Mediterranean diets: financial crisis prompts trimming of health care's waistline.

They’ve been pejoratively dubbed the “PIGS” of Europe: Portugal, Italy, Greece and Spain. Their financial indebtedness has necessitated bailouts from the European Union and other international institutions, and as they scramble to sort out their wrecked economies, health care is starting to feel the pinch. Greece has perhaps been the hardest hit. After it teetered on the brink of bankruptcy earlier this year, it received a salvage package from the European Union and is now dealing with the consequences. Among those is a cut in salaries and benefits for physicians. “Greek doctors took the same hit in their 13th and 14th salaries as every other civil employee,” Dr. Stylianos Tsintzos writes in an email. (In Greece, public workers receive what are called 13thand 14th-month salaries. They work for 12 months but are paid for 13 or 14. As part of European bailout, Greece had to agree to cap those salaries at a flat rate). Tsintzos, who left Greece to work in the medical device industry in Switzerland, adds that the financial impact probably isn’t as severe for senior doctors. "Senior doctors, who earn their lifestyle from informal payments from patients and pharmaceutical industry kick-backs, are unlikely to suffer with the average population.” All doctors have felt the pinch, Dr. Stella Argyriadou, vice-president of the Greek association of General Practitioners, writes in an email. “There have been many problems concerning night and weekend shifts. In the attempt to save resources, there has been a cut in personnel, which lead to exhaustion and fatigue of doctors. There was also a cut in shifts of some specialties, such as lab doctors and dentists, who were considered unnecessary.” The financial crunch has also caused shortages in medical supplies, especially medicines and lab analysis materials. “The inability of hospitals to pay for medical equipment and the mandatory cuts in the prices of drugs has caused many distributors to limit their supplies and in some cases to even exit the market,” Tsintzos writes. Private health care providers are also taking a hit, as fewer Greeks are able to afford their services and are turning to the public sector, which has experienced a 20%to-30% increase in demand. In response, some private centres have dropped their fees and cut physician salaries. Greece’s government is expected to move with health legislation that will articulate further dimensions of change but make the financial situation more predictable, says Argyriadio. “Nonetheless, massive pessimism dominates [the] Greek medical sector.”