Access to Care for Multiple Sclerosis in Times of Economic Crisis in Greece – the HOPE II Study

Document Type : Original Article


1 Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece

2 Centre for Health Services Research, Medical School, University of Athens, Athens, Greece

3 Faculty of Social Sciences, University of Peloponnese, Corinth, Greece

4 National Organization for Healthcare Services Provision, Athens, Greece

5 Department of Statistics, Athens University of Economics and Business, Athens, Greece


While there is currently no cure for multiple sclerosis (MS), treatment with biologic diseasemodifying drugs (bDMDs) can reduce the impact of the condition on the lives of patients. In Greece, the regulatory change in the distribution system of bDMDs, limited their administration through the designated pharmacies of the National Organization for Healthcare Services Provision (EOPYY) or the National Health System (ESY) hospitals, thus potentially impacting access to MS treatment. In this context, the aim of this paper was to assess the barriers to bDMDs, by recording MS patients’ experiences.
A survey research was conducted between January and February 2014 in Athens and 5 other major Greek cities with the methods of personal and telephone interview. A structured questionnaire was used to elicit socio-economic and medical information, information related to obstacles in accessing bDMDs and medical treatment, from MS patients that visited EOPYY pharmacies during the study period.
During the last year 69% of 179 participants reported that the distribution system of bDMDs has improved. Thirteen percent of participants encountered problems in accessing their medication, and 16.9% of participants in accessing their physician, with the obstacles being more pronounced for non-Athens residents. Frequent obstacles to bDMDs were the distance from EOPYY pharmacies and difficulties in obtaining a diagnosis from an EOPYY/ESY physician, while obstacles to medical care were delays in appointment booking and travel difficulties.
Even though the major weaknesses of the distribution system of bDMDs have improved, further amelioration of the system could be achieved through the home delivery of medicines to patients living in remote areas, and through the development of a national MS registry.


Main Subjects

  1. Maxwell RJ. Quality assessment in health. Br Med J (Clin Res Ed). 1984;288(6428):1470-1472.     doi:10.1136/bmj.288.6428.1470
  2. Põlluste K, Kalda R, Lember M. Satisfaction with the access to the health services of the people with chronic conditions in Estonia. Health Policy. 2007;82(1):51-61. doi:10.1016/j.healthpol.2006.08.004
  3. Põlluste K, Kallikorm R, Meiesaar K, Lember M. Satisfaction with access to health services: the perspective of Estonian patients with rheumatoid arthritis. Sci World J. 2012;2012:257569. doi:10.1100/2012/257569
  4. Multiple Sclerosis International Federation. Atlas of multiple sclerosis 2013.
  5. Goldenberg MM. Multiple sclerosis review. P T. 2012;37(3):175-184.
  6. Damal K, Stoker E, Foley JF. Optimizing therapeutics in the management of patients with multiple sclerosis: a review of drug efficacy, dosing, and mechanisms of action. Biologics. 2013;7:247-258. doi:10.2147/BTT.S53007
  7. Kobelt G, Kasteng F. Access to innovative treatments in multiple sclerosis in Europe. Report prepared for the European Federation of Pharmaceutical Industry Associations (EFPIA). Published October 2009.
  8. Wilsdon T, Barron A, Mitchell- Heggs A, Ginoza S. Access to medicines for multiple sclerosis: challenges and opportunities. Report prepared for Biogen Idec. London; February 2014.
  9. European Multiple Sclerosis Platform. MS Barometer 2013.
  10. National Organization for Medicines (EOF) website.
  11. Souliotis K, Papageorgiou M, Politi A, Ioakeimidis D, Sidiropoulos P. Barriers to accessing biologic treatment for rheumatoid arthritis in Greece: the unseen impact of the fiscal crisis--the Health Outcomes Patient Environment (HOPE) study. Rheumatol Int. 2014;34(1):25-33. doi:10.1007/s00296-013-2866-1
  12. Laires PA, Exposto F, Mesquita R, Martins AP, Cunha-Miranda L, Fonseca JE. Patients’ access to biologics in rheumatoid arthritis: a comparison between Portugal and other European countries. Eur J Health Econ. 2013;14(6):875-885. doi:10.1007/s10198-012-0432-5
  13. Putrik P, Ramiro S, Kvien TK, et al. Inequities in access to biologic and synthetic DMARDs across 46 European countries. Ann Rheum Dis. 2014;73(1):198-206. doi:10.1136/annrheumdis-2012-202603
  14. Orlewska E, Ancuta I, Anic B, et al. Access to biologic treatment for rheumatoid arthritis in Central and Eastern European (CEE) countries. Med Sci Monit. 2011;17(4):SR1-SR13. doi:10.12659/MSM.881697
  1. Putrik P, Ramiro S, Kvien TK, Sokka T, Uhlig T, Boonen A. Variations in criteria regulating treatment with reimbursed biologic DMARDs across European countries. Are differences related to country’s wealth? Ann Rheum Dis. 2014;73(11):2010-2021. doi:10.1136/annrheumdis-2013-203819