EURIPA regularly holds a (virtual) discussion to explore current issues facing rural practice across Europe. During the summer and autumn 2013 we conducted a survey, Hot Topic 5, by means of a simple questionnaire (10 basic questions) on the consequences of the economic crisis.
There were 9 respondents (4 males and 5 females; median age 53 years; experience as rural GP: 10–25 years; solo/group practice 7/2). Countries represented were: Italy (1), Hungary (1), Slovenia (2), Poland (1), France (1), Norway (1), Greece (Crete) (1) and Romania (1). Most of the respondents (85%) can be considered opinion leaders in their respective countries.
All 9 respondents evaluated the impact of economic crisis and austerity measures on healthcare as negative. They named, among other factors, ‘cutting down of health care expenditures by authorities, increasing number of patients who abandon or delay their treatment, increasing numbers of unemployed people, reduced wages, migration of the rural population to cities, migration of GPs (especially younger ones) to other European countries, Australia or New Zealand’. On a personal level, 8/9 of the respondents mentioned reduced wages, limited funds of the local GP's organizations, inability/reduced ability to attend professional conferences or to purchase medical literature, reduced possibilities to travel in general.
As short-term consequences of the crisis, the following issues were stated: closure of local hospitals, shift in the population and medical professional demography; as long-term consequences ‘social changes’ were indicated, i.e. a move to the outskirts of large cities where the environment is less secure, and criminality is on the rise, and a ‘brain-drain,’ which may have significant negative impact on the health of European nations in the near future.
Most of the respondents (8/9) think that the measures undertaken by government officials and the professional medical bodies are not enough to improve the current situation.
This corresponds well to the data of two recent inquests from Spain (submitted by Jose Lopez-Abuin, Instituto Salud Rural) as follows:
An annual inquiry among 7800 patients undertaken by the Spanish government (called the ‘Health Care Barometer’), in 2012 reported for the first time since 2004, a lower level of satisfaction for the Public Health Care System than the previous year (6.57 points). Twenty per cent of Spanish patients said that the Primary Care system had worsened, while in the previous inquest (2011), only 11% of the patients felt that the Primary Care System was worse than the previous year. Patients’ appreciation of the Public Health Care System as ‘fine/good’ decreased from 73.9% in 2010 and 73.1% in 2011, to 70.6% in 2012.
An inquest performed in 2013 among 600 general practitioners by SEMERGEN (a Spanish GP Scientific Association) reported that 89% of the GPs said that the quality in Primary Care delivery had worsened in the last two-to-three years, most of all due to the progressively lower investments in the resources’ budget. Ninety-three per cent think that investment in Primary Care is not enough. More than 90% of the GPs, in the SEMERGEN survey said that they were suffering directly in their own practice from this progressively lower investment.
As a result of the above mentioned socio-economical shift, 6/9 of the EURIPA respondents have considered moving abroad but have not gone through with it, being concerned with their patients’ health and solidarity with their colleagues. The remaining 3 respondents had not considered moving to other countries usually because of age, family/professional ties to the local communities and love of their respective countries.
I personally think that the current trends may represent a real danger of the emptying of rural communities, which is a threat to society as a whole.