means integer in Swedish kronor. For example 52 - means 52 kronor . Unlike the : means that it will follow a decimal number eg 54:50 means 54.5 kronor ) .

I got the prices (also Retail Prices ) of the Greek generics from the site www.galinos.gr which is a private but well updated site that a lot of Greek Doctors use in order to find out the prices of the medicines that they prescribe.

On 29 June 2014, 100 Swedish Crones (SEK) = 10,88 Euro .

For medicines for chronic diseases, such as the following medicines, the packaging is usually 28 or 30 tablets/box in Greece, while in Sweden the packaging is usually of 98 or 100 tablets/box.

Since a similar comparison that I did in September 2013 the Greek medicines are a little bit cheaper but still much more expensive than the Swedish ones:

Omeprazole.

In Sweden the Caps. Omeprazole Teva 20 mg x 98 (i.e. a box with 98 capsules of Omeprazole Teva 20 mg), costs 59 SEK = 6,4  Euro

http://www.fass.se/LIF/product?userType=0&nplId=20061129000085#packages-prices

            when

In Greece the Caps. Penrazol 20 mg x 28 costs 13 Euro

http://www.galinos.gr/web/drugs/main/packages/6183#content

Ie the generic Omeprazole is 610 % more expensive in Greece than in Sweden.

Simvastatin.

In Sweden Tabl. Simvastatin Krka 40 mg x 100 costing 69.5 SEK = 7,56 Euro
http://www.fass.se/LIF/product?userType=0&nplId=20041018000310

when

In Greece the Tabl. Extrastatin 40 mg x 30 costs 18,05 euros

http://www.galinos.gr/web/drugs/main/packages/1708#content

Ie the generic Simvastatin is 695 % more expensive in Greece than in Sweden.


Atorvastatin

In Sweden Tabl. Atorvastatin Bluefish 20 mg x 100 costs 58 SEK = 6,31 Euro
http://www.fass.se/LIF/product?userType=0&nplId=20091210000151

                                                                                                                                                                   when

In Greece the Tabl. Atorstat 20 mg x 30 costs 14,90 Euro
http://www.galinos.gr/web/drugs/main/packages/10934#content

Ie the generic Atorvastatin is 687 % more expensive in Greece than in Sweden.

Finasteride

In Sweden Tabl. Finasterid Teva 5 mg x 100 costs 92 SEK = 10,00 Euro

http://www.fass.se/LIF/product?userType=0&nplId=20080318000057

when

In Greece the Tabl. Finastir 5 mg x 30 costs 12 euros
http://www.galinos.gr/web/drugs/main/packages/12185#content

Ie generic Finasteride is 300 % more expensive in Greece than in Sweden

Risperidone

In Sweden Tabl. Risperidon Teva 1 mg x 60 costs 59 SEK = 6,41 Euro

http://www.fass.se/LIF/product?userType=0&nplId=20070320000022

when

In Greece the Tabl. Rispelen 1 mg x 20 costs 7,01 Euro

http://www.galinos.gr/web/drugs/main/packages/14890#content

Ie generic Risperidone is 228 % more expensive in Greece than in Sweden.

Olanzapine

In Sweden Tabl. Olanzapine Teva 10 mg x 56 costing 61,50 SEK = 6,69 Euro.

http://www.fass.se/LIF/product?userType=0&nplId=20070127000065

when

In Greece the Tabl.Villamos 10 mg x 28 cost 41,05 Euros.
http://www.galinos.gr/web/drugs/main/packages/19008#content

Ie generic Olanzapine is 1127 % more expensive in Greece than in Sweden.

Citalopram

In Sweden Tabl. Citalopram Sandoz 20 mg x 100 costing 57 SEK = 6,2 Euro.

http://www.fass.se/LIF/product?userType=0&nplId=20040607006375

when

In Greece the Tabl. Seror 20 mg x 28 cost 9,92 Euros.
http://www.galinos.gr/web/drugs/main/packages/15120#content

Ie generic Citalopram is 471 % more expensive in Greece than in Sweden.

Even generics that are produced in Greece, can be found with a reduced price in Sweden: For example, a generic named "Rolenium 50/500" (produced in Greece by ELPEN http://www.elpen.gr) that costs 48.3€ in Greece, is imported to Sweden by "Bluefish Pharma" under the name Relanio and has price: 46.2€ (424.5 SEK). In this image: http://www.relanio.se/wp-content/uploads/2013/03/Forpackning-framifran.png  at the left down side you can see the ELPEN's brandname.

http://www.fass.se/LIF/product?userType=0&nplId=20100423000091

Does the Greek Government really want to reduce the cost of pharmaceutical expenditure in Greece ?

Then why don’t they reduce the price of generic drugs at Swedish levels?


Postscript : The fact that the prices of generics are held so high, flares on the over-prescribing of medicines by some corrupt doctors. (The larger the super-profits the  larger the kickbacks to the Doctors ..)

 

Dr Argirios Argiriou
Specialist in General Practice.
www.argiriou.se

Health depends mostly on exogenous factors not the healthcare system.

Richard Smith: The case for slow medicine

17 Dec, 12 | by BMJ

The characteristics of health systems are complexity, uncertainty, opacity, poor measurement, variability in decision making, asymmetry of information, conflict of interest, and corruption. They are thus largely a black box and uncontrollable, said Gianfranco Domenighetti of the Università della Svizzera Italiana at a meeting in Bologna on La Sanità tra Ragione e passione (Health through reason and passion). The meeting was held to celebrate the life and work of Alessandro Liberati, the founder of the Italian Cochrane Centre, who died last year.
Only 11% of 3000 health interventions have good evidence to support them, said Domenighetti. A third of the activity in the US health system produces no benefit, said a recent study in the New England Journal of Medicine. Half of all angioplasties are unnecessary. Some €153m a day is lost through corruption in health systems in the European Union. Four fifths of new drugs are copies of old drugs. Screening is creating diseases like ductal carcinoma in situ. Most doctors (80-90%) have taken “bribes” from pharmaceutical companies, although many may not see their free pens and lunches and subsidised travel as bribes (but if they are not bribes what are they?). Between 15% and 40% of articles in medical journals are ghostwritten. Half of clinical trials are not published, and there is systematic bias towards positive results, hence suggesting that treatments, usually drugs, are more effective and safer than they actually are.
Yet against this backcloth more than four fifths of people in most countries think medicine is an “exact or almost exact science.” In a study published in the Annals of Internal Medicine nearly 90% of patients undergoing percutaneous coronary intervention (PCI) thought that it would reduce their chances of having a heart attack, when it doesn’t. Asked about various scenarios almost half of cardiologists questioned would go ahead with a PCI even when they believed there was no benefit to the patient.
It is time, said Domenighetti, to open up the black box of healthcare. Encouraging “health literacy” seems to be a way to do this, but Domenighetti thought that this was “old wine in new bottles.” We need, he said, to encourage a healthy skepticism about the medical market and to help people understand that medicine is far from being an exact science. Data should be published exposing variations in practice, corruption, and conflicts of interest. We should explain that health depends mostly on exogenous factors not the healthcare system. And people should be given practical tools to promote their autonomy—tools like access to evidence based information.
Domenghetti ended his talk by pointing people towards the Choosing Wisely campaign in the US where professional organisations are identifying interventions that offer little or no value. A similar but broader campaign of Slow Medicine is underway in Italy, and I have little doubt that slow medicine—like slow food and slow lovemaking—is the best kind of medicine for the 21st century.
We need to pull back from what Ivan Illich called the hubris of medicine.
Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.
Competing interest: RS spoke at the meeting and had his expenses paid by the health department of Emilia-Romagna.

http://blogs.bmj.com/bmj/2012/12/17/richard-smith-the-case-for-slow-medicine/

"Ένα είδος καρκίνου."

Συζητούσα πρόσφατα με φίλο μου χειρουργό που τον σέβομαι όχι μόνο για τις χειρουργικές αλλά και για τις επικοινωνιακές του ικανότητες.

Του έλεγα ότι ενώ στην Σουηδία μου φαινόταν ευκολότερο να πω στον ασθενή την λέξη "καρκίνος" όταν ανακαλύπταμε μια κακοήθεια στον ασθενή αυτόν, στα Ελληνικά μου φαίνετα πολύ βαριά σαν λέξη και έτσι χρησιμοποιώ συνήθως την λέξη "κακοήθεια". Μόνο που την λέξη κακοήθεια δεν την καταλαβαίνουν όλοι.

Τότε ο φίλος μου, μου είπε ότι ο ίδιος χρησιμοποιεί την έκφραση "ένα είδος καρκίνου", που ακούγεται κάπως πιο ήπιο από το σκέτο "καρκίνο", αλλά ταυτόχρονα ξεκαθαρίζει για το τι πρόκειται.

Νομίζω ότι είναι καλή ιδέα.