Uninsured patients undergoing dialysis in Greece

We agree with Paul Caulford and Yasmin Vali that uninsured immigrant and refugee patients are undertreated.¹ In Greece, uninsured patients with end-stage renal disease cannot be registered to undergo regular hemodialysis. However, emergent hemodialysis sessions are financially covered by the national health system, so these patients are admitted to public hospitals as emergency cases and they undergo dialysis in the hopsitals' renal units. They are discharged after their dialysis session. In Greece, a different hospital is on duty to provide outpatient emergency service each day. Therefore, uninsured hemodialysis patients are treated in a different dialysis unit each time.

Our unpublished data show that these patients have a higher mortality rate (approaching 22% per dialysis year) than patients receiving regular hemodialysis in our unit. Possible reasons for this include inefficient dialysis dosing, a lack of standard monitoring and problems with follow-up after drug administration for the patients treated on an emergent basis. The uninsured population includes unemployed Greek-born patients, as well as immigrants and refugees from Southeastern Europe (e.g., Albania, Bulgaria and Romania), Asia (e.g., India and Pakistan) and Africa (e.g., Nigeria and Ivory Coast). Uninsured patients constitute a significant proportion of the total nephrology admissions to hospital (almost 19%), and their numbers are increasing dramatically each year. Action must be taken nationally and internationally so that uninsured immigrants and refugees with end-stage renal disease can receive adequate treatment and enjoy an acceptable quality of life in their new countries.