The costs in provision of haemodialysis in a developing country: A multi-centered study

<p>Abstract</p> <p>Background</p> <p>Chronic Kidney Disease is a major public health problem worldwide with enormous cost burdens on health care systems in developing countries. We aimed to provide a detailed analysis of the processes and costs of haemodialysis in Sri Lanka and provide a framework for modeling similar financial audits.</p> <p>Methods</p> <p>This prospective study was conducted at haemodialysis units of three public and two private hospitals in Sri Lanka for two months in June and July 2010. Cost of drugs and consumables for the three public hospitals were obtained from the price list issued by the Medical Supplies Division of the Department of Health Services, while for the two private hospitals they were obtained from financial departments of the respective hospitals. Staff wages were obtained from the hospital chief accountant/chief financial officers. The cost of electricity and water per month was calculated directly with the assistance of expert engineers. An apportion was done from the total hospital costs of administration, cleaning services, security, waste disposal and, laundry and sterilization for each unit.</p> <p>Results</p> <p>The total number of dialysis sessions (hours) at the five hospitals for June and July were 3341 (12959) and 3386 (13301) respectively. Drug and consumables costs accounted for 70.4-84.9% of the total costs, followed by the wages of the nursing staff at each unit (7.8-19.7%). The mean cost of a dialysis session in Sri Lanka was LKR 6,377 (US$56). The annual cost of haemodialysis for a patient with chronic renal failure undergoing 2-3 dialysis session of four hours duration per week was LKR 663,208-994,812 (US$ 5,869-8,804). At one hospital where facilities are available for the re-use of dialyzers (although not done during study period) the cost of consumables would have come down from LKR 5,940,705 to LKR 3,368,785 (43% reduction) if the method was adopted, reducing costs of haemodialysis per hour from LKR 1,327 at present to LKR 892 (33% reduction).</p> <p>Conclusions</p> <p>This multi-centered study demonstrated that the costs of haemodialysis in a developing country remained significantly lower compared to developed countries. However, it still places a significant burden on the health care sector, whilst possibility of further cost reduction exists.</p

‘Neither invisible nor abnormal!’ Exploring the invisibility and pathologisation of LGBT people in the Greek National Health System

This article presents findings from a research study aiming at exploring in-depth experiences of lesbian, gay, bisexual and transgender (LGBT) individuals and communities in the Greek healthcare system. This was the first study of its kind in Greece. Data collected from interviews with LGBT groups and individuals, as well as doctors, suggest that homophobia and transphobia are profound factors of systematic exclusion and restriction from access to good quality healthcare. Our findings suggest that within the healthcare context, LGBT people are routinely invisibilised and/or pathologised. The authors emphasise the urgent need for challenging chronic and institutionalised invisibility experienced by LGBT people as a necessary precondition of social equality and genuine universalism within the Greek Health System

Improving the Quality of Healthcare Services through Information and Quality Interrelation

The ongoing information revolution calls for the exploitation of new information services that may set to support the traditional quality management approaches in healthcare. The developments in information and communication technologies offer new opportunities, with the need for effective information management grow ing within it. This chapter addresses the following issues: What might be an approach for quality management considering the rapid advances of information technology and the growth of the “new economy”? What might be the contribution of library and information services in the improvement of the healthcare services quality? In order to study the aforementioned questions, initially the information requirements of well known quality management approaches such as ISO 9001:2000 and EFQM are investigated and thereafter, the role of library and information services is discussed. The design of library and information services for the support of quality is an interesting and innovative area of research within healthcare services.</jats:p

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 &apos;privatised&apos; 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. © 1998 John Wiley &amp; Sons, Ltd

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 hearth 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 hearth 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

Determinants of health- related quality of life (HRQoL) among deaf and hard of hearing adults in Greece: A cross-sectional study

Background: Hearing loss is an important public health issue, since it has a very negative impact on peoples&apos; lives, irrespective of the age at which it develops. However, globally there is a noticeable lack of epidemiological data for health outcomes for people who are deaf and hard of hearing. In Greece, people with hearing disabilities are systematically not included in health policy and planning processes, despite there being a marked tendency for global efforts aimed at improving their quality of life. Methods: The sample consisted of 140 adults with hearing loss (86 d/Deaf and 54 hard of hearing) and 97 normal hearing as the control group. We run data collection from April to June 2015, using the Greek version of the 36-Item Short Form Health Survey (SF-36v2). Socio-demographic and characteristics about non-medical determinants of health (tobacco and alcohol consumption levels, BMI and physical activity).were also collected and were analysed as possible determinants. Data analysis included bivariate and multivariate analyses such as linear regression models. Results: Multivariate analyses identified that in all the SF-36v2 dimensions, the scores among deaf people were lower than those with normal hearing. Determinants included the hearing loss degree, educational level, body mass index, levels of physical activity, and alcohol consumption levels, while the variable &quot;number of family members per household&quot; was inversely associated with physical health summary scale score. Conclusions: Improving knowledge of the health-related determinants that affect quality of life for the population with hearing loss is an important step in designing targeted services and interventions. In light of these findings, a special effort must be made to ensure the wellbeing of this population. © 2018 The Author(s)

Happiness and physical activity levels of first year medical students studying in Cyprus: A cross-sectional survey

Background: Levels of physical activity and happiness may impact the health and performance of future doctors. The specific relationship between physical activity and happiness among first year medical students is unclear. The purpose of this study was to investigate these variables and how they relate within first year, graduate entry Bachelor of Medicine, Bachelor of Surgery students studying in Cyprus. Methods: Self-administered questionnaires were provided for all first year medical students at the St. George&apos;s University of London medical programme delivered by the University of Nicosia Medical School in Cyprus. Physical activity was assessed using the International Physical Activity Questionnaire Short Form and happiness was assessed using the Short Depression Happiness Scale. Surveys were completed by 79 of the 120 students (median age of 24 years). Happiness and continuous measures of physical activity amounts were investigated using spearman&apos;s rank-order correlation. Mann-Whitney U Tests were used to make further comparisons between the physical activity levels across happy and depressed groups and gender, as well as to compare the levels of happiness reported by each gender. Results: High levels of physical activity were evident in 60.8% of students. Results suggested depression among 15.2% of students. A positive correlation was observed between happiness and amount of vigorous intensity physical activity among female students (p &lt; 0.05), but not males. Happy females performed more vigorous physical activity than depressed females (p &lt; 0.05). The total amount of physical activity performed, as well as level of happiness, did not significantly differ between genders. Conclusions: A relationship exists between physical activity and happiness among female first year medical students. The intensity of physical activity may play an important role within this group. There appears to be relatively high levels of physical activity and low levels of depression among male and female first year medical students studying in Cyprus. This study provides new knowledge regarding relationships between happiness and physical activity among first year medical students, and is also the first characterization of happiness and physical activity habits among students in Cyprus. This may help to inform future policies aimed at promoting health and wellness within student communities. © 2019 The Author(s)