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Observational Study
. 2021 Sep:198:85-88.
doi: 10.1016/j.puhe.2021.06.025. Epub 2021 Jul 10.

Essential public healthcare services utilization and excess non-COVID-19 mortality in Greece

E Kondilis  1 , F Tarantilis  2 , A Benos  2
Affiliations
Observational Study

Essential public healthcare services utilization and excess non-COVID-19 mortality in Greece

E Kondilis et al. Public Health. 2021 Sep.

Abstract

Objectives: Ensuring access to care for all patients-especially those with life-threatening and chronic conditions-during a pandemic is a challenge for all healthcare systems. During the COVID-19 pandemic, many countries faced excess mortality partly attributed to disruptions in essential healthcare services provision. This study aims to estimate the utilization of public primary care and hospital services during the COVID-19 epidemic in Greece and its potential association with excess non-COVID-19 mortality in the country.

Study design: This is an observational study.

Methods: A retrospective analysis of national secondary utilization and mortality data from multiple official sources, covering the first nine months of the COVID-19 epidemic in Greece (February 26th to November 30th, 2020), was carried out.

Results: Utilization rates of all public healthcare services during the first nine months of the epidemic dropped significantly compared to the average utilization rates of the 2017-19 control period; hospital admissions, hospital surgical procedures, and primary care visits dropped by 17.3% (95% CI: 6.6%-28.0%), 23.1% (95% CI: 7.3%-38.9%), and 24.8% (95% CI: 13.3%-36.3%) respectively. This underutilization of essential public services-mainly due to supply restrictions such as suspension of outpatient care and cancelation of elective surgeries-is most probably related to the 3778 excess non-COVID-19 deaths (representing 62% of all-cause excess deaths) that have been reported during the first 9 months of the epidemic in the country.

Conclusions: Greece's healthcare system, deeply wounded by the 2008-18 recession and austerity, was ill-resourced to cope with the challenges of the COVID-19 epidemic. Early and prolonged lockdowns have kept COVID-19 infections and deaths at relatively low levels. However, this "success" seems to have been accomplished at the expense of non-COVID-19 patients. It is important to acknowledge the "hidden epidemic" of unmet non-COVID-19 needs and increased non-COVID-19 deaths in the country and urgently strengthen public healthcare services to address it.

Keywords: COVID-19; Essential health services; Excess mortality; Excess non-COVID-19 deaths; Health services utilization.

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Conflict of interest statement

All authors (EK, FT, and AB) have no competing interests to declare.

Figures

Fig. 1
Fig. 1
(A) Public healthcare services utilization in Greece (Jan 1–Nov 30, 2020), compared to the average respective time period of 2017–19 (B) Excess deaths in Greece (ISO weeks 9–48; Feb 22–Nov 29, 2020), compared to the average respective time period of 2015–2019. Notes and Sources: (A) Authors' calculations are based on monthly aggregated data from all public hospitals and public primary care centers in Greece, as reported by the Greek Ministry of Health. Data were grouped by the type of facility (hospital vs primary care) and the type of service (emergency or non-emergency hospital visits, hospital admissions and surgical procedures, and total primary care visits), and utilization rates were calculated for each month from January until November 2020. The control period covers the average monthly utilization rates during the period 2017–19. (B) Authors' calculations are based on weekly data of all-cause deaths as reported by the Hellenic Statistical Authority and daily data of COVID-19 deaths as reported by the National Public Health Organisation in Greece. Excess non-COVID-19 deaths were calculated by extracting COVID-19 deaths from total all-cause excess deaths. The control period covers the average weekly all-cause deaths during the period 2015–19.
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