The influence of the medical profession on the National Health Service of Greece, 1983-2001

Greece has experienced three major Health Care Reforms since 1974, in 1983,1992 and 2001.The common characteristic of all three has been that they have still not realized their aims and objectives. One explanation for the puzzling failure may lie in the way structural institutions shape and are being shaped by the main actors in the health arena in Greece. Furthermore, this study argues that health policy-making is dependent on broader policy making and on decisions or non decisions that have already been made in the past. W.ithin this context, there are several embedded interests, such as the medical profession and its trade unions, civil servants and social insurance funds, which benefit from the failure of any reform, and are in favour of the preservation of the status quo, ignoring the dissatisfaction of the Greek citizens with the health services they receive. The aim of this study is to reveal the influence of the main actors in the system, with particular reference to the medical profession, through careful and in-depth analysis of the series of reforms. The strongest focus will be on the most recent reforms of 2001. Documentary collection and interviews with key informants (participants and representatives of organizations/interests) in the Greek Health Care System, were undertaken and analyzed, using the most suitable framework derived from historical institutionalism.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The influence of the medical profession on the National Health Service of Greece, 1983-2001

Greece has experienced three major Health Care Reforms since 1974, in 1983,1992 and 2001.The common characteristic of all three has been that they have still not realized their aims and objectives. One explanation for the puzzling failure may lie in the way structural institutions shape and are being shaped by the main actors in the health arena in Greece. Furthermore, this study argues that health policy-making is dependent on broader policy making and on decisions or non decisions that have already been made in the past. W.ithin this context, there are several embedded interests, such as the medical profession and its trade unions, civil servants and social insurance funds, which benefit from the failure of any reform, and are in favour of the preservation of the status quo, ignoring the dissatisfaction of the Greek citizens with the health services they receive. The aim of this study is to reveal the influence of the main actors in the system, with particular reference to the medical profession, through careful and in-depth analysis of the series of reforms. The strongest focus will be on the most recent reforms of 2001. Documentary collection and interviews with key informants (participants and representatives of organizations/interests) in the Greek Health Care System, were undertaken and analyzed, using the most suitable framework derived from historical institutionalism.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

How breast cancer treatments affect the quality of life of women with non-metastatic breast cancer one year after surgical treatment: a cross-sectional study in Greece

Background: The continuously increasing survivorship of female breast cancer makes the monitoring and improvement of patients' quality of life ever so important. While globally there is a growing body of research on health-related quality of life 1 year after surgical treatment for non-metastatic breast cancer, up-to-date information regarding Greek patients is scarce. Objective: To measure the level of QoL of non-metastatic BC survivors in Greece 1 year after surgery. Methods: A sample of 200 female breast cancer survivors aged 18 to 75, who followed up as outpatients in five public hospitals were included in this cross-sectional study. All recruited patients agreed to participate in the study (100% response rate). Quality of life data were collected through the EORTC QLQ-C30 as well as BR23 questionnaires. Results: Cronbach's alpha for all scales of the two questionnaires was from 0.551 to 0.936 indicating very good reliability. According to the Multiple Linear Regression, older patients showed a lower future perspective (p =.031), with those living in rural areas, which was associated with more financial difficulties (p =.001). Women with tertiary education and those who had been hospitalized in a university hospital recorded better on global health status (p =.003 and.000 respectively). Patients who underwent chemotherapy reported better scores in the emotional function sub-scale (p =.025). Women with reconstruction and at least one complication appeared to have significantly better scores in future perspective and social function (p =.005,.002 respectively). Conclusions: Breast cancer survivors were found to have an overall good quality of life, functioning/symptoms scores and were satisfied with the provided care

The influence of the medical profession on the National Health Service of Greece, 1983-2001.

Greece has experienced three major Health Care Reforms since 1974, in 1983, 1992 and 2001.The common characteristic of all three has been that they have still not realized their aims and objectives. One explanation for the puzzling failure may lie in the way structural institutions shape and are being shaped by the main actors in the health arena in Greece. Furthermore, this study argues that health policy-making is dependent on broader policy making and on decisions or non decisions that have already been made in the past. Within this context, there are several embedded interests, such as the medical profession and its trade unions, civil servants and social insurance funds, which benefit from the failure of any reform, and are in favour of the preservation of the status quo, ignoring the dissatisfaction of the Greek citizens with the health services they receive. The aim of this study is to reveal the influence of the main actors in the system, with particular reference to the medical profession, through careful and in-depth analysis of the series of reforms. The strongest focus will be on the most recent reforms of 2001. Documentary collection and interviews with key informants (participants and representatives of organizations/interests) in the Greek Health Care System, were undertaken and analyzed, using the most suitable framework derived from historical institutionalism

Η επιρροή των ιατρών (του ιατρικού επαγγέλματος) στο Εθνικό Σύστημα Υγείας της Ελλάδας, 1983-2001.

Greece has experienced three major Health Care Reforms since 1974, in 1983, 1992 and 2001. The common characteristic of all three has been that they have still not realized their aims and objectives. One explanation for the puzzling failure may lie in the way structural institutions shape and are being shaped by the main actors in the health arena in Greece. Furthermore, this study argues that health policy-making is dependent on broader policy making and on decisions or non decisions that have already been made in the past. Within this context, there are several embedded interests, such as the medical profession and its trade unions, civil servants and social insurance funds, which benefit from the failure of any reform, and are in favour of the preservation of the status quo, ignoring the dissatisfaction of the Greek citizens with the health services they receive. Three theoretical frameworks for understanding the health care system and the role of the medical profession within it are explored: sociological theories of professions; historical institutionalism; and structural interest theory, to see which best explains the nature and extent of health care reform. All three have the virtue of focusing to differing degrees on how institutions reflect the imprint of interest group activity and, conversely, how the resultant institutions shape the relative influence and way of acting of dominant interests, (i.e. the medical profession, and particularly hospital and university doctors). Explanatory analysis proved that historical institutionalism offers the greatest potential to explain the outcome of health care reforms from 1983 to 2001. The empirical evidence of this thesis (documentary collection and interviews with key informants (participants and representatives of organizations/interests) in the Greek Health Care System, were undertaken and analyzed, using the most suitable framework derived from historical institutionalism) strongly supports the argument that health care reform in Greece is path-dependent because the parliamentary and government process allows the main actors in the system, such as hospital doctors and university doctors, to shape any reforms so as to maintain the status quo. The role of institutions is crucial in explaining this - in particular, the development of Greek society, the resultant nature of the Greek state and the related peculiarities of its Welfare State. The extensive historical narratives of the three periods of recent system reforms shows how vested interests, such as the trade unions of already privileged group and, the medical profession (junior hospital doctors, senior hospital doctors and university doctors) have been able to exploit party-to-person clientelism, the absence of political consensus on the type and the character of reforms, the administrative and financial weaknesses of the state, institutional fragmentation and a weak collective culture to impede the establishment of a universal health insurance system.Το Ελληνικό κράτος έχει προσπαθήσει να μεταρρυθμίσει το σύστημα υγείας στην Ελλάδα τρείς φορές μετά τη σύσταση του ΕΣΥ το 1983. Οι μεταρρυθμίσεις σχεδιάστηκαν με απώτερο στόχο να εκπληρωθούν οι θεμελιώδεις αρχές της αποδοτικότητας και ισότητας στη παροχή υπηρεσιών υγείας. Η διδακτορική μου διατριβή μελετά την επιρροή του ιατρικού κλάδου και των οργανώσεων των ιατρών και άλλων συμφερόντων στις μεταρρυθμίσεις του Ελληνικού συστήματος υγείας από το 1983 έως το 2001. Η διεθνής βιβλιογραφία περιέχει μια πλειάδα θεωριών μέσω των οποίων γίνονται κατανοητές οι βασικές αρχές και λειτουργίες των συστημάτων υγείας και ο ρόλος του ιατρικού κλάδου μέσα σε αυτά. Οι κυριότερες είναι: (1) Κοινωνιολογικές θεωρίες περί συντεχνιών/επαγγελματιών (sociological theories of professions), (2) Η θεωρία των ιστορικών θεσμικών καθεστώτων (historical institutionalism), και (3) Η θεωρία των συστεμικών συμφερόντων (structural interest theory). Αν και κάθε προαναφερόμενη θεωρία έχει κάτι να πρσφέρει στην ανάλυση η οποία εμπεριέχεται στο διδακτορικό μου, η ΄΄θεωρία των θεσμικών καθεστώτων’’ είναι αυτή η οποία προσφέρει την καλύτερη επεξήγηση των μεταρρυθμίσεων του Ελληνικού συστήματος υγείας και των μειονεκτημάτων τους. Πιο συγκεκριμένα το ΕΣΥ παρουσιάζει ιδιαίτερα χαρακτηριστικά που έχουν άμεση σχέση με το πώς το Ελληνικό Κράτος Πρόνοιας έχει εξελιχθεί στην μεταδικτατορική εποχή (μετά το 1974). Η αναλύση των στοιχείων που συνέλεξα μέσω συνεντεύξεων και αρχειακού υλικού αποδεικνύει ότι η κύρια εξήγηση για την πορεία των μεταρρυθμίσεων του ΕΣΥ μετά το 1983, προέρχεται από την ύπαρξη συστεμικών θεσμικών καθεστώτων τα οποία επιτρέπουν σε εδραίες ομάδες συμφερόντων, π.χ. του ιατρικού κλάδου και όχι μόνο, να επωφεληθούν από την διατήρηση του status quo και εν τέλει να καταφέρουν να καταστήσουν τις όποιες μεταρρυθμίσεις κένα γράμματα. Αυτό αποδεικνύεται περίτρανα στις μεταρρυθμιστικές απόπειρες όλων των κυβερνήσεων μετά το 1983. Ειδικά για τις μεταρρυθμίσεις των δεκαετιών 1980, 1990 και 2000 παρέχεται ενδελεχές πρωτογενές και δευτερογενές αρχειακό και προφορικό υλικό για την ανασύστασή και επεξήγησή τους

Reliability and validity of the Greek translation of the patient assessment of chronic illness care + (PACIC-PLUS GR) survey

The article was funded by the “CUT Open Access Author Fund”This study aimed to investigate the Patient Assessment of Chronic Illness Care+ (PACIC+) which is a tool to assess care for Chronic Conditions combining PACIC items with an overall 5As score derived from the '5As' model (ask, advise, agree, assist, and arrange), and is congruent with the Chronic Care Model. In addition, the study at hand aimed to translate the PACIC+ tool into Greek and test its psychometric properties to the Greek patients

Knowledge and Perceptions of Cypriots about Oral Cancer

Introduction: Oral cancer is the sixth most common cancer in the world. Cyprus recorded 312 new cases between 1998 and 2009, which represent a significant percentage of all cancers reported in Cyprus

Validation of the Greek Version of Euthanasia Attitude Scale (EAS) in Greek Medical Doctors

This study aimed to examine the reliability and validity of the Euthanasia Attitude Scale (EAS) in Greek medical doctors. A cross-sectional study design was conducted, including 120 physicians at clinical setting in 2019 (men 64.5%). A self-report questionnaire, including socio-demographic data and the Euthanasia Attitude Scale, which assesses attitudes towards euthanasia, were used for data collection. The mean (standard deviation) of the EAS were 74.62 (14.33). The Cronbach’s alpha was 0.944 and the confirmatory factor analysis to investigate the validity of the EAS scale, after modification effects, revealed an acceptable adjustment for the questionnaire. The GFI index was above 0.8 and close to 0.9, and the CFI index was above 0.9, which is the acceptable limit. The RMSEA index was acceptable below 0.08. The total Gr-EAS correlated with all five factors (Pearson r = 0.400–0.973, p < 0.001). According to the findings of this study, the Euthanasia Attitude Scale is a reliable and valid measure for assessing the attitudes toward euthanasia in Greek physicians. This Greek adaptation will be valuable in future studies examining the attitude of physicians towards euthanasia

Validation of the Greek Version of Euthanasia Attitude Scale (EAS) in Greek Medical Doctors

This study aimed to examine the reliability and validity of the Euthanasia Attitude Scale (EAS) in Greek medical doctors. A cross-sectional study design was conducted, including 120 physicians at clinical setting in 2019 (men 64.5%). A self-report questionnaire, including socio-demographic data and the Euthanasia Attitude Scale, which assesses attitudes towards euthanasia, were used for data collection. The mean (standard deviation) of the EAS were 74.62 (14.33). The Cronbach’s alpha was 0.944 and the confirmatory factor analysis to investigate the validity of the EAS scale, after modification effects, revealed an acceptable adjustment for the questionnaire. The GFI index was above 0.8 and close to 0.9, and the CFI index was above 0.9, which is the acceptable limit. The RMSEA index was acceptable below 0.08. The total Gr-EAS correlated with all five factors (Pearson r = 0.400–0.973, p < 0.001). According to the findings of this study, the Euthanasia Attitude Scale is a reliable and valid measure for assessing the attitudes toward euthanasia in Greek physicians. This Greek adaptation will be valuable in future studies examining the attitude of physicians towards euthanasia