Pregnant mothers are advised to remain calm at all times, but Elli Zachariadou could not hide her shock a few weeks ago when she heard reports about women having to pay at least €900 up front in order to give birth at public hospitals. Even more shocking to Zachariadou and other Greeks was the news that a number of hospitals had turned away pregnant women because they did not have the necessary cash.

“My immediate thought on hearing about the hospital charges was, how am I going to have this baby?” Zachariadou said. “You know, €900 is about three months’ rent. It’s not the kind of money we have lying around.” In years gone by, the 33-year-old Athenian’s social-security fund would have picked up most of her hospital bill, but she has joined the growing ranks of Greece’s long-term unemployed who have no such coverage.

As their country grapples with its economic problems, accessible and affordable health care is one of many things Greeks like Zachariadou can no longer take for granted. Burdened with a crippling public debt of some €350 billion, Greece’s economy is about to complete a worse-than-expected year. The recession will be deeper and the public deficit larger than the Greek government and its international lenders, the European Union and the International Monetary Fund, had forecast.

The added element to the Greek crisis is that amid this economic maelstrom, the government has to carry out much-delayed structural reforms. One of these is the overhaul of Greece’s health service, where attempts are being made to cut spending and waste. However, this comes at a time when cash-strapped Greeks are relying on free or subsidized medical care in greater numbers. The Health Ministry said earlier this year that the number of patients being treated was up 8 percent this year on 2010. As a result, Zachariadou is one of tens of thousands caught in a fiscal crunch.

Almost 900,000 people—a rate of 17.7 percent—are unemployed in Greece. Like Zachariadou, more than half of these people have been out of work for more than a year, meaning they do not have enough social-security credits to receive subsidized health care. It is not just those out of work who have to pay their medical bills themselves. Checks conducted this year by the Labor Inspectorate found that roughly three in 10 Greeks who are working are uninsured.

The Health Ministry intervened in late November to ensure that pregnant women were not turned away from public hospitals if they could not pay in advance. However, thousands of other Greeks can no longer afford the cost of basic health care and are turning to nongovernmental organizations (NGOs) for assistance. One of these is the Greek branch of Doctors of the World, which normally sends volunteer medics to deprived areas of Africa and Asia but is now concentrating its efforts on treating people in Greece. The group’s president, Nikitas Kanakis, said that last year that Greeks made up 8 percent of the patients his doctors treated at a medical center in Athens. This year they account for about 30 percent.

“Lots more people are being shut out of the national health system because they are unemployed and uninsured and they can’t pay, or because their income has been slashed—as in the case of pensioners—and they don’t have enough money for medication,” he said.

“In some cases, we help people who simply don’t have enough money to pay a doctor to find out what’s wrong with them. We’ve seen a dramatic rise since September as the impact of extra taxes and the recession takes its toll on people’s income. This will get worse when the government moves ahead with its plan to cut health-care benefits and spending on medication.”

Apart from slashing its health-care budget, the government has introduced measures aimed at improving efficiency in the sector, such as better accounting systems for the notoriously lax public hospitals and an electronic prescription scheme designed to reduce waste and fraud.

“There are still a lot of things to do,” admitted Ilias Mossialos, who left his post as professor of health policy at the London School of Economics to serve as government spokesman between June and November this year. “If we were at minus 100 before, we’re at minus 90 now, but we’re on the right track.”

At the end of September, the government increased charges for a range of services at public hospitals, so a natural birth went up from €225 to €872, the cost of a C-section rose by 500 percent to €1,541 and an appendectomy increased by 659 percent to €983. The price hikes caused some doctors to suggest that the public health system was in danger of collapsing because most patients and social insurance funds would be unable to keep up.

Mossialos recognizes the difficulty this will cause some people but argues that it is simply a case of correcting imbalances in the system. “The lower prices were subsidized from the state budget, so what is happening now is an internal shifting of the cost,” he said. “Those insured with social-security funds that subsidized medical care heavily but had low contributions will feel the impact most.”

However, Kanakis points out that attempting to make these huge adjustments in the middle of the country’s worst economic crisis for decades is shifting the burden onto society’s weakest and those who have done no wrong. “One category that is beginning to grow is children who have no health-care coverage,” he said. “Their parents do not have money to pay for their vaccines.”

The NGO chief suggests that the Greek government needs to improve health insurance for the unemployed and cover the cost of medicines for those who can no longer afford them. Otherwise organizations like his will soon be unable to cope with the growing demand for their services.

These developments fill expectant mother Zachariadou with concern about much more than just giving birth. “I now realize that finding the money to cover the cost of giving birth was the easy part,” she said. “The question is how are we going to survive after that? I wonder what kind of protection my child will have after it’s born.”