Elephtheria Theohari, 62, who is unemployed, waits for treatment in an orthopedic surgeon’s office in Helliniko. Fueled by massive unemployment, a five-year recession and deep budget cuts, the number of uninsured in the country has soared from fewer than 500,000 in 2008 to at least 2.3 million — or almost one in five Greeks — today.

Jan. 29, 2014 Elephtheria Theohari, 62, who is unemployed, waits for treatment in an orthopedic surgeon’s office in Helliniko. Fueled by massive unemployment, a five-year recession and deep budget cuts, the number of uninsured in the country has soared from fewer than 500,000 in 2008 to at least 2.3 million — or almost one in five Greeks — today. Yannis Kolesidis/For The Washington Post

Debt-laden European nations such as Greece are drifting away from a privileged era in public health. Greece offers state-subsidized insurance for the equivalent of several hundred dollars per month. But an unemployment rate that tops 27 percent has left hundreds of thousands without the means to pay. At the same time, eligibility for free indigent care has been tightened, while co-payments for those with insurance have increased.

President Obama’s health-care plan is, in fits and starts, attempting to extend coverage to millions of uninsured Americans. But here at the epicenter of Europe’s economic crisis, Nikos Solomos is the face of a continent where debt-laden nations are drifting away from a privileged era in public health.

Like most Greeks, Solomos, 60, and his wife, Amalia, 52, paid into a state insurance fund for years, granting them access to medical care for little or no cost. After their pickle business went bankrupt, they could not afford their premiums and descended into the cascading ranks of the uninsured. Fueled by massive unemployment, a five-year recession and deep budget cuts, the number of uninsured has soared from less than 500,000 in 2008 to at least 2.3 million — or almost one in five Greeks — today.

Then, after a lifetime of good health, came bad news. In 2011, Nikos was diagnosed with intestinal cancer, and the Solomoses sold off farm equipment and property to cover medical costs that quickly raced above $68,000. Last week, his situation went from bad to worse: A private doctor charged him $204 to read his medical tests and explain that the cancer had metastasized to his liver.

Steadying himself with a strong coffee at an Athens cafe shortly after receiving the diagnosis, the elegant man with perfectly combed salt-and-pepper hair looked tired and held his wife’s hand. Her eyes were red from crying. The cancer, he said, was beatable. But the bills weren’t.

“The operation alone is 12,000 euros ($16,200),” he said. “We just don’t have it. It’s funny. I saw President Obama on television the other day, talking about how the United States, a country known for being cold to its citizens, was trying to help the uninsured. Here, we have the opposite. The state used to take care of you. But if you are sick in Greece now, you have an expiration date.”

Europe, economists say, is turning a corner. After a four-year debt crisis that left a large swath of the region on financial life support, there are finally signs of a pulse in even some of the region’s most moribund economies.

But a look across the still-bleak landscape, from Greece to Spain, Ireland to Portugal, suggests a painful aftermath, where the plight of millions of Europeans is worsening even as the financial crisis passes. One of the biggest problems now is in an area that Europeans have long prided themselves: public health.

While core nations such as France and Germany are resisting higher co-payments or cuts in state-funded health care, public health is being hit in the most troubled corners of the European Union.

In Spain, the government has suspended free care for illegal immigrants, begun charging seniors for a portion of their prescriptions, cut aid to the mentally ill and moved to raise co-payments for medications, prosthetics and some emergency services. In Ireland, state assistance to the disabled has been slashed, and new rounds of cuts this year will remove some medications from the list of drugs covered by public health care while new reviews are being launched to determine whether those receiving free care are truly eligible.

Nowhere, however, has the impact been as dramatic as in Greece. Bloated, inefficient and plagued by corruption, the massive public-health system became a top target for cuts, with total health spending slashed by more than 25 percent since 2009, and more cuts are on the way this year.

Critics say those cuts have been made with an ax instead of a scalpel, leading to shortages and gaps in care at public hospitals and a growing crisis of the uninsured.

Stung by cutbacks in needle-

exchange programs for intra­venous drug users, HIV rates have soared, Greek health officials say, forcing the government to relaunch moth-balled programs last year.

Doctors, meanwhile, say worsening living conditions and limited access to primary care for hundreds of thousands of people have led to a resurgence of tuberculosis. Last week, Greek doctors took to the streets of Athens to protest changes that would allow public hospitals to fire physicians who also have private practices. As the government struggles to meet budget targets, at least 8,000 ­public-health workers are set to be furloughed, with a significant number likely to face layoffs.

At Gennimatas General Hospital, one of Athens’s largest, attending physician Elena Karabatzaki said that the hospital can’t afford to repair broken medical equipment, forcing patients to wait a week or more for procedures such as MRIs and CAT scans. The hospital is facing periodic shortages of antibiotics and other medications. Meanwhile, emergency care is under strain from a deluge of uninsured patients with minor problems using the hospital for primary care — as well as patients who have waited too long to seek medical assistance and are now arriving in acute condition.

A four-year hiring freeze for doctors and nurses has left the hospital desperately short-staffed. “For things like feeding and bathing patients, we now depend on relatives,” she said.

Last week, Angeliki Pogrotopoulos, 72, was racing up and down the halls at Gennimatas as she cared for her 92-year old sister, Alexandra Stathakou, who had had a stroke. To cover for staff shortages, she has been feeding and bathing Stathakou, as well as buying adult diapers for her at a pharmacy since the hospital has run out. She also pays $68 per shift for a private nursing assistant to watch over her sister at night.

“It’s a disaster,” Pogrotopoulos said. “The hospital staff is wonderful, but there are too few of them now and too many shortages.”

A strain on clinics

The biggest challenge is a massive increase in the uninsured.

Greece offers state-subsidized insurance for the equivalent of several hundred dollars per month. But an unemployment rate that tops 27 percent has left hundreds of thousands without the means to pay. At the same time, eligibility for free indigent care has been tightened, while co-payments for those with insurance have increased.

Many of the sick and uninsured rely on free clinics such as the Metropolitan Community Center, operating in a former barracks of an abandoned U.S. military base in South Athens. On a recent afternoon, volunteer cardiologists, gynecologists and other specialists took shifts seeing uninsured patients. At 5 p.m. every weekday, aides dole out donated prescription drugs, offering free insulin for diabetics, pills for heart patients and antibiotics for ill babies.

Doctors are also acting as advocates for the uninsured. George Vihas, one of the clinic’s founders, said that staff had to intervene last week on behalf of an uninsured woman who had given birth and whose hospital had refused to release her newborn until payment was made. The clinic is also attempting to secure free or discounted medication and treatments for uninsured cancer patients on a case-by-case basis.

“But it doesn’t always work,” he said. “Sometimes, they come to us in poor condition because they’ve been unable to see a doctor, and even then it takes time to find a solution. We’ve lost dozens of patients who could have — who should have — been helped.”

Greek Health Minister Adonis Georgiadis said that the government is attempting to aid the uninsured, creating a $17.6 million fund for the most acute cases, using money seized in a crackdown on tax evasion. He hopes the fund will be dramatically boosted by the end of the year.

But Greeks, he said, must also understand that the public-heath system was broken before the crisis by years by mismanagement and corruption. The state was sometimes paying three to four times more than other European countries for certain prescription drugs, with middle men, doctors and pharmacies pocketing the difference. If hospitals are facing shortages, he said, it is because they are having a hard time adhering to more reasonable budgets.

Georgiadis said that emergency cases are still being treated at public hospitals irrespective of insurance status. “But,” he said, “illnesses like cancer are not considered urgent, unless you are in the final stages.”

That is exactly what troubles Solomos, the uninsured cancer patient.

“What am I supposed to do?” he said.

Elinda Labropoulou contributed to this report.