Daphne Kaitelidou

Informal payments for maternity health services in public hospitals in Greece.

BACKGROUND Private health expenditure for consuming maternity health services has been identified as an issue within public hospitals. AIM To estimate level of private health expenditure, in the form of informal payments, for maternal services in public hospitals in Greece. METHODS The study population consisted of 160 women who had recently given birth in three provincial general hospitals and one general hospital in Athens. A three-part questionnaire was developed in order to collect financial information regarding the use of public obstetrics services in Greece. RESULTS The mean age of respondents was 29.5 (±5.6) years. There was a high rate of informal payments with 74.4% of women involved in informal transactions. Mean total private payments were €1549 (±992), representing 7.9% of the mean annual per capita income in Greece. Mean informal payment was €848 (±714). For 56.3% of the respondents, it was at the obstetricians request, on top of formal payment of €701 (±1351). Total informal payments were higher for women who gave birth in Athens (p<0.001), for Greek women compared to non Greek (p<0.001) and for deliveries that were conducted by womens personal obstetrician (p=0.001). CONCLUSION There is a large black economy in the field of obstetric services, as 74.4% of women who used public maternity services had to pay under-the-table payments corresponding approximately to the net salary of an intern physician. There is a need for the state to adopt innovative strategies and mechanisms in order to reduce informal payments for obstetric services in the public sector.

Economic evaluation of hemodialysis: Implications for technology assessment in Greece

OBJECTIVES Hemodialysis is a well-established treatment for 74 percent of end-stage renal disease (ESRD) patients in Greece. The purpose of this study is to provide an estimate of the direct cost of dialysis in a public hospital setting and an estimate of the loss of production for ESRD patients. The results will be useful for public health facility planning purposes. METHODS A socioeconomic prevalence-based analysis was performed using micro-economic evaluation of health-care resources consumed to provide hemodialysis for ESRD patients in 2000. Lost productivity costs due to illness were estimated for the patient and family using the human capital approach and the friction method. Indirect morbidity costs due to absence from work and long-term were estimated, as well as mortality costs. Mean gross income was used for both patient and family. RESULTS Total health-sector cost for hemodialysis in Greece exceeds 171 million Euros, or 182 Euros per session and 229 Euros per inpatient day. There were 2,046 years lost due to mortality, and the potential productivity cost was estimated at 9.9 million Euros, according to the human capital approach, and 303.000 Euros, according to the friction method. Total morbidity cost due to absence from work and early retirement was estimated at more than 273 million Euros, according to the human capital approach, and 12.5 Euros, according to the friction method. CONCLUSIONS Providing hemodialysis care for 0.05 percent of the population suffering from ESRD absorbs approximately 2 percent of total health expenditure in Greece. In addition to the cost for the National Health System, production loss due to mortality and morbidity from the disease are also considerable. Promoting alternative technologies such as organ transplantation and home dialysis as well as improving hemodialysis efficiency through satellite units are strategies that may prove more cost-effective and psychologically advantageous for the patients.

Conflict management in public hospitals: the Cyprus case

BACKGROUND Conflict among health-care personnel has been identified as an issue within health-care settings around the world. AIM To investigate the existence and management of conflict among health-care personnel in public hospitals in Cyprus; to assess the factors leading to conflict among staff members; to evaluate the consequences of conflict arising; and to consider the management strategies. METHODS A self-administered questionnaire was completed by a random sample of 1037 health-care professionals in all (seven) state-run hospitals in Cyprus in 2008. RESULTS Mean age of respondents was 41 years, and 75% were female. Sixty-four per cent of respondents reported that they had never been informed about conflict management strategies, with physicians being the least informed as the relative percentage was 79.8% (χ(2) = 33, P < 0.001). Sixty per cent of health-care professionals reported conflict at work with other health-care personnel one to five times per week, and 37% of the respondents stated that they devote 90 min (mean value) from work during their shift in conflict resolution, meaning that managing conflicts may absorb 19% of working time daily. The majority of respondents agreed that organizational problems and communication gaps were the main issues creating conflict. Avoidance and collaboration were the preferable strategies for conflict resolution, used by 36.6% and 37.5% of the respondents, respectively. CONCLUSION   Better communication, fair management practices and clear job descriptions and expectations may be needed in order to facilitate change and reverse the negative atmosphere that exists. Further education in conflict management for physicians, nurses and their managers may also be needed.

Public health services knowledge and utilization among immigrants in Greece: a cross-sectional study

BackgroundDuring the 90s, Greece has been transformed to a host country for immigrants mostly from the Balkans and Eastern European Countries, who currently constitute approximately 9% of the total population. Despite the increasing number of the immigrants, little is known about their health status and their accessibility to healthcare services. This study aimed to explore the perceived barriers to access and utilization of healthcare services by immigrants in Greece.MethodsA pilot cross-sectional study was conducted from January to April 2012 in Athens, Greece. The study population consisted of 191 immigrants who were living in Greece for less than 10 years. We developed a questionnaire that included information about sociodemographic characteristics, health status, public health services knowledge and utilization and difficulties in health services access. Statistical analysis included Pearson’s ×2 test, ×2 test for trend, Student’s t-test, analysis of variance and Pearson’s correlation coefficient.ResultsOnly 20.4% of the participants reported that they had a good/very good degree of knowledge about public health services in Greece. A considerable percentage (62.3%) of the participants needed at least once to use health services but they could not afford it, during the last year, while 49.7% used public health services in the last 12 months in Greece. Among the most important problems were long waiting times in hospitals, difficulties in communication with health professionals and high cost of health care. Increased ability to speak Greek was associated with increased health services knowledge (p<0.001). Increased family monthly income was also associated with less difficulties in accessing health services (p<0.001).ConclusionsThe empowerment and facilitation of health care access for immigrants in Greece is necessary. Depending on the needs of the migrant population, simple measures such as comprehensive information regarding the available health services and the terms for accessibility is an important step towards enabling better access to needed services.

Changing the public-private mix: an assessment of the health reforms in Greece.

The 1983 health reform in Greece was a major political event in the social policy agenda. The main objective of the reform was the institution of a National Health System and the expansion of the health sector, improved equity, and the assumption of full responsibility for health services delivery by the state. An assessment of the results 10 years after full implementation of the reform shows that despite the expansion of the public sector, the public-private mix in financing and delivery has changed in favour of the private sector, making the Greek health system the most ‘privatised’ among the EU countries. The main reasons why the health reform failed to meet its objectives was the restrictive enforcement of full-time and exclusive hospital employment for doctors, the virtual ban on private hospital expansion, the much faster introduction and diffusion of new health technology by the private sector, and poor management, planning and control in the public sector. A new health reform voted into law in the summer of 1997 shows promise of redressing some of the shortcomings of the 1983 reform.

Conflict management and job satisfaction in paediatric hospitals in Greece

AIM To assess the major causes of conflict and to identify choices of strategy in handling conflicts. BACKGROUND Conflict is inherent to hospitals as in all complex organizations, and health personnel deal with internal and external conflicts daily. METHODS The sample consisted of 286 participants. A five-part questionnaire, specific for conflicts in hospitals, was administered to health personnel. RESULTS Of the participants 37% were physicians and 63% were nurses and nursing assistants. As far as choice of strategy in conflict management is concerned, avoidance was found to be the most frequent mode chosen while accommodation was the least frequent mode. Organizational problems were the main issue creating conflicts since 52% of nurses and 45% of physicians agreed that receiving direction from more than one manager may lead to conflicts (P=0.02). Educational differences and communication gaps were reported as another cause of conflicts, with nurses supporting this statement more than the other groups (P=0.006). CONCLUSION To become effective in conflict management nurses and physicians must understand causes and strategies in handling conflicts. IMPLICATIONS FOR NURSING MANAGEMENT Major changes are needed regarding human resource management, work incentives and dynamics of teamwork in order to improve working conditions in Greek public hospitals.

Health technology assessment in Greece.

In 1983 a health reform aimed to assure universal coverage and equity in the distribution of services in Greece. The reform implied state responsibility for the financing and delivery of services and a reduction of the private sector. The model was a Bismarckian scheme for social insurance. However, healthcare delivery remains fragmented and uncoordinated and the private sector is getting stronger. The dominant payment system is fee-for-service for the private sector and administered prices and salaries for public hospitals and social insurance funds. The many insurers have their own eligibility requirements, validation procedures, etc. Coverage of services by social security funds, probably among the most comprehensive in Europe, is determined more on historical and political grounds than on efficiency or cost-effectiveness. The system is plagued by problems, including geographical inequalities, overcentralization, bureaucratic management, poor incentives in the public sector, open-ended financing, inefficient use of hospital beds, and lack of cost-effectiveness. There are no specific legal provisions for the control of health technology. Technologies are introduced without standards or formal consideration of needs. There are no current efforts to control health technology in Greece. However, health technology assessment (HTA) has gained increasing visibility. In 1997 a law provided for a new government agency responsible for quality control, economic evaluation of health services, and HTA. The hope is that the new law may introduce evaluation and assessment elements into health policy formulation and assure that cost effectiveness, quality, and appropriate use of health technology will receive more attention.

The accessibility of vulnerable groups to health services in Greece: a Delphi study on the perceptions of health professionals.

BACKGROUND Problems of accessibility to healthcare services notably affect certain population groups such as poor and unemployed people, migrants and minorities, thus having a negative impact on their health. The aim of this study was to investigate these problems from the perspective of health professionals and to formulate empirically informed suggestions to solve the issue. METHODS Primary data were collected in 2010-2011 by using a panel of 36 experienced health professionals around Greece. A two-round Delphi method was undertaken to achieve the objectives of the study. The first questionnaire investigated the factors that hinder accessibility to health services. The second round aimed at determining the relative importance of each of the factors emerging in the first round. RESULTS The group of experts identified 345 factors in the first round, which were grouped in 55 statements. Consensus was achieved in 22 statements. The study revealed important issues, and health professionals proposed a number of actions to eliminate the accessibility problems. CONCLUSIONS The use of medical interpreters and cultural mediators, transcultural education and stronger linkages among medical facilities are important to reduce accessibility problems. Restructuring primary healthcare and better documenting of the beneficiaries could also improve the quality of provided healthcare services.

Health technology assessment in the area of prevention: selected screening cases in Greece.

OBJECTIVE To explore the impact of health technology assessment (HTA) on health policy and practice in Greece through selected screening case studies in the prevention area. The three cases studied were mammography screening, PSA screening, and routine ultrasonography in normal pregnancy. METHODS Official policy recommendations or reports, a literature review of Greek published research as well as gray literature from various sources, and interviews with specialists and medical associations were performed, and their impact on health policy formulation was examined. RESULTS The implementation of the screening tests does not take the form of structured mass screening programs. Almost all physicians (urologists-pathologists, gynecologists) apply PSA and routine ultrasonography in normal pregnancy respectively with the purpose of either prevention or diagnosis. Mammography is applied generally for prevention or diagnosis, but there are some mass screening programs at a local level. In addition, the results show no evidence that the efficacy and the cost-effectiveness of the three screening programs have been a matter of serious concern and investigation for the purposes of policy formulation in Greece. CONCLUSION The results point to a need for the implementation of HTA methods on mass screening preventive programs in which real value and cost remain unclear and whose use is based on empirical and personal assessments.

The cost of home care for patients with malignant neoplasms.

A microeconomic study evaluated the health sector cost of home care in Greece for patients with malignant neoplasms. A cost-identification analysis was performed from the home care services perspective. According to the results of the study, the cost varies among the main categories of malignant neoplasms because of a fluctuation in the cost of drugs, whereas the main cost-driver factor is the cost of laboratory tests. In comparison with the corresponding cost of in-hospital care, the cost of home care for patients with malignant neoplasms is significantly lower, which also is confirmed by the results of other international studies.