Uninsured citizens in the period of the Greek economic crisis: Health, income, housing. The case of an Attica Region Municipality.

Abstract

Introduction: In Greece, the implementation of the Fiscal Adjustment Programs was combined with policies of economic austerity resulting in high levels of unemployment and exclusion from health insurance for a large proportion of the population. Aim: This study explores the demographic and socio-economic characteristics and the health status of the uninsured citizens in one of the biggest Municipalities in Attica region. The study covers the period 2012-2016, during the economic crisis in Greece. Methods: Data stemming from official documents, from individual files of 1,738 uninsured citizens were processed. Possible associations between population characteristics and chronic disease categories were examined, using the chi-square test and univariable/multivariable analysis for chronic disease as an outcome. Results: Almost forty-two percent (41.7%) of the study population suffered from a chronic disease; with the 48% of those patients having zero real annual income and 60.4% being hosted by a relative or an acquaintance. Of the sample diagnosed with a mental illness 71% lived as guests to friends or relatives. Diagnosis with cancer appeared to be more related to zero income, compared to other chronic disease categories (72.7%, p <0.001). In the multivariable model, male gender (OR=1.70 95% CI: 1.35-2.13), age (OR=1.03 95% CI: 1.02-1.04) and guest status (OR=1.57 95% CI: 1.24-2.00) were associated with a chronic disease. Conclusions: In Greece, in the midst of the economic crisis, uninsured citizens with chronic illness are called upon to manage their health problem with zero income and housing problems. A key strategy to address such a prospect of further health degradation of the particular population group can only be the strengthening and reorganization of the provision of social protection and health services around a primary care model developed and functioning at community level, with as its basic principle, universal and equal access to it, for all citizens.