Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area

BACKGROUND: Given the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors. METHODS: Data was obtained from a representative sample (N = 1426) residing in the broader Athens area (response rate 70.6%). Perceived health-related quality of life (HRQOL), as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a) last-month visits to public sector physicians, b) last-month visits to private sector physicians, c) last-year visits to hospital emergency departments and d) last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models. RESULTS: Health care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector). Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care. CONCLUSION: This study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources

Validating and norming of the Greek SF36 Health Survey

Abstract The main objective of this study was to validate the Greek SF-36 Health Survey and to provide general population normative data. The survey was administered to a stratified representative sample (n ¼ 1426) of the general population residing in the broader Athens area and the response rate was 70.6%. Statistical analysis, according to documented procedures developed within the IQOLA Project, was performed. The missing value rate was very low, ranging from 0.1 to 1.3% at the item level. Multitrait scaling analysis confirmed the hypothesized scale structure of the SF-36. Cronbach's a coefficient met the criterion (>0.70) for group analysis in all eight scales. Known group comparisons yielded consistent support of construct validity of the SF-36. Significant statistical differences in mean scores were observed in relation to demographic and social characteristics such as gender, age, education and marital status

Assessing the socio-economic and demographic impact on health-related quality of life: Evidence from Greece

Objectives: The impact of socioeconomic status on health has been extensively studied and studies have shown that low socio-economic status is related to lower values of various health and quality-of-health measures. The aim of this study was to assess the influence of demographic and socio-economic factors on health- related quality of life (HRQoL). Methods: A cross-sectional study was carried out in 2003 using a representative sample of a Greek general population (n = 1007, 18+ years old), living in Athens area. Multivariate stepwise linear regression analyses were performed to investigate the influence of socio-demographic and economic variables on HRQoL, measured by eight scales of the SF-36. Interaction effects between socioeconomic status (SES) and demographic variables were also performed. Results: Females and elderly people were associated with impaired HRQoL in all SF-36 scales. Disadvantaged SES i. e. primary education and low total household income was related to important decline in HRQoL and a similar relation was identified among men and women. Only the interaction effects between age and SES was statistically significant for some SF-36 scales. Multiple regression analyses produced models explaining significant portions of the variance in SF-36 scales, especially physical functioning. Conclusions: The analysis presented here gives evidence of a relationship existing between SES and HRQoL similar to what has been found elsewhere. In order to protect people from the damaging effects of poverty in health it is important to formulate health promotion educational programs or to direct policies to empower the disposable income etc. Helping people in disadvantaged SES to achieve the good health that people in more advantaged SES attained would help to prevent the widening of health inequalities. © Birkhäuser Verlag, Basel 2009

Validity of SF12 summary scores in a Greek general population

BACKGROUND: The 12-item Health Survey (SF-12) was developed as a shorter alternative to the SF-36 for use in large-scale studies, particularly when overall physical and mental health are the outcomes of interest instead of the typical eight-scale profile. The main purpose of this study was to assess the validity of the Greek version of the SF-12. METHODS: A stratified representative sample (N = 1005) of the Greek general population was interviewed. The survey included the SF-36, the EQ-5D and questions on socio-demographic and health-related characteristics. SF-12 summary scores were derived using the standard US algorithm. Factor analysis was used to confirm the hypothesized component structure of the SF-12 items. Construct validity was investigated with "known groups" validity testing and via convergent and divergent validity, which in turn were assessed by the correlations with the EQ-5D dimensions. Concurrent validity was assessed by comparisons with SF-36 summary scores. RESULTS: SF-12 summary scores distinguished well, and in the expected manner, between groups of respondents on the basis of gender, age, education, socio-economic status, self-reported health problems and health services utilization, thus providing evidence of construct validity. Effect size differences between SF-36 and SF-12 summary scores were generally small (<0.2), supporting concurrent (criterion) validity. Significantly lower mean PCS-12 and MCS-12 scores were observed for respondents reporting chronic conditions compared to those without (P < 0.001). Convergent and divergent validity were supported by expected relationships with the EQ-5D. Reporting a problem in an EQ dimension was associated with lower SF-12 summary scores, supporting concurrent validity. Sensitivity of the Greek SF-12 and replication of the original measurement and conceptual model were demonstrated. CONCLUSION: The results provide evidence on the validity of the Greek SF-12 and, in conjunction to future studies addressing test-retest reliability and responsiveness, support its use in Greek health status studies as a brief, yet valid, alternative to the SF-36

Validity of SF-12 summary scores in a Greek general population

Background: The 12-item Health Survey (SF-12) was developed as a shorter alternative to the SF-36 for use in large-scale studies, particularly when overall physical and mental health are the outcomes of interest instead of the typical eight-scale profile. The main purpose of this study was to assess the validity of the Greek version of the SF-12. Methods: A stratified representative sample (N = 1005) of the Greek general population was interviewed. The survey included the SF-36, the EQ-5D and questions on socio-demographic and health-related characteristics. SF-12 summary scores were derived using the standard US algorithm. Factor analysis was used to confirm the hypothesized component structure of the SF-12 items. Construct validity was investigated with &quot;known groups&quot; validity testing and via convergent and divergent validity, which in turn were assessed by the correlations with the EQ-5D dimensions. Concurrent validity was assessed by comparisons with SF-36 summary scores. Results: SF-12 summary scores distinguished well, and in the expected manner, between groups of respondents on the basis of gender, age, education, socio-economic status, self-reported health problems and health services utilization, thus providing evidence of construct validity. Effect size differences between SF-36 and SF-12 summary scores were generally small (&lt;0.2), supporting concurrent (criterion) validity. Significantly lower mean PCS-12 and MCS-12 scores were observed for respondents reporting chronic conditions compared to those without (P &lt; 0.001). Convergent and divergent validity were supported by expected relationships with the EQ-5D. Reporting a problem in an EQ dimension was associated with lower SF-12 summary scores, supporting concurrent validity. Sensitivity of the Greek SF-12 and replication of the original measurement and conceptual model were demonstrated. Conclusion: The results provide evidence on the validity of the Greek SF-12 and, in conjunction to future studies addressing test-retest reliability and responsiveness, support its use in Greek health status studies as a brief, yet valid, alternative to the SF-36. © 2007 Kontodimopoulos et al; licensee BioMed Central Ltd

Prescribed-drug utilization and polypharmacy in a general population in Greece: Association with sociodemographic, health needs, health-services utilization, and lifestyle factors

Purpose: Our aim was to analyze, in a multivariate framework, how sociodemographic, health-service utilization, health needs, and lifestyle risk factors influence drug utilization and polypharmacy (PP) in a general population in Greece. Methods: The cross-sectional study took place in 2006. In total 1,005 individuals (&gt;18 years old) of 1,388 who were approached (response rate 72.4%) were interviewed by trained interviewers. Thirty-seven reported only over-the-counter (OTC) drug use and were excluded. The final sample was 968 individuals. Multivariable logistic regression and multinomial regression analyses were conducted to determine the predictors of drug use and PP at a significance level of p&lt;0.05. Results: The results revealed a high rate of drug use and PP. Drug use and PP were more common among women and increased with age. Advanced age 65+ [odds ratio (OR) 11.6), university education (OR 2.3), visits to physician (OR 2.2), comorbidity (OR 6.8), or poor physical and mental health were associated with higher likelihood of using drugs. Minor (two to three drugs) and major (four or more drugs) PP depended on comorbidity, physical health, and increased age. Furthermore, visits to physicians (OR 1.1), smoking (OR 3.0), and obesity (OR 3.8) increased the likelihood of major PP. Conclusions: Overall, drug utilization and PP depended on health needs followed by education, utilization of health services, and age. Social disparities do persist and, after adjustments for health needs and obesity, had a significant influence on PP. © 2010 Springer-Verlag

Physician consultations according to different BMI levels of the Greek general population

Obesity constitutes a global epidemic which is rapidly becoming a major public health problem in many parts of the world, threatening peoples&apos; health and quality of life. The aim of our study was to estimate the prevalence and impact of overweight and obesity on physician consultations and frequency of use and furthermore, to investigate whether physician consultations in each of the groups defined by BMI level correspond to the need for care implied by health risk level, using logistic regression models. The survey was carried out in Greece in 2006 and involved complete data from 645 individuals consulted by physicians. Overweight and obese users constituted 41.7% and 19% of the sample respectively. The findings showed firstly that the odds of obese individuals visiting a physician (OR 2.15) or making more than three visits (OR 2.12) was doubled compared to the odds of individuals with normal weight. Secondly, we conclude that physician consultations in overweight and obese subgroups as well as the frequency of visits were predicted by factors such as co-morbidities, low HRQL, low educational level which are associated directly or indirectly with obesity, and thus with a greater health need, assuming vertical equity in the utilization of such services. © 2011 by the authors; licensee MDPI, Basel, Switzerland

Investigating unmet health needs in primary health care services in a representative sample of the Greek population

Unmet health care needs are determined as the difference between the services judged necessary and the services actually received, and stem from barriers related to accessibility, availability and acceptability. This study aims to examine the prevalence of unmet needs and to identify the socioeconomic and health status factors that are associated with unmet needs. A cross-sectional study was conducted in Greece in 2010 and involved data from 1,000 consenting subjects (&gt;18 years old). Multiple binary logistic regression analysis was applied to investigate the predictors of unmet needs and to determine the relation between the socio-demographic characteristics and the accessibility, availability and acceptability barriers. Ninety nine participants (9.9%) reported unmet health needs during the 12 months prior to the research. The most frequently self-reported reasons were cost and lack of time. Youth, parenthood, physician consultations, and poor mental health increased the likelihood of unmet needs. Women were less likely to report accessibility and availability than acceptability barriers. Educational differences were evident and individuals with primary and secondary education were associated with significantly more accessibility and availability barriers compared with those with tertiary education. Unmet health needs pose a significant challenge to the health care system, especially given the difficult current financial situation in Greece. It is believed that unmet health needs will continue to increase, which will widen inequalities in health and health care access. © 2013 by the authors; licensee MDPI, Basel, Switzerland