Nikolaos Polyzos

Public procurement of health technologies in Greece in an era of economic crisis

Public procurement is generally an important sector of the economy and, in most countries, is controlled by the introduction of regulatory and policy mechanisms. In the Greek healthcare sector, recent legislation redefined centralized procurement through the reestablishment of a state Health Procurement Committee (EPY), with an aim to formulate a plan to reduce procurement costs of medical devices and pharmaceuticals, improve payment time, make uniform medical requests, transfer redundant materials from one hospital to another and improve management of expired products. The efforts described in this paper began in early 2010, under the co-ordination of the Ministry of Health (MoH) and with the collaboration of senior staff from the International Monetary Fund (IMF), the European Commission (EC) and the European Central Bank (ECB). The procurement practices and policies set forth by EPY and the first measurable outcomes, in terms of cost savings, resulting from these policies are presented. The importance of these measures is discussed in light of the worst economic crisis faced by Greece since the restoration of democracy in 1974, as a result of both the world financial crisis and uncontrolled government spending.

Restructuring the Finances of the Greek Health Care System in the Era of Economic Crisis

The Greek health system has recently faced problems because of the measures taken to resolve our state fiscal deficit and debt caused mainly by Greece’s conservative administration during 2007–2009 and the world crisis. Financial regulations and structural reforms were needed in many governmental sectors, among them health, under the socialist administration (2010–2011), which made mistakes when planning how to correct the situation. Based on comparisons for the years 2009 and 2011, when efforts had begun to address the situation, there were several obvious improvements. Hospital budgets were found to be 20 % less in 2011 than in 2009 as a result of more efficient financial management (e.g., procurement, logistics, accounting systems, costing, pricing). Before 2009, it had not been fully recognized that prices of medical supplies were overpriced by approximately 20 %. The National Health Service (NHS) witnessed a more than 20 % increase in admissions to its hospitals in 2011 compared with 2009, mainly because patients could no longer afford care from the private sector. According to the Hellenic Statistical Authority, the mortality rate was the same for the two years in question [1]. Furthermore, data envelopment analysis based on the esy.net (web page of the Greek Ministry of Health, or MoH) annual data (2010–2011) showed an increase in hospital efficiency, implying that the crisis has not had a short-term effect on NHS services [2]. It should be noted that the NHS doctors adapted their practices to the above changes. Also, NHS hospitals’ chief executive officers were directed to redistribute resources from noneffective services to others that were more effective in an effort to offer citizens a better quality of service through NHS professionals. In 2010, the MoH reestablished a Health Procurement Committee (EPY) and set up a different system for providing medical supplies. The new system combined the individual annual tenders usually put out by hospitals into a single tender, thereby reducing procurement costs, improving payment time, making uniform medical requests, transferring redundant materials from one hospital to another, and improving management of expired products. Under the new centralized procurement system, a request is initiated at the lowest level of hospital management (e.g., a medical department). The request then goes to the hospital CEO, who sends it to the respective regional health system (DYPE), which conveys the demands of all of the hospitals under its jurisdiction, and sends it to the EPY. The EPY, before organizing the tender, explores the possibility of standardizing similar requests, which could involve going back to each hospital for appropriate alterations. Previously, public hospitals purchased goods directly from suppliers at massively inflated prices through contracts/agreements established after the tenders had gone out. These products included cardiovascular implants (intracoronary prostheses, pacemakers, defibrillators), hemodialysis filters and needles, peritoneal This letter refers to the article available at doi: 10.1007/s00268-011-1228-y

The contribution of generic substitution to rationalizing pharmaceutical expenditure in Greek public hospitals under recent economic crisis

This paper focuses on practices and policies implemented by the Greek Ministry of Health to reduce pharmaceutical expenditure in public hospitals in light of the economic crisis, and presents cost savings resulting from brand–generic substitution.

Do Self-Perceptions of Emotional Intelligence Predict Health-Related Quality of Life? A Case Study in Hospital Managers in Greece

The aim of this study was to examine HRQoL outcome and EI of managers of Health Organizations. We collected data from 120 general managers of Greek public hospitals who completed the Assessing Emotions Scale (AES) and the SF-36 Health Survey. The results showed that male managers generally exhibited better HRQoL and slightly worse EI than females, although differences were not significant throughout. The three EI factors of the AES addressing appraisal, optimism/regulation and utilization of emotions correlated from 0.18 to 0.39 with sub-dimensions of HRQoL mostly related to mental -rather than physical- aspects of health, and were also significant predictors of HRQoL. There was a noteworthy gender difference in the manner in which EI predicted HRQoL and this suggests more testing. Overall, this study might enrich the potential for EI studies in Greece as well as to contribute to the international literature.

The impact of economic crisis on the Greek hospitals' productivity

During the recent economic crisis, Greece implemented a comprehensive reform in the health care system. The 2010 health reform occurred under the constraints imposed by the memorandum of understanding that the Greek Government signed with its EU/International Monetary Fund creditors to control its deficit. The objective of the study is to examine the impact of the reform on the efficiency and productivity of public hospitals in Greece. We use the Malmquist productivity index to comparatively examine the potential changes before and after the reform years. We compare productivity, efficiency, and technological changes using panel data of 111 public acute hospitals operating in Greece throughout the recession period of 2009 to 2012. Bootstrapping methods are applied to allow for uncertainty owing to sampling error and for statistical inference for the Malmquist productivity index and its decompositions. The analysis indicates that the productivity has been increased following the policy changes. It appears that the expected benefits from the reform in general have been achieved, at least in the short-term. This result is examined in the light of management and operations activities, which are related with the reform process. Therefore, at a second stage, the Malmquist index is regressed on variables that may potentially be statistically associated with productivity growth.

Reengineering NHS Hospitals in Greece: Redistribution Leads to Rational Mergers

The purpose of this study was to record and evaluate existing public hospital infrastructure of the National Health System (NHS), in terms of clinics and laboratories, as well as the healthcare workforce in each of these units and in every health region in Greece, in an attempt to optimize the allocation of these resources. An extensive analysis of raw data according to supply and performance indicators was performed to serve as a solid and objective scientific baseline for the proposed reengineering of the Greek public hospitals. Suggestions for “reshuffling” clinics and diagnostic laboratories, and their personnel, were made by using a best versus worst outcome indicator approach at a regional and national level. This study is expected to contribute to the academic debate about the gap between theory and evidence based decision-making in health policy.

Primary Care Doctors’ Assessment of and Preferences on Their Remuneration: Evidence From Greek Public Sector

Despite numerous studies on primary care doctors’ remuneration and their job satisfaction, few of them have quantified their views and preferences on certain types of remuneration. This study aimed at reporting these views and preferences on behalf of Greek doctors employed at public primary care. We applied a 13-item questionnaire to a random sample of 212 doctors at National Health Service health centers and their satellite clinics. The results showed that most doctors deem their salary lower than work produced and lower than that of private sector colleagues. Younger respondents highlighted that salary favors dual employment and claim of informal fees from patients. Older respondents underlined the negative impact of salary on productivity and quality of services. Both incentives to work at border areas and choose general practice were deemed unsatisfactory by the vast majority of doctors. Most participants desire a combination of per capita fee with fee-for-service; however, 3 clusters with distinct preferences were formed: general practitioners (GPs) of higher medical grades, GPs of the lowest medical grade, residents and rural doctors. Across them, a descending tolerance to salary-free schemes was observed. Greek primary care doctors are dissatisfied with the current remuneration scheme, maybe more than in the past, but notably the younger doctors are not intended to leave it. However, Greek policy makers should experiment in capitation for more tolerable to risk GPs and introduce pay-for-performance to achieve enhanced access and quality. These interventions should be combined with others in primary care’s new structure in an effort to converge with international standards.

REEVALUATION OF THE DIAGNOSIS RELATED GROUPS SYSTEM IN GREECE: THE EXAMPLE OF CORONARY ARTERY BYPASS GRAFT PROCEDURE

Background. Aim of the current prospective study is to investigate and revise the basic information related to the coronary artery bypass graft (CABG) procedure, in an attempt to reevaluate the current Greek Diagnosis Related Groups (DRGs) system. Methods. In a Greek academic cardiothoracic surgical department, implementing clinical therapeutic protocols, we prospectively recruited 75 patients planned to undergo elective CABG. All basic demographic, medical and perioperative data were gathered in an extensive database, so as to be compared with data predicted by the DRG’s system. Clinical indicators of performance aiming towards quality control were: perioperative mortality, postoperative myocardial infarct, postoperative stroke, postoperative renal failure, total hospital length of stay, rate of reoperation and rate of readmission. Results. None of the study patients deceased. No cases of perioperative myocardial infarct, stroke or renal failure were observed. Two of the patients developed respiratory failure, and one was reoperated for the control of perioperative bleeding. There were no cases of readmission to the hospital. The total length of stay was longer than the DRG’s prediction (mean 11.5 vs 7 days), owed partially to the preoperative stay (mean 3.18 days) in the department, due to reasons of medical vigilance and organisatory problems that led to the postponement of the operation. Conclusions. A review of the CABG related DRG’s in Greece seems appropriate, based on the findings of the current study, suggesting a longer than predicted hospital stay.

ABC analysis: a tool of effectively controlling pharmaceutical expenditure in Greek NHS hospitals

The technical cost analysis, in order to highlight expensive medicines, is an important factor in the administration of health units. The purpose of the study is to analyse the annual pharmaceutical expenditures in NHS hospitals and to investigate the therapeutic categories requiring greater supervisory, for years 2013–2014.