Citizen Preferences for Primary Health Care reform in Greece (original) (raw)
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Citizens' preferences on healthcare expenditure allocation: evidence from Greece
Health Expectations, 2015
Priority setting and resource allocation across various health care functions is a critical issue in health policy and strategic decision making. As health resources are limited while there are so many health challenges to resolve, consumers and payers have to make difficult decisions about expenditure allocation. Our research focus on the (dis)agreement between citizens" preferences and actual public health expenditure across broad health care functions, on whether this (dis)agreement is persistent, on whether various demographic factors amplify this (dis)agreement and to derive useful implications for public health policies. Using survey data of 3,029 citizens in Greece for the year 2012 and employing logit estimation techniques, we analyzed the effect of demographic and other factors in shaping citizens" (dis)agreement with public health expenditure allocation. Our results demonstrate the important role of income, family members and residence in shaping citizens" preferences regarding health expenditure priorities in almost all health care functions, while other demographic factors such as job, age, gender and marital status do partly associate and play a significant role.
Introduction: The Greek public is currently not represented at any level of the healthcare system’s organisational structure. This study aimed to investigate the opinions of Greek citizens as well as doctors regarding their representation in priority setting and to compare these two groups’ preferences when prioritising competing resources. Methods: A sample of 300 citizens and 100 doctors were asked by means of a standardised questionnaire: (a) whether their views should inform healthcare decisions; (b) to rank in terms of importance other groups that should participate in the process; and (c) to allocate competing resources to a series of alternative prevention programmes, medical procedures or across different population groups. Results: As many as 83% of the citizens stated that their opinions should inform decisions regarding prevention and population-group programmes, while a slightly lower 70% believed their opinions should also be heard regarding medical procedures. However, when asked to rank six different population groups in terms of their importance, the public ranked their role quite low. Generally, doctors and patients, and their families were ranked highest, while politicians were ranked last by both groups. Regarding allocation of funds, a remarkable consensus was observed between doctors and the public. Conclusion: This study documents for the first time in Greece the clear preference for active involvement of both the public and healthcare professionals in the process of priority setting and resource allocation. There is great urgency in complementing these findings with qualitative research methods, such as in-depth interviews and discussions with focus groups, so that a more democratic, participative and transparent process for healthcare priority setting can be initiated, based on the actual needs and health problems of the public.
Public engagement in setting healthcare priorities: a ranking exercise in Cyprus
Background: In countries such as Cyprus the financial crisis and the recession have severely affected the funding and priority setting of the health care system. There is evidence highlighting the importance of population' preferences in designing priorities for health care settings. Although public preferences have been thorough analysed in many countries, there is a research gap in terms of simultaneously investigating the relative importance and the weight of differing and competing criteria for determining healthcare priority settings. The main objective of the study was tο investigate public preferences for the relative utility and weight of differing and competing criteria for health care priority setting in Cyprus. Methods: The 'conjoint analysis' technique was applied to develop a ranking exercise. The aim of the study was to identify the preferences of the participants for alternative options. Participants were asked to grade in a priority order 16 hypothetical case scenarios of patients with different disease and of diverse socioeconomic characteristics awaiting treatment. The sample was purposive and consisted of 100 Cypriots, selected from public locations all over the country. Results: It was revealed that the " severity of the disease " and the " age of the patient " were the key prioritization criteria. Participants assigned the smallest relative value to the criterion " healthy lifestyle ". More precisely, participants older than 35 years old assigned higher relative importance to " age " , while younger participants to the " severity of the disease ". The " healthy lifestyle " criterion was assigned to the lowest relative importance to by all participants. Conclusion: In Cyprus, public participation in health care priority setting is almost inexistent. Nonetheless, it seems that the public's participation in this process could lead to a wider acceptance of the healthcare system especially as a result of the financial crisis and the upcoming reforms implemented such as the establishment of the General System of Health Insurance.
Primary Health Services Utilization in Greece:Studying the Past for Planning the Future
The objective of this paper is to study healthcare utilization in Greece. The data were derived from a national survey conducted in 2006, and analysed through Logistic and Linear Regression. The likelihood of primary healthcare utilization is determined by the gender, the existence of a chronic disease, the self-rated health and the age, while the logarithm of the visits to primary health services is determined by the gender, the existence of a chronic disease, the income, the geographical region and the perceived threat from the health condition. Thus, primary healthcare utilization is determined by beliefs, health need as well as socioeconomic factors.
Journal of Public Health, 2019
Aim The aim of the study was to examine the factors associated with health-service use, obtain a self-assessment of health status, and evaluate overall satisfaction with healthcare in adults living in the city of Patras, Greece. Subjects and methods We designed a cross-sectional study. A random sample of 312 people from Patras was collected to assess respondents' use of health services, their subjective perceptions of health status, and their satisfaction with healthcare services. Univariate analyses with Pearson's chi-square test and Student's t-test were followed by multivariate logistic regression models investigating the impact of socioeconomic factors on health-service use and satisfaction. Results Of the respondents, 17.9% hadused a healthcare service at least once within the last 12 months. Self-assessments of health status above average were reported by 66.3% of respondents, and 61.2% were satisfied with their healthcare services. Multivariate logistic regression analyses identified the predictive factors for healthcare visits, subjective perceptions of health status, and satisfaction with healthcare services. Below average subjective health perception was more likely in the older, female, and socioeconomically deprived population with chronic medical conditions. Females with chronic medical conditions were more likely to use healthcare services, and they had a greater likelihood to be satisfied with their healthcare services. Conclusions Recognition of people's needs and satisfaction with services will lead to more rational implementations of healthdirected policies.
Interest Groups and Health System Reform in Greece
West European Politics, 2005
Despite the establishment of the National Health System in Greece in the early 1980s, the institutional framework remained largely unchanged due to opposition from interest groups and large setup costs, thus allowing the powerful stakeholders to preserve their privileges. Not until almost two decades later was reform attempted in order to rationalise and modernise purchasing and delivery. The objective of this paper is to analyse the ambitious reform attempt of 2000 through the lens of rational choice institutionalism, identifying the initial goals of the reform, the reactions of the key stakeholders and the legislative outcome.
The evolution of health care reforms in Greece: charting a course of change
International Journal of Health Planning and Management, 1998
An examination of Greece's experience with health care reform planning over the past half century reveals a remarkable consistency in reform themes pursued by planners. However, few of the plans resulted in legislation, and of the legislation that was passed even fewer were implemented. The present paper traces out reform plans since the early 1950s and argues that legislative and implementation failures have been due to a lack of political will, insucient attention to consensus-forming mechanisms, and inadequate consideration of the technical, administrative, and institutional feasibility of reform plans. By contrast, developments in the 1990s, which have seen three pieces of health care reform legislation, suggest that processes of health care planning and change are becoming more focused, rational and pragmatic. Macroeconomic constraints, and consensus on broader economic policies focusing on the EU convergence requirements have produced a consensus regarding the imperative of change in the health sector, and have given rise to mechanisms which facilitate the task of implementation. The most recent health care reform act (of 17 July 1997) is less radical than many of its predecessors, but includes issues that had entered the health care reform agenda as early as 1952, as well as the more current issues of health sector rationalization. Implementation of the most recent legislative act has already begun. #
Informing primary care reform in Greece: patient expectations and experiences (the QUALICOPC study)
BMC health services research, 2017
Primary health care is the cornerstone of a high quality health care system. Greece has been actively attempting to reform health care services in order to improve heath outcomes and reduce health care spending. Patient-centered approaches to health care delivery have been increasingly acknowledged for their value informing quality improvement activities. This paper reports the quality of primary health care services in Greece as perceived by patients and aspects of health care delivery that are valued by patients. This study was conducted as part of the Quality and Costs of Primary Care in Europe (QUALICOPC) study. A cross-sectional sample of patients were recruited from general practitioner's offices in Greece and surveyed. Patients rated five features of person-focused primary care: accessibility; continuity and coordination; comprehensiveness; patient activation; and doctor-patient communication. One tenth of the patients ranked the importance of each feature on a scale of o...
Exploring health care reform in a changing Europe: Lessons from Greece
European Journal of General Practice, 2013
The economic crisis is the major theme in the Eurozone and its impact on public health and outcomes is largely discussed. Under this pressure, concerns of further inequalities exist that may have an impact on the burden of several diseases in certain European countries. In this context, Greece is currently an issue of top interest in any international economic discussion. Although the background of the recession has been largely discussed as a political crisis, its health eff ects on the population, as well as the key role of primary care and general practice/family medicine in health care reform remain to be explored. Serving both the worldwide trend of orienting health care systems towards strengthened primary care and the inner need for minimizing the demand and lessening the burden from the dysfunctional and costly hospital-care system, the economic crisis sets the perfect timing for prioritizing primary health care. In this article a unique window of opportunity for health care reform in Greece is examined, attempting to establish the axes of an example of how health care system can be reshaped amidst the economic crisis. Equity, quality, value framework, medical professionalism, information technology and decentralization emerge as topics of central interest. There is no doubt that Europe is transitioning under challenging social, economic and public health perspectives. However, taking Greece as an example, the current economic situation sets a good timing for health care reform and the key messages of this paper could be used by other countries facing similar problems.
International Journal of Environmental Research and Public Health, 2013
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 (>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