Relationship between profitability and financial factors of hospitals after a period of austerity and health care reforms: evidence from Greece.

PURPOSE: The reduction of government expenditure in the healthcare system, the difficulty of finding new sources of funding and the reduction in disposable income per capita are the most important problems of the healthcare system in Greece over the last decade. Therefore, studying the profitability of health structures is a crucial factor in making decisions about their solvency and corporate sustainability. The aim of this study is to investigate the effect of economic liquidity, debt and business size on profitability for the Greek general hospitals (GHs) during the period 2016-2018. DESIGN/METHODOLOGY/APPROACH: Financial statements (balance sheets and income statements) of 84 general hospitals (GHs), 52 public and 32 private, over a three-year period (2016-2018), were analyzed. Spearman's Rs correlation was carried out on two samples. FINDINGS: The results revealed that there is a positive relationship between the investigated determinants (liquidity, size) and profitability for both public and private GHs. It was also shown that debt has a negative effect on profitability only for private GHs. PRACTICAL IMPLICATIONS: Increasing the turnover of private hospitals through interventions such as expanding private health insurance and adopting modern financial management techniques in public hospitals would have a positive effect both on profitability and the efficient use of limited resources. ORIGINALITY/VALUE: These results, in conjunction with the findings of the low profitability of private hospitals and the excess liquidity of public hospitals, can shape the appropriate framework to guide hospital administrators and government policymakers.

The Association between Fear of COVID-19 and Health-Related Quality of Life: A Cross-Sectional Study in the Greek General Population.

The aim of this cross-sectional study was to assess the level of fear related to the SARS-CoV-2 virus and the association of fear, and of sociodemographic and clinical characteristics, with health-related quality of life (HRQoL). A large sample of the Greek general population (N = 583) completed the validated versions of the Fear of COVID-19 scale (FCV-19s) and the 12-item Short Form (SF-12), and provided data on socio-demographic status, health history and COVID-19 protective behaviors. Variables were compared with Mann-Whitney and Kruskal-Wallis tests and associations with Spearman's correlations. Gamma regression models investigated the influence of sociodemographic and COVID-related variables on HRQoL. The mean FCV-19s score for the sample was 18.3 ± 5.6, and physical and mental component summary scores were 50.2 ± 7.9 and 46.7 ± 10.1, respectively. More fear of COVID-19 was expressed by females (p < 0.001), individuals with comorbidities (p < 0.01), those with contacts with comorbidities (p < 0.001), and individuals not having caught COVID-19 (p < 0.05). Contrastingly, less fear was expressed by unvaccinated individuals and those with less frequent intake of information about the pandemic. Item level and overall FCV-19s scores were negatively associated with SF-12 summary scores, and fear of COVID-19 was the most important predictor of both physical and mental HRQoL. The findings from this and other similar studies could help to identify specific population groups in need of interventions to improve their physical and mental health, which had deteriorated due to the pandemic.

Does bullying in the hospital affect the health-related quality of life of health professionals?

BACKGROUND: This study investigates workplace harassment among Greek NHS employees and its impact on Health Related Quality of Life (HRQoL). OBJECTIVES: In the present study, we highlight that the consequences of workplace harassment and the concomitant damaged satisfaction can negatively affect health-related quality of life in Public Hospitals. METHODS: A sample of 343 employees from five Athens-based hospitals, including doctors, nurses, administrative and technical personnel, completed the Greek versions of the Leymann Inventory of Psychological Terrorization (LIPT) and the Short Form-36 (SF-36). Multiple logistic regression identified factors associated with mobbing, and adjusted odds ratios were computed. RESULTS: Out of the 37.5% of the employees who reported experiencing mobbing, 22.7% were bullied daily, and 49.2% almost daily. Furthermore, 66.7% were bullied by colleagues of the same grade, while 58.7% were from superiors. Regarding HRQoL, all SF-36 dimension scores were significantly lower (p < 0.001) for the mobbing victims, compared to others not having suffered workplace harassment. CONCLUSION: The existence of mobbing in the Greek NHS is evident, and that harms health. Preventing workplace harassment should be high on policymakers' agendas to improve human resource management and health system performance.

A Comparison of EQ-5D-3L, EQ-5D-5L, and SF-6D Utilities of Patients with Musculoskeletal Disorders of Different Severity: A Health-Related Quality of Life Approach.

This study compares EQ-5D-3L, EQ-5D-5L, and SF-6D utilities in patients with different musculoskeletal (MSK) disorders, also differing in disease severity as defined by valid clinical indexes. Utilities were measured from a cross-sectional sample of rheumatoid arthritis (N = 114), psoriatic arthritis (N = 57), ankylosing spondylitis (N = 49), and osteopenia/osteoporosis (N = 95) patients. For the first three groups, disease activity (severity) was measured with the DAS-28, DAPSA, and BASDAI clinical indexes, respectively. Mean differences and effect sizes were measured, and agreement between utilities was estimated with the intraclass correlation coefficient and Bland−Altman plots. Higher agreement was observed between EQ-5D-5L and SF-6D, compared to EQ-5D-3L and SF-6D, in all MSK disorder groups and severity levels. In groups with moderate to high severity, agreement between EQ-5D-3L/SF-6D and EQ-5D-5L/SF-6D was between low and fair, and both EQ-5D-3L and 5L utilities were lower than SF-6D (p < 0.001). On the other hand, in remission or low activity groups, agreement was excellent, and SF-6D utilities were again typically higher than EQ-5D-3L/5L, but not significantly. In more severe patients, SF-6D generated significantly higher utilities than EQ-5D-3L and 5L, which is consistent with most previous studies. Such discrepancies could have implications on economic evaluations of interventions targeting patients with MSK disorders.

Psychometric evaluation of the Overactive Bladder Questionnaire (OAB-q) for measuring quality of life and clinical implications in Greek patients with overactive bladder.

INTRODUCTION AND HYPOTHESIS: The Overactive Bladder Questionnaire (OAB-q) measures overactive bladder patients' severity of symptoms and their impact on health-related quality of life (HRQoL). The aim of this study was to validate the OAB-q in Greek patients with overactive bladder and report clinical implications of the disease. METHODS: In total, 107 patients were recruited consecutively in our clinic. They completed the OAB-q and Short Form-36 Health Survey (SF-36) twice, 3 months apart. Simultaneously, they initiated lifestyle changes and drug therapy. The reliability of OAB-q was estimated by its internal consistency (Cronbach's α). Validity was estimated by criterion validity and concurrent validity by comparison with SF-36. RESULTS: The sample's mean age was 62.1 years, and 74.8% were women. Cronbach's α exceeded the 0.7 threshold in all OAB-q subscales, implying good reliability of internal consistency for the OAB-q. In addition, moderate (Pearson's r > 0.3) or strong (r > 0.5) correlations were observed between OAB-q subscales and the relevant SF-36 subscales, implying concurrent validity. Clinically, urgency incontinence affected symptom bother (p = 0.001), concern/worry (p = 0.031) and social interaction (p = 0.027). Nocturia had the largest impact on HRQoL in patients with overactive bladder, as it affected all the OAB-q subscales (p < 0.001). CONCLUSIONS: The Greek version of the OAB-q has shown strong psychometric properties of reliability and validity in our study. Urgency incontinence and especially nocturia seem to affect the HRQoL of patients with overactive bladder. OAB-q is valid for Greek patients with overactive bladder and can be used for clinical and academic purposes.

Willingness to pay and quality of life in patients with pruritic skin disorders.

Pruritic dermatosis is a frequent and burdensome disease. The objectives of this study were (1) to assess the willingness to pay (WTP) and the health-related quality of life (HRQoL) in patients with pruritic dermatoses and (2) to compare the results with data on socio-demographic data, and clinical features/symptoms of the patients. One hundred and three patients with pruritic dermatosis had participated in a non-interventional, cross-sectional study. Socio-demographic data, clinical features/symptoms, a health-related quality of life (HRQoL)-based and a dermatology-specific instrument (SF-6D and DLQI, respectively), and two utility indicators such as rating scale (RS) and time-trade-off (TTO) as well as willingness to pay (WTP) were recorded. In our study, there was a significant correlation between DLQI scores and WTP (p < 0.001). Time-trade-off (TTO) was also statistically correlated with SF-6D (p = 0.001). Regression models showed that daily duration and pruritus intensity were associated with lower HRQoL. Furthermore, WTP was the only measure revealing demographic and socio-economic characteristics such as age, education level, family status and income as predicting factors. No significant differences between groups of varying skin diseases were observed. HRQoL and WTP proved to be valid tools to assess the burden of disease in patients with pruritic dermatosis. However, further research with a larger number of patients is needed to validate the present findings.

Comparison of health-related quality of Life (HRQOL) among patients with pre-diabetes, diabetes and normal glucose tolerance, using the 15D-HRQOL questionnaire in Greece: the DEPLAN study.

BACKGROUND: Diabetes mellitus is usually preceded by a pre-diabetic stage before the clinical presentation of the disease, the influence of which on persons' quality of life is not adequately elucidated. The purpose of this study was to compare the Health-Related Quality of Life (HRQOL) of persons with pre-diabetes with that of diabetes or normal glucose tolerance (NGT), using the validated HRQOL-15D questionnaire. METHODS: The HRQOL-15D scores of 172 people with pre-diabetes (108 with Impaired Fasting Glucose [IFG], 64 with Impaired Glucose Tolerance [IGT], aged 58.3 ± 10.3 years) and 198 with NGT (aged 54.4 ± 10.1 years) from the Greek part of the DEPLAN study (Diabetes in Europe - Prevention using Lifestyle, Physical Activity and Nutritional Intervention), were compared to 100 diabetes patients' scores (aged 60.9 ± 12.5 years, diabetes duration 17.0 ± 10.0 years, HbA1c 7.2 ± 1.2%), derived from the outpatient Diabetes Clinic of a University Hospital. RESULTS: The diabetes patients' HRQOL-15D score (0.8605) was significantly lower than the pre-diabetes' (0.9008) and the controls' (0.9092) (p < 0.001). There were no differences in the total score between the controls and the group with pre-diabetes. However, examination of individual parameters of the score showed that people with IGT had lower scores compared to the control group, as related to the parameters of "mobility" and "psychological distress". No differences were found in any component of the HRQOL-15D score between the control group and the IFG group, nor between the two groups with pre-diabetes (IFG vs. IGT). CONCLUSIONS: Persons with pre-diabetes had a similar HRQOL score with healthy individuals, and a higher score than persons with diabetes. Specific components of the score, however, were lower in the IGT group compared to the controls. These findings help clarify the issue of HRQOL of persons with pre-diabetes and its possible impact on prevention.

Quality of life in children with chronic kidney disease.

BACKGROUND: Progressive chronic kidney disease (CKD), irrespective of the underlying etiology, affects the quality of life (QoL) of children due to the need for regular follow-up visits, a strict medication program and diet intake. METHODS: The Greek version of the KIDSCREEN-52 multidimensional questionnaire was used in children with CKD, renal transplantation (RT) and in a control group (CG) of healthy children. RESULTS: Fifty-five patients between 8 and 18 years, with CKD (n = 25), RT (n = 16) and with end-stage renal disease (ESRD) on peritoneal dialysis (PD) (n = 14) were included. Each group of studied children was compared with the CG (n = 55), the validation sample (VS) (n = 1200) and the parent proxy scores. Physical well-being of all studied children was significantly lower compared to CG (p = 0.004). In contrast, all studied children between 8 and 11 years showed better social acceptance compared to VS (p = 0.0001). When QoL of children with CKD was compared with parent proxy QoL, conflicting opinions were observed in several dimensions, such as self-perception (p = 0.023), autonomy (p = 0.012), school environment (p = 0.012) and financial resources (p = 0.03). CONCLUSIONS: QoL and mainly the dimension of physical well-being, may be affected dramatically in children with CKD unrelated to disease stage. In early school years children with CKD seem to feel higher social acceptance than the healthy controls, exhibiting better score in this dimension. Optimal care requires attention not only to medical management, but also to an assessment of QoL factors, that may help promote pediatric patient's health.