Health policy making under information constraints: An evaluation of the policy responses to the economic crisis in Greece

Introduction

Cost consolidation in the highly fragmented and inefficient Greek health care system was necessary. However, policies introduced were partly formed in a context of insufficient information. Expenditure data from a consumption point of view were lacking and the depth of the political and structural problems was of unknown magnitude to the supervisory authorities.

Methods

Drawing upon relevant literature and evidence from the newly implemented OECD System of Health Accounts, the paper evaluates the health policy responses to the economic crisis in Greece. The discussion and recommendations are also of interest to other countries where data sources are not reliable or decisions are based on preliminary data and projections.

Results

Between 2009 and 2012, across-the-board cuts have resulted in a decline in public health expenditure for inpatient care by 8.6%, for pharmaceuticals by 42.3% and for outpatient care by 34.6%. Further cuts are expected from the ongoing reforms but more structural changes are needed.

Conclusion

Cost-containment was not well targeted and expenditure cuts were not always addressed to the real reasons of the pre-crisis cost explosion. Policy responses were restricted to quick and easy fiscal adjustment, ignoring the need for substantial structural reforms or individuals’ right to access health care irrespective of their financial capacity. Developing appropriate information infrastructure, restructuring and consolidating the hospital sector and moving toward a tax-based national health insurance could offer valuable benefits to the system.     

Evaluation of the socialist health policy in Greece

Following seven years of military rule and seven years of "democratic restoration" under the Right, Greece is now sailing under the flag of the Panhellenic Socialist Movement (PASOK). The Movement was inspired by the ideals of participatory democracy and socialization of the economy and of social services. A central part of socialist planning brought about the National Health System Act (1983) and related legislation intended to universalize health care, remove disparities, and restrict the private sector. It is argued here that the implementation of PASOK's statutory reforms in this field, as in others, will be subject to its ability to transform traditional patterns of production and consumption. As is now increasingly understood, it is hard to plan for socialism on the basis of wants provisions and patterns of consumption established under capitalism.     

Health economic evaluation in Greece

OBJECTIVES: There is a growing volume of literature on health economic evaluation, with this form of analysis becoming increasingly influential at the decision-making level worldwide. The purpose of this study was to review the current state of health economic evaluation in Greece, with a view to uncovering reasons why its use in this country is limited. METHODS: A search of the NHS Economic Evaluation Database was undertaken. The search included cost, cost-of-illness, cost-minimization, cost-effectiveness, cost-consequences, cost-utility, and cost-benefit analyses and was narrowed only to Greek authors undertaking solo or joint health economic evaluation in Greece. RESULTS: The search revealed that, in Greece, very little health economic evaluation has been undertaken. The main reason for the lack of interest is that the current chaotic healthcare system structure and financing does not provide the appropriate incentives to stimulate a powerful interest in this type of research. This condition is a result of the lack of a long-term national health policy and the hesitation of the present and past Greek governments to date to proceed to large-scale reforms because of political considerations. The Greek governments have also been content with the good health indicators being achieved. CONCLUSIONS: Even if it is accepted that good health prevails in Greece, slower economic growth rates, an ageing population, and the continuous immigration will place increasing pressure on healthcare resources and will necessitate a more rational use of these resources. Health economic evaluation, by weighing benefits against costs, therefore, has an important role to play.     

Smoking policy and prevalence in Greece: an overview

BACKGROUND: Smoking is one of the largest public heath problems and a cause of major concern not only among European members such as Greece but also worldwide. Greece over the past years has been suffering from a smoking epidemic with dramatic consequences on the economy and the cost of health services. Therefore, the purpose of this study is to describe the extent of tobacco usage, the methods used to control tobacco consumption, and the main reasons of anti-tobacco legislation failure over the past decades in Greece. METHODS: Data were collected from the international PubMed database and from the Greek database, Iatrotek, during January 2006 and the tobacco legislation was discussed with other counterparts in Greece and was rechecked with the Greek ministry of Health and Social Welfare. RESULTS: Currently Greece has the highest smoking prevalence not only among members of the European Union but also among all members of the OECD. Recent epidemiological studies estimate that 40% of the adult population are daily smokers, with one in two adolescents in certain areas also current smokers. Although anti-smoking policies do exist, and have been enforced over the years, many factors have contributed to their failure with a pro-tobacco culture and an increasing number of adolescent smokers exacerbating the problem. CONCLUSIONS: It is obvious that the strict enforcement of a nationwide anti-tobacco policy must be a priority on the national health agenda, if we are to ever effectively combat the high prevalence of smoking in Greece.     

Preliminary psychometric properties of the CFTIndex in Greece: the perspective of physical education

The promotion of creativity has been proved a necessity in the education process. The research on creativity in physical education though is very limited worldwide and there is a lack of multilingual evaluation instruments. In the current study, the Creativity Fostering Teacher Index (CFTIndex) was translated and culturally adapted in Greek and further checked for its stability and internal consistency. The final version of the Greek CFTIndex (Gr-CFTIndex) was assessed for items stability, sub-scales and total instrument internal consistency using a sample of 220 primary physical educators. Items stability was measured with Kendall's τ_c and was found to have a moderate positive significant correlation (+0.3?<?τ_c ?>?+0.8, p?<?.01). Exploratory factor analysis yielded six factors and their Cronbach alpha coefficients varied from .695 to .897. The total internal consistency of the Gr-CFTIndex was high (α?=?.92). All sub-scales’ inter-correlations were positive and significant.     

Stigmatization,discrimination and fear of aids in Greece: Implications for health policy

A prospective health‐education research project about AIDS knowledge and attitudes towards AIDS was conducted in Athens and nine adjacent municipalities in west Attica, Greece. Socioeconomic and demographic data, AIDS knowledge, and attitudinal information were collected from 1552 respondents and analysed treating the attitudes of stigmatization, discrimination and fear towards AIDS as the dependent variable. Statistically significant correlations were found between each of the three attitudinal variables and the independent ones; specifically, age, place of residence, marital status and level of AIDS knowledge. Our working hypothesis—that the higher the level of AIDS knowledge, the lower the level of discrimination and stigmatization—was supported by our data. The relationship between AIDS knowledge and fear was less clear. Fear probably inhibits a rational approach to screening for HIV, and more empirical research is needed about fear and its interaction with stigmatizing and discriminatory attitudes and behaviours. Such research should be aimed at identifying population groups ‘at risk’ of expressing high levels of negative social attitudes about AIDS so that educational programmes can be appropriately designed.     

Economic evaluation of irbesartan in combination with hydrochlorothiazide in the treatment of hypertension in Greece

Objectives  

Hypertension is a major risk factor for cardiovascular disease and a leading cause of morbidity and mortality. This study evaluates irbesartan in relation to commonly used alternative hypertension therapies losartan and valsartan given in combination with hydrochlorothiazide (HCTZ) in the general hypertensive population in Greece.     

Economic evaluation of hemodialysis: implications for technology assessment in Greece

OBJECTIVES: Hemodialysis is a well-established treatment for 74 percent of end-stage renal disease (ESRD) patients in Greece. The purpose of this study is to provide an estimate of the direct cost of dialysis in a public hospital setting and an estimate of the loss of production for ESRD patients. The results will be useful for public health facility planning purposes. METHODS: A socioeconomic prevalence-based analysis was performed using micro-economic evaluation of health-care resources consumed to provide hemodialysis for ESRD patients in 2000. Lost productivity costs due to illness were estimated for the patient and family using the human capital approach and the friction method. Indirect morbidity costs due to absence from work and long-term were estimated, as well as mortality costs. Mean gross income was used for both patient and family. RESULTS: Total health-sector cost for hemodialysis in Greece exceeds 171 million Euros, or 182 Euros per session and 229 Euros per inpatient day. There were 2,046 years lost due to mortality, and the potential productivity cost was estimated at 9.9 million Euros, according to the human capital approach, and 303.000 Euros, according to the friction method. Total morbidity cost due to absence from work and early retirement was estimated at more than 273 million Euros, according to the human capital approach, and 12.5 Euros, according to the friction method. CONCLUSIONS: Providing hemodialysis care for 0.05 percent of the population suffering from ESRD absorbs approximately 2 percent of total health expenditure in Greece. In addition to the cost for the National Health System, production loss due to mortality and morbidity from the disease are also considerable. Promoting alternative technologies such as organ transplantation and home dialysis as well as improving hemodialysis efficiency through satellite units are strategies that may prove more cost-effective and psychologically advantageous for the patients.     

无烟政策国内外进展及效果评估

公共场所无烟政策基于两大科学依据:一是被动吸烟的危害性,二是被动吸烟不存在所谓的"安全暴露"水平。前者决定需要禁止被动吸烟,后者决定禁止被动吸烟的具体方式———室内100%无烟。科学研究证明,无论是单独设立吸烟区,还是使用任何通风和过滤措施,都不能有效保护     

上海市药品零差率政策实施效果的初步分析

目的:对上海市社区卫生服务中心实施药品零差率政策一年来的效果进行初步分析。方法:采用上海市药品采购数据库中的数据,对药品金额、数量和价格等进行分析。结果:零差率药品在社区卫生服务中心的使用金额构成比为17.54%,该政策实施后这一比例并无提高;而所有药品的总金额增长了15.79%,金额前20位药品的价格水平提高了11.25%。讨论:零差率药品目录的科学性是该政策得以有效实施的基础,促进合理使用的措施和补偿到位是保证该政策效果的必要条件;分析发现,该政策实施1年来,降低居民就医负担,引导常见病、多发病和诊断明确慢性病在社区诊治等主要政策目标可能并未达到;零差率这一做法是否还要在基本药物制度中继续沿用值得进一步探讨。     

An evaluation of the new home-care needs assessment policy in the Netherlands

The aim of the present study was to describe the realisation of the new-style needs assessment in the Netherlands and how it is evaluated. Furthermore, judgements about the new way of assessing (chronic) patients' needs with respect to home care are presented. Data were gathered by means of a postal survey of all assessment agencies, home-care organisations and health insurers. The new-style assessment, as regulated by the Needs Assessment Decree, implies that home-care needs should be objectively assessed independently of the availability of care supply and integrally with other types of (long-term) care. This study shows that all the organisational structures required to realise these goals are present. However, according to factual and evaluative data, many practical aspects of these structures appear to be deficient. The national assessment forms, an instrument for gaining objectivity, are judged impracticable by half of the assessment agencies. Mandating arrangements threaten independent as well as integral needs assessment. Whether the new-style assessment is evaluated positively or negatively depends upon the type of organisation under study. On the one hand, assessment agencies are positive about their achievements. On the other, home-care organisations are generally negative about the functioning and advantages of the new style of needs assessment. Health insurers' opinions are in between those of assessment agencies and home-care organisations.     

Examples of the influence of evaluation on health policy.

Regulation strategies for controlling hospital costs are widely discussed today and medical technology assessment is one of these strategies. A Committee for Evaluation of the Diffusion of Innovative Technologies (CEDIT) was created in 1982 at the 'Assistance Publique de Paris', the most important health care institution in France. The CEDIT makes recommendations to the Director General on the use of new technologies. Since 1982, more than 50 medical technologies have been studied by the CEDIT: procedures such as plasmapheresis, bone marrow transplantation and percutaneous transluminal angioplasty; equipment such as lasers and the lithotriptor. The CEDIT helps planners who have to make difficult choices.     

政策评价在卫生领域的研究综述

卫生领域政策评价是卫生政策过程的一个重要组成部分，政策评价对于审查新的政策方案、调控政策执行资源、决定政策持续、修正或终结等方面的具有重要的意义。但现阶段我国对这一问题的研究尚不多见，该文就政策评价在卫生领域的应用和发展予以汇总和分析，在明确了医疗卫生政策评价功能的基础上，为进一步完善我国卫生政策运做过程科学化提供几许参考。     

Patient adherence to pharmaceutical care amid the economic crisis in Greece: Underlying priority areas for policy makers

The purpose of the study was to investigate the degree to which chronic patients adhered to medication regimens during the economic crisis in Greece. It is a quantitative cross-sectional study, with a convenience sample of 1,009 residents of Western and Northern Greece, aged ≥ 18 years, with chronic health problems. The survey was conducted between February and June 2016. Data were collected via a structured questionnaire with closed-ended questions, filled out during face to face interviews with all participants. The vast majority of respondents (94.5 %) said that they were able to buy prescribed drugs but had to economise in other ways (for example, by cutting back on clothing and travel) to cope with essential household expenses, including medication. Only 71 % of participants said they remembered to take their prescribed medications every day, following all of their physicians’ recommendations. Almost 70 % of participants said that using generic medications made it easier to adhere to their treatment regimens. The results of a correlation analysis showed that patients experiencing financial hardships as a result of health problems were less likely to adhere to pharmaceutical care regiments than those who were not experiencing financial difficulties (p = 0.026). Men had a higher level of adherence than women (p = 0.001).     

Nutritional evaluation and health promoting activities of nuts and seeds cultivated in Greece

Abstract

Available data suggest that genetic as well as environmental factors may influence nuts and seeds nutrients content. In this context nuts and seeds cultivated in Greece were studied. Macronutrients content was in agreement with that from other areas. Total phenolics content was in the range of 43.0?±?2.1–1512.7?±?60.7?mg GAE/100?g for chestnut and walnut, respectively. Thirteen to 22 individual phenolics were identified in the studied species. Oleanolic acid was in the range of 0.10–9.03?mg/100?g. Pumpkin seeds contained the higher squalene content (71.6?mg/100?g). β-Sitosterol predominated in all samples except pumpkin seeds. Tocopherols ranged from 8.9?mg/100?g (chestnut) to 29.3?mg/100?g (almond). Nuts and seeds hydrophilic extracts at quantities corresponding to the estimated daily consumption by the Greeks succeeded in inhibiting LDL oxidation in vitro by increasing lag time 1.1–14.1 times. One serving of nuts or seeds may cover a significant fraction of health promoting microconstituents daily intake.     

Economic evaluation methods and health policy.

Economic evaluation of health services may take many forms, depending on the range of costs and consequences included in the analysis and the methods employed to measure and value them. In order to clarify the sometimes confusing array of economic analyses for users and evaluations, an analytic overview of costs and consequences to be considered for inclusion in such evaluations is presented. This allows the techniques of cost-effectiveness, cost-benefit, and cost utility analysis to be differentiated. Two often neglected methodologic issues are also discussed. First, it is suggested that the significance of the analytic viewpoint for economic evaluations should not be underestimated. Second, it is recognized that economic evaluations that demonstrate cost savings from a program or policy change implicitly assume that resources can be removed from the health sector. In fact, this is seldom true, consequently strategies for incorporating this knowledge into evaluations are discussed.