Lycurgus Liaropoulos

The socioeconomic impact of musculoskeletal infections.

Musculoskeletal disorders are a leading cause of severe chronic pain and physical disability for millions of people around the globe. It is anticipated that their prevalence will increase dramatically in the future because of extended life expectancies and lifestyle changes toward more mobility and recreation1. Epidemiologic studies have linked population aging with future increases in the prevalence of age-related musculoskeletal conditions, such as fragility fractures and osteoarthritis2-8. The number of primary and revision total hip and total knee arthroplasties has increased steadily between 1990 and 2002, and these numbers are anticipated to further escalate over the next two decades9,10. The rate of deep infection following total hip arthroplasty and total knee arthroplasty has been reported to range between 1% and 4%11, and the rate of deep infection as a reason for revision is projected to increase at a faster rate for total knee arthroplasty than for total hip arthroplasty. Kurtz et al. used the U.S. Nationwide Inpatient Sample (1990-2003) to demonstrate that the number of infections after revision total hip arthroplasty is projected to increase from 3400 in 2005 to 46,000 in 2030, while infections after revision total knee arthroplasty are projected to increase from 6400 in 2005 to 175,500 in 203012. Infections with resistant pathogens, such as the community-acquired and the health-care-acquired methicillin-resistant Staphylococcus aureus, have become increasingly common over the past two decades13. Soft-tissue infections such as cellulitis, abscesses, and pyomyositis from community-acquired methicillin-resistant Staphylococcus aureus occur with increasing frequency in athletes, especially in those engaged in team sports14-16. Health-care-acquired methicillin-resistant Staphylococcus aureus generally affects acutely and chronically ill patients with central lines, indwelling catheters, and internal fixation devices, causing septic arthritis, osteomyelitis, and bacteremia17. In …

Public/private financing in the Greek health care system: implications for equity

The 1983 health reforms in Greece were indirectly aimed at increasing equity in financing through expansion of the role of the public sector and restriction of the private sector. However, the rigid application of certain measures, the failure to change health care financing mechanisms, as well as growing dissatisfaction with publicly provided services actually increased the private share of health care financing relative to that of the public share. The greatest portion of this increase involved out-of-pocket payments, which constitute the most regressive form of financing, and hence resulted in reduced equity. The growing share of private insurance financing, though as yet quite small, has also contributed to reducing equity. Within public funding, while a small shift has occurred in favor of tax financing, it is questionable whether this has contributed to increased equity in view of widespread tax evasion. On balance, it is most unlikely that the 1983 health care reforms have led to increased equity; it is rather more likely that the system in operation today is more inequitable from the point of view of financing than the highly inequitable system that was in place in the early 1980s.

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.

HEALTH TECHNOLOGY ASSESSMENT IN POLICY AND PRACTICE: Working Group 6 Report

According to the HTA-Europe report, health technology assessment (HTA) has the potential to influence health policy in the fields of research and development, regulation of pharmaceuticals, devices, and services, quality assurance, reimbursement, education and training of healthcare providers, and consumer education (1). To identify and bridge the gaps between HTA production and implementation, the goal of Working Group 6 was to approach the use of HTA in policy and practice on the aggregate policy level as well as in the local context, such as in hospitals. Members of Working Group 6 included both users (e.g., members of decision-making bodies) and producers (e.g., members of HTA agencies) of HTA reports. The aim of the working group was to identify three types of information on HTA implementation and impact. These included identifying successful examples of the implementation of HTA results, examples of structures that require HTA information as part of the decision-making process, and finally, identifying groups and persons who use HTA frequently and are willing to share their experiences with other HTA users and producers.

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.

Health services financing in Greece: a role for private health insurance

Private health insurance can play a significant role in the financing and delivery of health services in relatively undeveloped health systems which suffer from limited public expenditures, resource shortages, and quality of care problems. Research results, however, indicate that private health insurance in Greece has not yet assumed that role. The rapid increase of private health insurance was the result of underfinancing by the public sector and restrictive policies for the private sector. The private sector, however, largely financed by private health insurance, found alternative investment and profit opportunities, which, unfortunately, did not improve health system microeconomic efficiency. In this paper we propose that a way of cooperation could exist between the public sector and private health insurance, which would improve public health services provision and the overall technical, allocative and dynamic efficiency of the health system.

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.

A Multinational Study to Measure the Value that Patients with Cancer Place on Improved Emesis Control Following Cisplatin Chemotherapy

AbstractBackground: The neurokinin-1 (NK1) receptor antagonists are a new class of agents designed to reduce the risk of emesis following chemotherapy, particularly with cisplatin. Early data from double-blind randomised trials suggest that an orally administered NK1 antagonist can reduce the absolute risk of acute and delayed emesis following cisplatin by 20 and 30%, respectively. Objective: To measure the value that patients with cancer place on improved emesis control and quality of life. Design: Willingness-to-pay analysis. Setting: Five study sites in Canada, Italy, Spain and Greece. Patients and participants: 245 patients with cancer either receiving chemotherapy with cisplatin or who had received cisplatin-based chemotherapy within the previous 6 months. Methods: After background information had been presented, patientswere asked to define the maximum that they would pay per day for a drug that reduced their risk of acute and delayed (days 2 to 5) emesis by 20 and 30%, respectively. Costs were converted to US dollars (

Health technology assessment in Greece.

US) using year 2000 exchange rates. Results: For a 20% improvement in acute emesis, Canadian, Italian and Spanish patients with cancer were willing to pay

Economic Evaluation of Nimesulide Versus Diclofenac in the Treatment of Osteoarthritis in Greece

US46,