Cost and reimbursement analysis of end-of-life cancer inpatients. The case of the Greek public healthcare sector.

BACKGROUND: While hospital-based Palliative Care services are usually covered through the main funding healthcare framework, traditional reimbursement methods have been criticized for their appropriateness. The present study investigates for the first time the case of treating end-of-life cancer patients in a Greek public hospital in terms of cost and reimbursement. METHODS: This retrospective observational study used health administrative data of 135 deceased cancer patients who were hospitalized in the end of their lives. Following the cost estimation procedure, which indentified both the individual patient and overhead costs, we compared the relevant billing data and reimbursement requests to the estimated costs. RESULTS: The average total cost per patient per day was calculated to be 97 EUR, with equal participation of individual patient's and overhead costs. Length of stay was identified as the main cost driver. Reimbursement was performed either by per-diem fees or by Diagnosis Related Groups' (DRGs), which were correspondingly associated with under or over reimbursement risks. In the case of the combined use of the two available reimbursement alternatives a cross-subsidization phenomenon was described. CONCLUSION: Although the cost of end-of-life care proved to be quite low, the national per-diem rate fails to cover it. DRGs designed for acute care needs are rather unsuitable for such sub acute hospitalizations. POLICY SUMMARY: There is a concrete need for reconsidering the current reimbursement schemes for this group of patients as part of any national plan concerning the integration and reformation of Palliative Care services. Otherwise, there is a serious danger for public institutions' reluctance to admit them with a serious impact on access and equity of end-of-life cancer care.

Exceeding parents' expectations in Ear-Nose-Throat outpatient facilities: the development and analysis of a questionnaire.

The study attempts to develop an outpatient service quality scale by investigating the key dimensions which assess parental satisfaction and provides a recommendation on an improved health service delivery system. The survey was conducted in an Ear-Nose-Throat outpatient clinic of a Greek public pediatric hospital. A total of 127 parents in outpatient waiting areas were chosen; 74.8% of the sampled parents were under 40, and 78% were mothers. A factor analysis was performed; while a Fischer's exact test and multinomial logistic regression analysis was conducted. All Cronbach's α exceeded 0.70 and all factor loadings exceeded 0.50. Twenty-three items were retained through the scale development process and seven factors were formed that appear to be statistically valid and clinically meaningful: access and convenience, doctor's attention, customization, reliability, assurance, satisfaction and loyalty. Findings were discussed in relation to parents' overall satisfaction and intention of reusing and recommending outpatient clinic. Satisfaction was found to be positively affected by access and convenience and doctors' attention. Staff attitude and the telephone procedure of scheduling the child's examination found positively correlated to the likelihood of recommending services to friends and relatives. Time and communication in the waiting room influenced parents' satisfaction. Overall, results reveal the measures that need to be taken in order to improve outpatient service quality.

How do nursing students perceive the notion of EHR? an empirical investigation.

This paper describes an empirical study aiming to assess nursing students' perceptions on Electronic Health Record (EHR) concepts and their potential future attitude towards use. Based on the theoretical ground of Rogers' Innovation Diffusion Theory and other research works, a formulated model was empirically validated among ninety nursing undergraduates. Data analysis was based on partial least squares path modeling. Results highlighted the very strong significant effect of relative advantage and observability as well as the significant effect of perceived ease of use to attitude towards using EHR systems. The study findings are discussed along with limitations and future work in the current field.

Investigating the potential of e-Learning in healthcare postgraduate curricula: a structural equation model.

The objective of this paper is to assess the future adaptability of e-Learning platforms within postgraduate modules. An ongoing empirical assessment was conducted amongst postgraduate students, based on the Technology Acceptance Model (TAM). The current paper presents the outcomes from the second phase of a survey, involving fifty six participants. Data analysis was performed using a structural equation model, based on partial least squares. Results highlighted the very strong effect of perceived usefulness and perceived ease of use to attitude towards using e-Learning platforms. Consequently, attitude towards use proved to be a very strong predictor of behavioral intention. Perceived usefulness, on the contrary, did not prove to have an effect to behavioral intention. Implications on the potential of using e-Learning platforms are discussed along with limitations and future directions of the study.

Approaching the management of hospital units with an operation research technique: the case of 32 Greek obstetric and gynaecology public units.

Controlling healthcare costs is a multifaceted problem for governments all over the world, as they have the difficult task of ensuring that patients receive high quality care, and that this is delivered as efficiently as possible. Through the use of quantitative analysis, an attempt is made to determine the areas of activity of 32 Greek Public Obstetrical and Gynaecological Units which present problems with regard to their performance. Based on the results that emerge from the application of Data Envelopment Analysis in the 32 hospital units of the sample, information is provided to their managers, which refer to: (i) the degree of utilization of their production factors, (ii) the particular weight of each factor of production in the formation of the relative efficiency score, (iii) the utilization level of each factor of production, and (iv) those hospital units that utilize their factors of production in an optimal way and constitute models for the exercising of effective management. The derived information assists in the formulation of an appropriate policy mix per hospital unit which should be applied by their management teams along with a set of administrative measures that need to be undertaken in order to promote efficiency.