13 research outputs found
Measuring intra-hospital clinic efficiency and productivity : an application to a Greek university general hospital
In this paper we use Data Envelopment Analysis and the Malmquist
Productivity Index and its decompositions to assess the productive efficiency and
productivity of the in-patient clinics of a large Greek University General Hospital.
Clinics are represented by means of a simple model whereby they use inputs (labor
and capital) to produce outputs (in-patient days and patient discharges). The
efficiency model is input oriented and assumes constant returns to scale. Model
validation analyses showed that this model appears to be externally valid. The
framework proposed here is a simple and useful tool for informing intra-hospital
management decisions.peer-reviewe
Health care services performance measurement : theory, methods and empirical evidence
Despite the growing international literature in the field of efficiency and productivity
measurement there are very limited Greek applications partly due to inadequate and
incomplete datasets. The aim of this article is to illustrate the main methodologies for health
care services efficiency and productivity measurement, to present their strengths and
weaknesses and to discuss the existing evidence from applications in other countries.
Notwithstanding the fact that the related methodologies have been recently developed these
methods may help practitioners and health care decisions makers in improving health care
management in Greece.peer-reviewe
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
Factors influencing prescribing behaviour of physicians in Greece and Cyprus: results from a questionnaire based survey
<p>Abstract</p> <p>Background</p> <p>Over the past few decades, drug and overall healthcare expenditure have risen rapidly in most countries. The present study investigates the attitudes and the factors which influence physician prescribing decisions and practice in Greece and Cyprus.</p> <p>Methods</p> <p>A postal questionnaire was developed by researchers at the Department of Health Economics at the National School of Public Health in Greece, specifically for the purposes of the study. This was then administered to a sample of 1,463 physicians in Greece and 240 physicians in Cyprus, stratified by sex, specialty and geographic region.</p> <p>Results</p> <p>The response rate was 82.3% in Greece and 80.4% in Cyprus. There were similarities but also many differences between the countries. Clinical effectiveness is the most important factor considered in drug prescription choice in both countries. Greek physicians were significantly more likely to take additional criteria under consideration, such as the drug form and recommended daily dose and the individual patient preferences. The list of main sources of information for physicians includes: peer-reviewed medical journals, medical textbooks, proceedings of conferences and pharmaceutical sales representatives. Only half of prescribers considered the cost carried by their patients. The majority of doctors in both countries agreed that the effectiveness, safety and efficacy of generic drugs may not be excellent but it is acceptable. However, only Cypriot physicians actually prescribe them. Physicians believe that new drugs are not always better and their higher prices are not necessarily justified. Finally, doctors get information regarding adverse drug reactions primarily from the National Organisation for Medicines. However, it is notable that the majority of them do not inform the authorities on such reactions.</p> <p>Conclusion</p> <p>The present study highlights the attitudes and the factors influencing physician behaviour in the two countries and may be used for developing policies to improve their choices and hence to increase clinical and economic effectiveness and efficiency.</p
Economic Evaluation of Three Frequently Used Gonadotrophins in Assisted Reproduction Techniques in the Management of Infertility in the Netherlands
Background and Objective Subfertility represents a multidimensional
problem associated with significant distress and impaired social
well-being. In the Netherlands, an estimated 50,000 couples visit their
general practitioner and 30,000 couples seek medical specialist care for
sub-fertility. We conducted an economic evaluation comparing recombinant
human follicle-stimulating hormone (follitropin alfa, r-hFSH, Gonal-F
(R)) with two classes of urinary gonadotrophins-highly purified human
menopausal gonadotrophin (hp-HMG, Menopur (R)) and urinary
follicle-stimulating hormone (uFSH, Fostimon (R))-for ovarian
stimulation in women undergoing in vitro fertilization (IVF) treatment
in the Netherlands.
Methods A pharmacoeconomic model was developed, simulating each step in
the IVF protocol from the start of therapy until either a live birth, a
new IVF treatment cycle or cessation of IVF, following a long
down-regulation protocol. A decision tree combined with a Markov model
details progress through each health state, including ovum pickup, fresh
embryo transfer, up to two subsequent cryo-preserved embryo transfers,
and (ongoing) pregnancy or miscarriage. A health insurer perspective was
chosen, and the time horizon was set at a maximum of three consecutive
treatment cycles, in accordance with Dutch reimbursement policy.
Transition probabilities and costing data were derived from a real-world
observational outcomes database (from Germany) and official tariff lists
(from the Netherlands). Adverse events were considered equal among the
comparators and were therefore excluded from the economic analysis. A
Monte Carlo simulation of 5000 iterations was undertaken for each
strategy to explore uncertainty and to construct uncertainty intervals
(UIs). All cost data were valued in 2013 Euros. The model’s structure,
parameters and assumptions were assessed and confirmed by an external
clinician with experience in health economics modelling, to inform on
the appropriateness of the outcomes and the applicability of the model
in the chosen setting.
Results The mean total treatment costs were estimated as (sic)5664 for
follitropin alfa (95 % UI (sic)5167-6151), (sic)5990 for hp-HMG (95 %
UI (sic)5498-6488) and (sic)5760 for uFSH (95 % UI (sic)5256-6246). The
probability of a live birth was estimated at 36.1 % (95 % UI 27.4-44.3
%), 33.9 % (95 % UI 26.2-41.5 %) and 34.1 % (95 % UI 25.9-41.8 %)
for follitropin alfa, hp-HMG and uFSH, respectively. The costs per live
birth estimates were (sic)15,674 for follitropin alfa, (sic)17,636 for
hp-HMG and (sic)16,878 for uFSH. Probabilistic sensitivity analysis
indicated a probability of 72.5 % that follitropin alfa is cost
effective at a willingness to pay of (sic)20,000 per live birth. The
probabilistic results remained constant under several analyses.
Conclusion The present analysis shows that follitropin alfa may
represent a cost-effective option in comparison with uFSH and hp-HMG for
IVF treatment in the Netherlands healthcare system