Impacts of the economic crisis on access to healthcare services in Greece with a focus on the vulnerable groups of the population1

Το 2010, η ελληνική οικονομία εισήλθε σε μια βαθιά, δομική και πολύπλευρη κρίση, τα κύρια χαρακτηριστικά της οποίας είναι το μεγάλο δημοσιονομικό έλλειμμα και το πολύ υψηλό δημόσιο χρέος. Αρνητικές επιπτώσεις παρατηρούνται και σε κοινωνικό επίπεδο, καθώς όλοι οι κοινωνικοί δείκτες έχουν επιδεινωθεί. Το άρθρο αυτό εξετάζει την επίπτωση της οικονομικής κρίσης στην πρόσβαση των υπηρεσιών φροντίδας υγείας ιδιαίτερα των ευάλωτων ομάδων του πληθυσμού. Οι ανασφάλιστοι, οι άνεργοι, οι ηλικιωμένοι, οι μετανάστες, τα παιδιά και οι πάσχοντες από μακροχρόνιες ασθένειες και ψυχικές διαταραχές είναι οι ομάδες που επλήγησαν περισσότερο από την οικονομική κρίση στην Ελλάδα. Το υψηλό κόστος, η χαμηλή εγγύτητα και οι μεγάλες λίστες αναμονής είναι μερικά από τα εμπόδια στην πρόσβαση των υπηρεσιών υγείας που αντιμετωπίζουν οι παραπάνω ομάδες.In 2010, the Greek economy entered a deep, structural and multi-faceted crisis, the main futures of which are a large fiscal deficit and huge public debt. The negative effects can also be observed at the societal level, as all social indicators have deteriorated. The present paper discusses the impact of economic crisis on access to healthcare services especially for the vulnerable groups. Uninsured, unemployed, older people, migrants, children and those suffering from chronic disease and mental disorders are among the groups most affected by the crisis in Greece. High costs, low proximity and long waiting lists are among the main barriers in accessing health care services

Using patient experience measures to evaluate the quality of medical and nursing care in the newly established PHC units (TOMYs), in Greece

Η Πρωτοβάθµια Φροντίδα Υγείας (ΠΦΥ) αποτελεί αναπόσπαστο µέρος του συστήµατος υγείας κάθε χώρας και της συνολικής κοινωνικής και οικονοµικής ανάπτυξης της κοινότητας. Στην Ελλάδα, το Υπουργείο Υγείας, σε µια προσπάθεια βελτίωσης της παροχής υπηρεσιών ΠΦΥ σε εθνικό επίπεδο, ίδρυσε το ∆εκέµβριο του 2017 τις πρώτες Τοπικές Μονάδες Υγείας (TOMY). Αυτές οι νέες µονάδες ΠΦΥ αποσκοπούσαν στην παροχή ποιοτικών υπηρεσιών ΠΦΥ προς τους πολίτες, βελτιώνοντας την υγεία του πληθυσµού και συµβάλλοντας στη µείωση των δαπανών για την υγεία. Σε αυτό το πλαίσιο, είναι σηµαντικό οι ασθενείς/λήπτες των υπηρεσιών ΠΦΥ να µπορούν να αξιολογούν τις εµπειρίες τους, όπως συσσωρεύονται κατά τη διάρκεια των επισκέψεών τους στις νέες αυτές δοµές ΠΦΥ. Σκοπός της αυτής της µελέτης ήταν η αξιολόγηση της ποιότητας της ιατρικής και νοσηλευτικής φροντίδας στις νεοσύστατες µονάδες ΠΦΥ (TOMY) στην Ελλάδα, µέσω της αποτύπωσης των εµπειριών των ασθενών.Primary Health Care (PHC) is an integral part of both a country’s health system and of the overall social and economic development of the community. In Greece, in an effort to improve the provision of the PHC services on a national level, the Ministry of Health established the first Local Health Units (TOMYs) in December 2017. These new PHC units aimed to contribute to the provision of quality primary care services to citizens, while at the same time favoring the health system by improving the health of the population and helping to reduce health costs. Within this context, it is important for patients/PHC services’ recipients to be able to evaluate their experiences, as accumulated during their visits at these new health PHC structures. The aim of this paper was to evaluate the quality of medical and nursing care in the newly established PHC units (TOMYs) in Greece, using patient experience measures

Management of Precancerous Lesions of the Uterine Cervix according to Demographic Data

Aims. Worldwide, cervical cancer is the fifth most deadly cancer in women, but screening prevents cancer by detecting precancerous lesions. The purpose of this study is to present the treatment profile for precancerous lesions of the uterine cervix, according to demographic data. Methods. An annual retrospective study was conducted in two public primary health care centres in Greece. The total number of Pap smears and colposcopies performed as well as the management of women with cervical intraepithelial neoplasia was collected and analysed. Results. Demographic characteristics and correlations with levels of Cervical Intraepithelial Neoplasia (CIN) and treatment path are presented. For each case, we noted the patients' age, the marital and educational status, and the professional and insurance type. From a total of 238 diagnostic procedures, 118 (49.5%) showed precancerous lesions, 83.3% of these were high grade while 16.7% were low grade. Conclusions. This study provides an estimate of the extensiveness of precancerous lesions of the uterine cervix. Management of CIN should be accounted for when balancing the benefits and unfavourable effects of this screening

Inequalities between migrants and non-migrants in accessing and using health services in Greece during an era of economic hardship

A cross-sectional study was conducted from April 2013 until March 2014 to explore the existence of inequalities in access to and utilization of health services by migrants compared to non-migrants in Greece and to test the influence of various factors on these disparities. Also, we investigated the influence of several socioeconomic and demographic characteristics. Study population included 1,152 migrants and 702 non-migrants. Migrants, participants suffering from a chronic disease, those without health insurance, and patients who assessed their health status as not at all good/a little good/moderate were statistically more likely to report unmet needs in getting their medication. Uninsured participants, females, those unemployed or without a permanent occupational status, and those who assessed their health status as not at all good/a little good/moderate were statistically more likely to report unmet needs in access to health services during the last year. Regarding the use of health services, those with health coverage, non-migrants, and females were statistically more likely to go for a blood test as a hospital outpatient. Greece, despite administrative delays and barriers, provided full coverage to the uninsured, asylum seekers, and migrants, even many groups of undocumented migrants

Physicians’ Perceptions and Adherence to Guidelines for the Management of Hypertension: A National, Multicentre, Prospective Study

Background. The aim of the current study was to investigate physicians’ perceptions and adherence to the European guidelines for the management of hypertension. Methods. This is a national, multicentre, prospective, observational study, conducted between November 2007 and June 2008, in Cyprus. Consecutive hypertensive patients have been recruited by a random sample of physicians. The physicians’ recommendations for every single patient have been recorded and compared with the 2007 ESH/ESC guidelines. Results. Of the total of 654 patients, 477 (72.9%) were correctly advised by their physician to receive antihypertensive treatment to control their blood pressure, while 396 (60.5%) correctly got advices to adopt only lifestyle changes. The overall adherence of physicians to the European guidelines (overall agreement rate) was 70.4% (k=0.258, P<0.001). Of the total of 68 physicians, 65 (95.6%) reported that they were aware of some guidelines. There was no statistically significant effect of specific physicians’ characteristics on the overall adherence to guidelines, but there was in the percentage of patients achieving medication guidelines. Conclusions. The study demonstrated that although Cypriot physicians declared that they were aware of the clinical guidelines for the management of hypertension, more than one-fourth of high risk hypertensive patients remained untreated and 40% of low risk patients received inappropriate medication

Measuring across hospital efficiency and productivity : the case of second regional health authority of Attica

The purpose of the study is to investigate technical efficiency and productivity change of a sample of Greek Hospitals over the period 1998 - 2005. Efficiency and productivity measurement became a crucial issue in Greece after the launching of health reforms in 2001, with the legislative Act No. 2889, aiming at cost containment and improvements in hospital efficiency. Applying the linear programming method of Data Envelopment Analysis we investigate how efficiently the hospital resources are used to obtain the maximum possible outcome, before and after the reforms. Hospital output is modelled in terms of interventions, laboratory examinations, outpatient and inpatient cases. Inputs considered include beds, doctors, nurses and rest personnel and operational expenses. The analysis indicates that the reforms have generated efficiency gains when only input and output quantities are considered. During the period 1998- 2002 an overall efficiency regress is observed followed by an upturn, after the launching of managerial reforms. However, when the running costs of the hospitals are considered, then the sample experiences significant regress, implying relatively higher production costs over time. We conclude that DEA is a useful technique to assess relative efficiency and optimum hospital performance across hospitals.peer-reviewe

Human Resources for Health in Greece: Current status and the way forward

Το παρόν άρθρο παρουσιάζει συνοπτικά μια πρόταση για την εθνική στρατηγική για το ανθρώπινο δυναμικό στην υγεία, η οποία βασίζεται στην αξιολόγηση της παρούσας κατάστασης και αναπτύχθηκε με βάση 5 πεδία/στρατηγικούς τομείςκλειδιά: τον προγραμματισμό του ανθρώπινου δυναμικού, τις δεξιότητες και την κατανομή των επαγγελματιών υγείας, τη συγκράτηση προσωπικού, τη διακυβέρνηση και τις εθνικές προτεραιότητες στον τομέα της υγείας. Παρέχει μια επισκόπηση των δημογραφικών και επιδημιολογικών προκλήσεων, των προβλημάτων που αντιμετωπίζει το ελληνικό σύστημα υγείας και των πολιτικών που επηρεάζουν τη στρατηγική για το ανθρώπινο υγειονομικό δυναμικό. Περιγράφονται οι κύριοι στόχοι και οι κατευθυντήριες αρχές της προτεινόμενης εθνικής στρατηγικής για τους ανθρώπινους πόρους στον τομέα της υγείας και εξετάζονται οι αναγκαίες δράσεις και τα επόμενα βήματα που θα εξασφαλίσουν την επιτυχή υλοποίηση αυτής.This paper presents briefly the suggested national human resources for health strategy for Greece, which is based on a rapid assessment of the current situation and drafted around 5 domains/strategic key areas: planning, skills and distribution, retention, governance and government health priorities. It provides an overview of the national context including demographic challenges, health status of the population and emerging health issues as well as health system organizational characteristics and policies with an impact on human resources for health strategy. The main objectives and the guiding principles of the suggested national strategy are explained and proposals for the way forward to successfully implement it are discussed

Restructuring the hospital sector in Greece in order to improve effectiveness and efficiency

Το άρθρο αυτό παρουσιάζει τη μελέτη πουαφορούσε στην αναδιάρθρωση του ΕλληνικούΝοσοκομειακού Τομέα Σκοπός της μελέτηςήταν να προτείνει ένα νέο πρότυπο οργάνω-σης των νοσοκομείων σε ομάδες με βάση τηναναμόρφωση της επείγουσας φροντίδας και τηδιαχείριση των πέντε κύριων χρόνιων νοση-μάτων (Οξύ Έμφραγμα του Μυοκαρδίου, Αγγειακό Εγκεφαλικό Επεισόδιο, Καρκίνος, Σακχαρώδης Διαβήτης και Χρόνια ΑποφρακτικήΠνευμονοπάθεια). Στο πλαίσιο της βελτίωσηςτης αποτελεσματικότητας και αποδοτικότηταςτου νοσοκομειακού τομέα παρουσιάστηκανπροτάσεις όπως η συνεργασία ιδιωτικού καιδημόσιου τομέα καθώς και μέτρα περιορισμούτων δαπανών. Η αναδιάρθρωση του δημόσιουνοσοκομειακού τομέα στηρίχθηκε σε έξι δια-κριτά κριτήρια τα οποία συμπεριελάμβαναν τοπληθυσμιακό κριτήριο, τη συγκέντρωση τουπληθυσμού, το μέγεθος του νοσοκομείου, τηνπαλαιότητα των υποδομών, την ένταση της αξιοποίησης της νοσοκομειακής υποδομής και τηνοικονομική αποδοτικότητα του νοσοκομείου.This paper discusses the study focused on thereform of Greek Hospital Sector, also known as“hospital mergers”. The aim of the study was topropose a new pattern of organizing hospitalsin groups based on the reform of emergencycare and the management of five main chronicdiseases (AMI, Stroke, Cancer, Diabetes Mellitusand COPD). The proposals in general concern thecreation of a national network of health servicesprovided mainly by primary healthcare units andthe largest hospitals of the groups in each healthregion. In the context of improving the hospitalsector efficiency, ways of collaborations betweenprivate and public sector and expenditurecontainment measures are presented. Therestructuring of the public hospital sector reliedon six specific criteria including the populationcriterion, catchment area, hospital size,infrastructure age, utilization of hospital facilitiesand cost. Due to its nature, the study was exposedto various factors such as the diversity of actorsbeing involved, collection and compilation of therelevant data in a short term of three months, lastminute adjustments and the variety of audience

Restructuring the hospital sector in Greece in order to improve effectiveness and efficiency

Το άρθρο αυτό παρουσιάζει τη μελέτη πουαφορούσε στην αναδιάρθρωση του ΕλληνικούΝοσοκομειακού Τομέα Σκοπός της μελέτηςήταν να προτείνει ένα νέο πρότυπο οργάνω-σης των νοσοκομείων σε ομάδες με βάση τηναναμόρφωση της επείγουσας φροντίδας και τηδιαχείριση των πέντε κύριων χρόνιων νοση-μάτων (Οξύ Έμφραγμα του Μυοκαρδίου, Αγγειακό Εγκεφαλικό Επεισόδιο, Καρκίνος, Σακχαρώδης Διαβήτης και Χρόνια ΑποφρακτικήΠνευμονοπάθεια). Στο πλαίσιο της βελτίωσηςτης αποτελεσματικότητας και αποδοτικότηταςτου νοσοκομειακού τομέα παρουσιάστηκανπροτάσεις όπως η συνεργασία ιδιωτικού καιδημόσιου τομέα καθώς και μέτρα περιορισμούτων δαπανών. Η αναδιάρθρωση του δημόσιουνοσοκομειακού τομέα στηρίχθηκε σε έξι δια-κριτά κριτήρια τα οποία συμπεριελάμβαναν τοπληθυσμιακό κριτήριο, τη συγκέντρωση τουπληθυσμού, το μέγεθος του νοσοκομείου, τηνπαλαιότητα των υποδομών, την ένταση της αξιοποίησης της νοσοκομειακής υποδομής και τηνοικονομική αποδοτικότητα του νοσοκομείου.This paper discusses the study focused on thereform of Greek Hospital Sector, also known as“hospital mergers”. The aim of the study was topropose a new pattern of organizing hospitalsin groups based on the reform of emergencycare and the management of five main chronicdiseases (AMI, Stroke, Cancer, Diabetes Mellitusand COPD). The proposals in general concern thecreation of a national network of health servicesprovided mainly by primary healthcare units andthe largest hospitals of the groups in each healthregion. In the context of improving the hospitalsector efficiency, ways of collaborations betweenprivate and public sector and expenditurecontainment measures are presented. Therestructuring of the public hospital sector reliedon six specific criteria including the populationcriterion, catchment area, hospital size,infrastructure age, utilization of hospital facilitiesand cost. Due to its nature, the study was exposedto various factors such as the diversity of actorsbeing involved, collection and compilation of therelevant data in a short term of three months, lastminute adjustments and the variety of audience

Barriers in Access to Pharmaceutical Care in Greece: The Case Study of the Out-of-Hospital Management of Patients With Acute Asthma

Aim: The objectives of this study were to evaluate the effectiveness of information and administrative assistance regarding patient adherence to asthma guidelines and investigate the nature of the barriers in access to pharmaceutical care in Greece based on the case study of the out-of-hospital management of patients with acute asthma.Materials and Methods: The sample of the study consisted of 100 patients with acute asthma who visited the Emergency Department of a General Hospital of Athens. A comparative cross-sectional study using convenience sampling was conducted during October 2014 and June 2015 regarding the adherence to the follow up.Results: Patients who complied with the follow up visit constituted 61% of the total sample (82% of the patients from the intervention group and 40% from the control group) and for those for whom the follow up visit had been scheduled by the researchers had been compliant with the physician's instructions more often than patients for whom the follow up had not been scheduled by the researchers (OR = 8.2, 95%CI = 2.9–23.2). Patients with increased hospitalization days during the previous year and who did not consume the appropriate medication prescribed for asthma due to lack of a prescription, visited the ED more frequently than the rest of the patients (OR = 271.47, 95%CI = 14.53–5070.8). More than one out of three patients (36.4%) reported that they had not bought their asthma medications because they had no prescription while almost one out of five stated that they had purchased their medications but had used them with savings in doses. Patients who had not taken their asthma medication due to lack of prescription, visited more than once the ED, resulting in non-admission, when compared to patients who had a prescription for their medications. (OR = 3.5, 95%CI = 1.3–9.3).Discussion–Conclusions: Out-of-hospital management of asthma in Greece presents significant gaps and shortcomings, mainly due to important unresolved issues regarding availability, accessibility and use of services. The findings of the present study confirm the cause-effect relationship between ineffective out-of-hospital management of asthma and the increase in the frequency of the use of hospital emergency departments, resulting in an increase in health costs