Payments and quality of care in private for-profit and public hospitals in Greece (original) (raw)
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HEALTH SERVICES IN GREECE: AN APPROACH TO THEIR OPERATIONAL COST
In recent years, Private Clinics as well as State Hospitals (Healthcare Units) in Greece have been forced to find a method in order to arrive at their operational costs. The method Healthcare Units have selected is that of direct costing. The present article attempts to present the operational cost Private Healthcare Units in Greece have. Furthermore, the article shows how hospitalization charges developed in Greece during the 1992-2002 decade. Last, the results deriving from the assessment of cost through real cost data and delineated in the present article lead to the conclusion that the operation of Healthcare Units in Greece is almost prohibitive since the aid the state grants for hospitalization charges does not suffice in covering the fixed costs units incur during their operation.
Health Policy
The influence of the financial crisis on the efficiency of Greek public hospitals has been widely debated. Despite this increasing interest in such research, the question of to what extent the recent reforms in the Greek National health care system were effective in establishing a health care structure and process that provide better results for patients has yet to be fully investigated. As a step in this direction, the paper focuses on patient's experience with public hospital care quality before and during the economic crisis. A questionnaire survey was carried out among 1872 patients discharged from 110 out of the total of 124 Greek public hospitals. Patients' perceptions were analysed using a structural equation modelling approach. The findings reveal that public hospital service quality is at a medium level (66.2 on a scale from 1 to 100) over 2007-2014, presenting a decreasing trend during the recession. Policies to address the crisis may have contributed to a reduction in hospital expenditures, but at the same time patients were increasingly dissatisfied with the technical care. Consequently, there is a need for reforms aimed at the achievement of productivity gains, responsibility, and transparency in the management of productive resources, by enabling health organisations to reduce their costs without a deterioration in the quality of care.
Private health expenditure in the Greek health care system: Where truth ends and the myth begins
Health Policy, 2008
Greece today has the most "privatized" health care system among EU countries. Given the country's universal coverage by a public system this may be called "the Greek paradox". The Objective of this paper is to analyze private health payments by provider and type of service in order to bring to light the reasons for and the nature of the extraordinary private expenditure in Greece. Methods: We used a randomized countrywide sample of 1616 households. Regression analysis was used to determine the extent to which social and economic household characteristics influence the frequency of use of certain health services and the size of household payments for such services. In all statistical analyses we used the p < 0.05 level of significance. Results: Out of the total private household health expenditure (D 6141 million), 66% is for outpatient services, with the largest share for dental services, absorbing 31.1% (D 1912 million or 1.5% of GDP) of the total out-of-pocket health expenditure. Rural dwellers seek private outpatient care more often, because of the understaffed public primary facilities. The hospital sector absorbs less than 15% (or D 884 million) of household private health expenditure. A significant part (20%) of hospital care financed privately concerns informal payments within public hospitals, an amount almost equal with formal payments in the form of cost sharing. Admissions to private hospitals are only 16% of total admissions. Our results indicate that this is a result of the political emphasis in public hospitals and of the considerably high cost of private hospital care. Conclusions: The rise in private health expenditure and the development of the private sector during the last 20 years in Greece is associated with public under financing. The gap was filled by the private sector through increased investment, mostly in upgraded amenities and new technology. Today, the complementary nature of private care in Greece is no longer disputed, but is a matter of serious concern, as it undermines the constitutionally guaranteed free access and equitable distribution of health resources.
Comparing public and private providers: a scoping review of hospital services in Europe
BMC Health Services Research
Background: What is common to many healthcare systems is a discussion about the optimal balance between public and private provision. This paper provides a scoping review of research comparing the performance of public and private hospitals in Europe. The purpose is to summarize and compare research findings and to generate questions for further studies. Methods: The review was based on a methodological approach inspired by the British EPPI-Centre's methodology. This review was broader than review methodologies used by Cochrane and Campbell and included a wider range of methodological designs. The literature search was performed using PubMed, EconLit and Web of Science databases. The search was limited to papers published from 2006 to 2016. The initial searches resulted in 480 studies. The final sample was 24 papers. Of those, 17 discussed economic effects, and seven studies addressed quality. Results: Our review of the 17 studies representing more than 5500 hospitals across Europe showed that public hospitals are most frequently reported as having the best economic performance compared to private not-for-profit (PNFP) and private for-profit (PFP) hospitals. PNFP hospitals are second, while PFP hospitals are least frequently reported as superior. However, a sizeable number of studies did not find significant differences. In terms of quality, the results are mixed, and it is not possible to draw clear conclusions about the superiority of an ownership type. A few studies analyzed patient selection. They indicated that public hospitals tend to treat patients who are slightly older and have lower socioeconomic status, riskier lifestyles and higher levels of co-morbidity and complications than patients treated in private hospitals. Conclusions: The paper points to shortcomings in the available studies and argues that future studies are needed to investigate the relationship between contextual circumstances and performance. A big weakness in many studies addressing economic effects is the failure to control for quality and other operational dimensions, which may have influenced the results. This weakness should also be addressed in future comparative studies.
Restructuring the hospital sector in Greece in order to improve effectiveness and efficiency
Social Cohesion and Development, 2016
This paper discusses the study focused on the reform of Greek Hospital Sector, also known as "hospital mergers". The aim of the study was to propose a new pattern of organizing hospitals in groups based on the reform of emergency care and the management of five main chronic diseases (AMI, Stroke, Cancer, Diabetes Mellitus and COPD). The proposals in general concern the creation of a national network of health services provided mainly by primary healthcare units and the largest hospitals of the groups in each health region. In the context of improving the hospital sector efficiency, ways of collaborations between private and public sector and expenditure containment measures are presented. The restructuring of the public hospital sector relied on six specific criteria including the population criterion, catchment area, hospital size, infrastructure age, utilization of hospital facilities and cost. Due to its nature, the study was exposed to various factors such as the diversity of actors being involved, collection and compilation of the relevant data in a short term of three months, last minute adjustments and the variety of audience.
Tomorrow’s public hospital in Greece: Managing health care in the post crisis era
Social Cohesion and Development, 2016
The management of the hospitals (defined as the attempt for optimum performance via appropriate cycles of planning, deciding, evaluating, and reviewing), transcends all the functional parameters of the production and provision of health services. Tomorrow's public hospital in Greece demands a new managerial approach. This approach would sufficiently answer to the main four problematic conundrum of today: the perverse unaccountability of medical subjectivity, the obsolete management model, the lack of human resources management tools and the unhealthy financing of hospitals. Tomorrow's hospital would respect the autonomy of the medical profession while at the same time would demand scientific accountability, would utilize modern organizational tools to manage its human resources in order to produce effectively and efficiently quality services and finally would measure its performance on a case by case basis.
Factors’ Affecting the Hospital’s Cost Structure: the Case of a Greek University Hospital
Universal Journal of Accounting and Finance, 2013
This paper analyzes the data that compose the cost structure of Greek Public Hospitals. Moreover, an attempt is made to explore the main operating factors that affect the total cost of public hospitals. This study, tries to contribute to literature in order to group into categories the expenses of public hospitals, while also it provides information to users on the cost structure of those hospitals. In order to do so, a big Public University Hospital of Greece was taken into account, for the period 2005-2009 in a quarterly basis for both financial and operative factors. Eleven cost categories which constitute the cost structure of the Hospital and four operative factors were taken into account for this analysis. The results show the cost factors who significantly affect the cost structure of this particular University Hospital.
SAGE Open Medicine, 2019
Background and Aims: Clinical audit is applied to optimize clinical practice and quality of healthcare services while controlling for money spent, critically in resource-deprived settings. This case study reports on the outcomes of a retrospective clinical audit on private hospitalizations, for which reimbursement had been pending by the Health Care Organization for Public Servants (OPAD) in Greece. This case study is the first effort by a social insurance organization in Greece to employ external clinical audit before settling contracted private healthcare charges. Methods: One thousand two hundred hospitalization records were reviewed retrospectively and a fully anonymized clinical audit summary report created for each one of them by a team of clinical audit experts, proposing evidence-based cuts in pending charges where medical services were deemed clinically unnecessary. These audit reports were then collated and analysed to test trends in overcharges among hospitalized insureds...
Health Economics Review, 2021
Background In developed countries around the world there is a trend to enhance the public-private collaboration in healthcare. In Spain, a decentralized country with a NHS funded with taxes and universal coverage, commissioning to for-profit private hospitals the production of healthcare services to specific patients that are publicly insured is a traditional practice. Around 43% of the for-profit private hospitals in Spain have a commissioning agreement with the NHS to diagnose or treat patients on public tariffs. These revenues represent 26% of the total revenues of private for-profit hospitals. The research question of this study is if commissioning with the NHS improves the financial performance of private-for-profit hospitals in Spain. Methods With a long panel (2000–2017) of for-profit hospitals we estimate a model for the financial performance (return on assets) using commissioning as main explanatory variable and other variables as control (variables financial indicators and...
Do public and private hospitals differ in quality? Evidence from Italy
Regional Science and Urban Economics, 2020
We investigate whether public and private providers di¤er in quality in Lombardy, a large Italian region. This region has adopted an "internal market" model where public and private providers are paid by DRG and compete for publicly-funded patients for both elective and emergency treatments. Using a large administrative sample in 2012-14, we measure clinical quality with 30-day mortality for the following emergency conditions: heart attack (AMI), stroke (ischemic and haemorrhagic) and hip fracture. For elective care, where mortality is negligible, we measure 30-day emergency readmission rates for hip replacement and knee replacement. Public and private hospitals may compete not only on clinical quality, but also on non-clinical aspects of patients'experience. We investigate whether private providers have shorter waiting times for hip and knee replacements. To control for unobserved di¤erences in casemix between public and private providers we pursue an instrumental variable approach based on the distance between patient's residence and the closest public and private provider: longer distances to the closest private and public hospital are highly signi…cant determinants of whether the patient is treated by a private versus a public provider. We …nd, with few exceptions, that public and private providers generally do not di¤er in elective and emergency quality, neither in waiting times. The only exception is AMI for which mortality risk is lower in private providers, and hip replacement for which readmission risk is higher in private providers.