National health policy in Greece : regulations or reforms? The Sisyphus myth

This paper attempts an evaluation of health care reforms and regulations in Greece. The main findings indicate that the existing Conservative Government has kept but not developed some previous Social-democrats’ major reforms concerning decentralisation and hospital management arrangements. The government also announced new regulations concerning the pharmaceutical sector and the procurement procedures of the national health units. On the other hand, precedent regulations for primary health care were to be postponed and the fundamental financing issue of the system has been neglected. In addition, this paper intends to take parallel account that terms such as globalisation and enlargement are still within the European perspective of the country. Overall, the Greek NHS seems to be developed and enlarged, besides the lack of strong political will to consider reforms and even regulations, into a continuous managerial process, assessment and public dialogue. In this sense, there is a continuing gap between - on the one hand - principles and goals and - on the other hand - rational planning, political issues and implementation process, all resulting in a never-ending reform scenario.peer-reviewe

Estimating the effort in the early stages of software development.

Estimates of the costs involved in the development of a software product and the likely risk are two of the main components associated with the evaluation of software projects and their approval for development. They are essential before the development starts, since the investment early in software development determines the overall cost of the system. When making these estimates, however, the unknown obscures the known and high uncertainty is embedded in the process. This is the essence of the estimator's dilemma and the concerns of this thesis. This thesis offers an Effort Estimation Model (EEM), a support system to assist the process of project evaluation early in the development, when the project is about to start. The estimates are based on preliminary data and on the judgement of the estimators. They are developed for the early stages of software building in which the requirements are defined and the gross design of the software product is specified. From these estimates only coarse estimates of the total development effort are feasible. These coarse estimates are updated when uncertainty is reduced. The basic element common to all frameworks for software building is the activity. Thus the EEM uses a knowledge-base which includes decomposition of the software development process into the activity level. Components which contribute to the effort associated with the activities implemented early in the development process are identified. They are the size metrics used by the EEM. The data incorporated in the knowledge-base for each activity, and the rules for the assessment of the complexity and risk perceived in the development, allow the estimation process to take place. They form the infrastructure for a 'process model' for effort estimating. The process of estimating the effort and of developing the software are linked. Assumptions taken throughout the process are recorded and assist in understanding deviations between estimates and actual effort and enable the incorporation of a feedback mechanism into the process of software development. These estimates support the decision process associated with the overall management of software development, they facilitate management involvement and are thus considered as critical success factors for the management of software projects

Information society and the state: the Greek version of the information society paradigm

The concept of the 'information society' has been systematically deployed to denote a new techno-socio-economic paradigm with information and communication technologies (ICTs) at the centre, which entails significant economic and social transformations and bears implications for governance and potential for development and quality of life. Departing from the deterministic view of information society as a set of uniform societal arrangements, the thesis examines its national variations, as they emerge from the interaction between ICTs and relevant policies with pre-existing social, political and economic realities. Drawing on a conceptual framework based on political economy and historical sociology, it proposes that the unfolding of any national information society is a contested process feeding on the historically formed relationship between the state and the national economy and society. This relationship is expected to inflect international policies and processes in quite idiosyncratic ways, leading to differentiated national information society trajectories, while the state is instrumental in articulating international policy directions with national societal arrangements. Identifying an empirical gap in the examination and analysis in semi-peripheral and middle-income countries, the thesis seeks to address evolving characteristics and dimensions of the 'Greek case' of information society, stressing the dialectic between European policy and the national socio-cultural, political and economic idiosyncrasies, the role of the Greek state, as well as the weaknesses encountered in the process. The emphasis is on the period 1998-2008, which includes the first comprehensive strategy and provides the opportunity to analyse preliminary results of the policies adopted. The empirical material includes relevant policy documents, quantitative indicators, personal observations, as well as a set of elite interviews with policymakers, ICT industry representatives and other actors involved in information society policies and processes

The meaning of ethics and ethical dilemmas in social work practice: A qualitative study of Greek social workers

This thesis was submitted for the degree of Master of Philosophy and awarded by Brunel University.Social work struggles between the dichotomy of “individual” and “society” as it is characterized as enhancing both individual well-being and social justice. As these are not always easily balanced and social work has limited autonomy, social workers must develop their capacity for making moral judgments and defend these within their various roles and responsibilities. Studies which explore the role of ethics in social work practice enhance the potential for maintaining a common identity. This exploration permits a deeper understanding of social work ethics and reinforces a common framework inclusive of purpose and standards for the profession. These studies also capture the contextual factors impacting on the moral agency of social workers, and thus substantiate the role for social work in a world with structured oppression. The purpose of this study was to obtain an in-depth understanding of social work ethics in the practice context of public hospitals in Greece. Using a case study design, data was gathered to explore and understand the role of social work ethics in daily practice and the formation of what is perceived as “good” practice. The analysis followed Yin‟s (1993) descriptive strategy. Data collection included fifteen in-depth interviews with hospital social workers, a group interview with social work academics, and a thematic analysis of the social work journal of the Hellenic Association of Social Workers (HASW). The meaning of ethical dilemmas and problems appeared to be constructed by personally held values, a lack of attention in social work education and the HASW on social work ethics, a professional emphasis on individualism rather than collectivism, and insufficient social protection in Greece. Importantly, these factors led to a fairly consistent response to ethical problems. “Having a clear conscience”, character traits such as bravery and imaginativeness, as well as the use of psychotherapy emerged as characteristics of “good” social work practice. These findings are of value to those who try to restore the values and ethics as central in social work. Values and ethics as key elements of social work expertise can lead social workers to a more competent and effective practice in terms of their ethical engagements

An investigation into the possibility of using sociological research methodologies for the elicitation of tacit knowledge for building knowledge intensive systems

The research notes that deficiencies in knowledge acquisition are impeding theadvancement of Knowledge Intensive Systems (KIS), such as Expert Systems (ES)and Decision Support Systems (DSS). Humphreys (1989) maintains the problem isnot the quantity of knowledge collected but its quality. Humphreys (1989) contendsthat 'Knowledge' has too narrow a definition in knowledge acquisition dogma and awider definition of 'knowledge' capable of handling 'procedural uncertainty' isrequired.'Tacit knowledge' by which Polanyi (1967) contends individuals interpret the worldappears a fruitful area to widen the definition of knowledge. The subjective natureof tacit knowledge makes its explication problematic, however, it is noted that tacitknowledge has a social aspect (interiorization) which appears amenable to sociologicalinvestigation.On the basis of the above it seemed prudent to focus the investigation down to thefollowing research question,'On the basis of its nature, is there a method whereby at least sometacit knowledge can be explicated for.a) building the knowledge base;b) more accurately predicting or planing for its usage and forsetting expectations.'To test the thesis, a pilot investigation was undertaken at a local Housing Associationin order to gain first hand experience of knowledge acquisition. Examples of howexperts tacitally classify their domain were identified and methods of explicating this knowledge were tentatively formulated.The above resulted in the formulation of a new perspective: traditionally KBS hasconcerned itself with eliciting knowledge to be embodied in the knowledge base,whereas, IS has concerned itself in gaining the knowledge involved in the systemsuse/interpretation.Fieldwork was later conducted in the maternity units of two local hospitals in orderto test the generalizability of these methods.Five methods for the explication of tacit knowledge were identified.1) The analysis of the reification of existing systems and the rationality internalto these systems, can be used to explicate tacit knowledge.2) More than one set of tacit knowledge can be present in one domain. Pointswhere two sets of tacit knowledge interact expose contradictions which can beused as a tool to explicate the tacit knowledge of both groups.3) The analysis of anecdotes revealed how domains were tacitally delimited andthe 'criticality' of tasks within a domain.4) Action research using a 'mock up' data base revealed tacitally held domainknowledge with implications for micro level criticality, of particularimportance to interface design.5) The thesis identified knowledge acquisition as a method of sociologicalinvestigation

Inequalities and Inequity in utilisation of health care among the older people in Greece

Thirty years have passed and five major reforms have followed since the establishment of the Greek National Health System (NHS) in 1983 on universal coverage as an elementary policy goal, and the Greek NHS is still insufficient with regard to organisation, coverage, funding and delivering health services. The primary objective of the thesis is to employ quantitative empirical methods to explore some key aspects of equity in the receipt of health care in Greece among the older population via two nationwide and one urban setting datasets. This thesis comprises three essays which shed light on the equity issue before and after NHS major reforms of 2001-4 and 2005-7. The findings of this thesis suggest that inequalities in health care exist mainly for the probability of specialist and dentist private visits. Income- related inequalities are less apparent in probability of inpatient admissions and probability of outpatient visits, favoring the less advantaged. Income itself is not the only contributor. The findings indicate intra and interregional inequalities in most of health care services use except for probability of GP visits, favoring residents of thinly-populated areas. Compared to Athens region, regional disparities-inequalities are not apparent for inpatient care, as well. Furthermore, the findings suggest that even though we signify territorial disparities in the probability of specialist visit favoring the better off, once the positive contacts of specialist visits are included, the elderly have equal probability to make a specialist private visit, irrespective of their income and their region of residence. In addition, this thesis finds that inequalities are apparent among the Social health insurance funds (SHIFs) in use of most health care types, except the probability of inpatient admissions. Non Noble Farmers OGA SHIF - who tends to be less advantaged - has a more pronounced pro poor contribution to overall inequity in the probability of specialist private visit than the Noble SHIFs, revealing an unfair relationship. This thesis also finds that OOP expenses constitute a significant financial burden to inpatient and outpatient care. There is a regressive trend in OOP amount for inpatient admission in terms of ability to pay and region of residence favoring residents of thinly-populated areas and Central Greece region- who tend to be less advantaged. For outpatient care, there is a progressive trend in OOP amount in terms of ability to pay, SHIF coverage and region of residence. The thesis provides useful tools for understanding and measuring inequalities in the use of health care among the older population, who are the most constant consumers of health services. It urges policy makers to review the governance of primary health care by setting conditions and implements measures for improving efficiency, unifying SHIFunds, eliminating geographical inequalities and control the role of OOP expenses as significant barriers to access health care, especially during the current period of economic crisis

Developing and running expert systems with PESYS

Recently there has been a growing interest in developing expert system shells that provide a user-friendly interface for the development of expert systems. In this paper we describe PESYS (Pascal Expert SYstem Shell) which is a software tool that enables the user to express his/her knowledge in natural language. In order for PESYS to ‘understand’ the natural language formalisms ‘commonsense’ knowledge is required and a method has been developed which obtains the basic meaning from sentences. We present this method and also how it is accomplished by PESYS