12 research outputs found

    The effect of environmental factors on technical and scale efficiency of primary health care providers in Greece

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    <p>Abstract</p> <p>Background</p> <p>The purpose of this study was to compare technical and scale efficiency of primary care centers from the two largest Greek providers, the National Health System (NHS) and the Social Security Foundation (IKA) and to determine if, and how, efficiency is affected by various exogenous factors such as catchment population and location.</p> <p>Methods</p> <p>The sample comprised of 194 units (103 NHS and 91 IKA). Efficiency was measured with Data Envelopment Analysis (DEA) using three inputs, -medical staff, nursing/paramedical staff, administrative/other staff- and two outputs, which were the aggregated numbers of scheduled/emergency patient visits and imaging/laboratory diagnostic tests. Facilities were categorized as small, medium and large (<15,000, 15,000–30,000 and >30,000 respectively) to reflect catchment population and as urban/semi-urban or remote/island to reflect location. In a second stage analysis, technical and scale efficiency scores were regressed against facility type (NHS or IKA), size and location using multivariate Tobit regression.</p> <p>Results</p> <p>Regarding technical efficiency, IKA performed better than the NHS (84.9% vs. 70.1%, Mann-Whitney <it>P </it>< 0.001), smaller units better than medium-sized and larger ones (84.2% vs. 72.4% vs. 74.3%, Kruskal-Wallis <it>P </it>< 0.01) and remote/island units better than urban centers (81.1% vs. 75.7%, Mann-Whitney <it>P </it>= 0.103). As for scale efficiency, IKA again outperformed the NHS (89.7% vs. 85.9%, Mann-Whitney <it>P </it>= 0.080), but results were reversed in respect to facility size and location. Specifically, larger units performed better (96.3% vs. 90.9% vs. 75.9%, Kruskal-Wallis <it>P </it>< 0.001), and urban units showed higher scale efficiency than remote ones (91.9% vs. 75.3%, Mann-Whitney <it>P </it>< 0.001). Interestingly 75% of facilities appeared to be functioning under increasing returns to scale. Within-group comparisons revealed significant efficiency differences between the two primary care providers. Tobit regression models showed that facility type, size and location were significant explanatory variables of technical and scale efficiency.</p> <p>Conclusion</p> <p>Variations appeared to exist in the productive performance of the NHS and IKA as the two main primary care providers in Greece. These variations reflect differences in primary care organization, economical incentives, financial constraints, sociodemographic and local peculiarities. In all technical efficiency comparisons, IKA facilities appeared to outperform NHS ones irrespective of facility size or location. In respect to scale efficiency, the results were to some extent inconclusive and observed differences were mostly insignificant, although again IKA appeared to perform better.</p

    Psychometric properties of the Greek Diabetes Treatment Satisfaction Questionnaire

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    <p>Abstract</p> <p>Objectives</p> <p>Measurement of treatment satisfaction in diabetes is important as it has been shown to be associated with positive outcomes, reduced disease cost and better health. The aim of this study was to assess the construct validity and internal consistency reliability of the Greek version of the Diabetes Treatment Satisfaction Questionnaire (DTSQ).</p> <p>Methods</p> <p>A sample of type II diabetes patients (N = 172) completed the DTSQ status version, the SF-36 health survey and also provided data regarding treatment method, clinical and socio-demographic status. Instrument structure, reliability (Cronbach's a) and construct validity (convergent, discriminative, concurrent and known-groups) were assessed.</p> <p>Results</p> <p>The DTSQ measurement properties were confirmed in the Greek version with confirmatory factor analysis (CFA). Scale reliability was high (Cronbach's a = 0.92). Item-scale internal consistency and discriminant validity were also good, exceeding the designated success criteria. Significant correlations were observed between DTSQ items/overall score and SF-36 scales/component scores, which were hypothesized to measure similar dimensions. Known groups' comparisons yielded consistent support of the construct validity of the instrument.</p> <p>Conclusions</p> <p>The instrument was well-accepted by the patients and its psychometric properties were similar to those reported in validation studies of other language versions. Further research, incorporating a longitudinal study design, is required for examining test-retest reliability and responsiveness of the instrument, which were not addressed in this study. Overall, the present results confirm that the DTSQ status version is a reasonable choice for measuring diabetes treatment satisfaction in Greece.</p

    Preliminary results of a healthcare contingent valuation study in Greece

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    Purpose: The primary aim of the present study was to elicit a WTP estimate for a health improvement targeting the general Greek population. Moreover, it intended to investigate socioeconomic, demographic and determinants differences between those willing to pay for a health improvement and those not willing to pay for such an improvement (protest responders). Design/Methodology/Approach: A specially designed questionnaire employing the iterative bidding technique and the EuroQoL-5D-3L tool was used. A representative sample of the general Greek population (n=1,342) completed the questionnaire via telephone interviews –computer-assisted telephone interview method for random sample selection. Socioeconomic, demographic and determinants differences between participants willing to pay (n=528) and protest responders (n=395) were assessed through Chi-square and Mann-Whitney U Test. Findings: The average WTP estimate for a health improvement was €26,280. Participants willing to pay for a health improvement differed significantly from protest responders with respect to age (p=0.000), household size (p=0.018), number of household members having a part- or full-time job (p=0.000), education (p=0.000), marital status (p=0.000), household income (p=0.000) and utility (p=0.003). Respondents willing to pay for the hypothetical treatment differed significantly from protest responders with respect to their views towards quality of healthcare services and healthcare personnel (p=0.000 and 0.005, respectively). Practical Implications: Preliminary findings revealed that, when the general Greek population is considered, the WTP estimate for a health improvement falls within the World Health Organization’s criterion currently used in Greek healthcare economic evaluations. Originality/Value: To the best of our knowledge, this is the first study aiming at eliciting a monetary value for a health improvement targeting the general Greek population and identifying socioeconomic differences between willing and not willing to pay individuals.peer-reviewe

    Development and preliminary validation of a Greek-language outpatient satisfaction questionnaire with principal components and multi-trait analyses

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    BACKGROUND: In the recent years there is a growing interest in Greece concerning the measurement of the satisfaction of patients who are visiting the outpatient clinics of National Health System (NHS) general acute hospitals. The aim of this study is therefore to develop a patient satisfaction questionnaire and provide its preliminary validation. METHODS: A questionnaire in Greek has been developed by literature review, researchers' on the spot observation and interviews. Pretesting has been followed by telephone surveys in two short-term general NHS hospitals in Macedonia, Greece. A proportional stratified random sample of 285 subjects and a second random sample of 100 outpatients, drawn on March 2004, have been employed for the analysis. These have resulted in scale creation via Principal Components Analysis and psychometric testing for internal consistency, test-retest and interrater reliability as well as construct validity. RESULTS: Four summated scales have emerged regarding the pure outpatient component of the patients' visits, namely medical examination, hospital environment, comfort and appointment time. Cronbach's alpha coefficients and Pearson, Spearman and intraclass correlations indicate a high degree of scale reliability and validity. Two other scales -lab appointment time and lab experience- capture the apparently distinct yet complementary visitor experience related to the radiographic and laboratory tests. Psychometric tests are equally promising, however, some discriminant validity differences lack statistical significance. CONCLUSION: The instrument appears to be reliable and valid regarding the pure outpatient experience, whereas more research employing larger samples is required in order to establish the apparent psychometric properties of the complementary radiographic and laboratory-testing process, which is only relevant to about 25% of the subjects analysed here

    Development and preliminary validation of a questionnaire to measure satisfaction with home care in Greece: an exploratory factor analysis of polychoric correlations

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    <p>Abstract</p> <p>Background</p> <p>The primary aim of this study was to develop and psychometrically test a Greek-language instrument for measuring satisfaction with home care. The first empirical evidence about the level of satisfaction with these services in Greece is also provided.</p> <p>Methods</p> <p>The questionnaire resulted from literature search, on-site observation and cognitive interviews. It was applied in 2006 to a sample of 201 enrollees of five home care programs in the city of Thessaloniki and contains 31 items that measure satisfaction with individual service attributes and are expressed on a 5-point Likert scale. The latter has been usually considered in practice as an interval scale, although it is in principle ordinal. We thus treated the variable as an ordinal one, but also employed the traditional approach in order to compare the findings. Our analysis was therefore based on ordinal measures such as the polychoric correlation, Kendall's Tau b coefficient and ordinal Cronbach's alpha. Exploratory factor analysis was followed by an assessment of internal consistency reliability, test-retest reliability, construct validity and sensitivity.</p> <p>Results</p> <p>Analyses with ordinal and interval scale measures produced in essence very similar results and identified four multi-item scales. Three of these were found to be reliable and valid: socioeconomic change, staff skills and attitudes and service appropriateness. A fourth dimension -service planning- had lower internal consistency reliability and yet very satisfactory test-retest reliability, construct validity and floor and ceiling effects. The global satisfaction scale created was also quite reliable. Overall, participants were satisfied -yet not very satisfied- with home care services. More room for improvement seems to exist for the socio-economic and planning aspects of care and less for staff skills and attitudes and appropriateness of provided services.</p> <p>Conclusions</p> <p>The methods developed seem to be a promising tool for the measurement of home care satisfaction in Greece.</p
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