'PRIVATE HEALTHCARE is all about the wealthy in large cities going to hospital' - right or wrong?
Wrong! Wrong! And wrong again! - according to a recent survey on 1,616 Greek households, reported in Health Policy (Private health expenditure in the Greek health care system: Where truth ends and the myth begins, May 2008)
There are some big surprises.
Firstly, the rural population spends more per capita on private healthcare than the urban. That really goes against the accepted wisdom that it is the wealthier urban population who spend most because the public sector is creakiest in large cities.
In fact, the authors point out that doctor shortages can be as high as 50% in rural areas.
This finding suggests that there is a huge demand for private healthcare outside the capital cities, where it is most concentrated.
I think this also holds true across much of Eastern Europe and in Turkey. Certainly, doctor shortages in rural areas is a phenomenon common across the region - in Turkey, doctors are conscripted for a period to work in rural areas and then paid double to stay there!
And, apart from doctors, pay in the rural areas is generally much lower for nursing and ancillary staff.
Secondly, the study found that, of the €6.146bn spent by the Greek population on healthcare, some 66% went on outpatient services, with dentistry taking €1.192bn, or 1.5% of GDP.
Again, this shows the mistake of thinking that private healthcare is all about hospitals (although, of course, much of that care will be provided from the outpatient department of private hospitals).
Greeks spent 20% of that on pharmaceuticals and therapeutic appliances. In-patient hospital care accounted for less than 15% of the total, coming in at €884m, including €176.8m of informal payments made to public sector hospitals.
That is a lower level of informal payments than one might have anticipated, but it still means that one Greek in three pays bribes in a stay in a public hospital. The study also points to high payments to specialists in private hospitals, and suggests that 85% of payments made to cardiologists are not declared for tax!
Some 3% of individuals sought care abroad, implying that Greeks spent €20m-€30m on hospital admissions abroad. But that figure will be swollen by the very wealthy.
Thirdly, the study also found that spending on private healthcare was not limited to the wealthy.
Yes, median income earners were 1.5 times more likely to spend on private healthcare and high earners 1.8 times, but low earners also spend. Indeed, the study found that the less well educated were more likely to visit surgical specialists.
Again, I think that some of this can be extrapolated across the region. Where public healthcare is of poor quality, private healthcare is not just for the wealthy.
And finally, this survey highlights the immense value of actually asking the consumer about healthcare. It strikes me that doing this with a statistically valid data set is the only way of accurately sizing healthcare markets or understanding how they work.
Fourthly, it highlights the importance of dentistry as a sector. Again, with much of this region not having adequate public sector care, this area has huge potential, providing it can be consolidated in some way.
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