The impact of economic crisis on the Greek hospitals' productivity.

During the recent economic crisis, Greece implemented a comprehensive reform in the health care system. The 2010 health reform occurred under the constraints imposed by the memorandum of understanding that the Greek Government signed with its EU/International Monetary Fund creditors to control its deficit. The objective of the study is to examine the impact of the reform on the efficiency and productivity of public hospitals in Greece. We use the Malmquist productivity index to comparatively examine the potential changes before and after the reform years. We compare productivity, efficiency, and technological changes using panel data of 111 public acute hospitals operating in Greece throughout the recession period of 2009 to 2012. Bootstrapping methods are applied to allow for uncertainty owing to sampling error and for statistical inference for the Malmquist productivity index and its decompositions. The analysis indicates that the productivity has been increased following the policy changes. It appears that the expected benefits from the reform in general have been achieved, at least in the short-term. This result is examined in the light of management and operations activities, which are related with the reform process. Therefore, at a second stage, the Malmquist index is regressed on variables that may potentially be statistically associated with productivity growth.

Managing for efficiency in health care: the case of Greek public hospitals.

This paper evaluates the efficiency of public hospitals with two alternative conceptual models. One model targets resource usage directly to assess production efficiency, while the other model incorporates financial results to assess economic efficiency. Performance analysis of these models was conducted in two stages. In stage one, we utilized data envelopment analysis to obtain the efficiency score of each hospital, while in stage two we took into account the influence of the operational environment on efficiency by regressing those scores on explanatory variables that concern the performance of hospital services. We applied these methods to evaluate 96 general hospitals in the Greek national health system. The results indicate that, although the average efficiency scores in both models have remained relatively stable compared to past assessments, internal changes in hospital performances do exist. This study provides a clear framework for policy implications to increase the overall efficiency of general hospitals.

A biobjective model for the locational planning of hospitals and health centers.

The aim of this paper is to propose a new location-allocation structure, in an effort to improve the operational shortcomings of the existing locations of primary health care centers. These shortcomings are mainly caused by the preference of patients to use local hospitals rather than health centers. The method is based on a biobjective mathematical programming model for locating hospitals and primary health care centers. Two objectives are considered: (1) minimization of distance between patients and facilities, (2) equitable distribution of the facilities among citizens. We formulate the model taking into consideration the interdependence of the locations i.e., the general hospitals and health centers. This approach enables us to introduce a new aspect to the location problem, namely public preferences and also to consider the decentralization of the health care system. In order to represent the available information we employ Geographic Information Systems (GIS). We apply this model in the area of Western Greece and then compare our results with the solution originally selected by planners. Demographic data concerning the major and minor population centers of the area were based on the latest census of 2001. The results confirm the necessity of applied scientific approaches for regulating the health care system in order to establish rational strategic planning and ensure the best use of the available resources.

Patients with type two diabetes mellitus: increased local inflammatory activation in culprit atheromatous plaques.

INTRODUCTION: Diabetes mellitus (DM) predisposes to coronary artery disease (CAD). The progression of CAD has recently come to be regarded as an inflammatory activation. Thermography detects local inflammatory involvement as heat generation. The aim of this study was to investigate whether patients with CAD and DM have increased local heat generation compared to non-diabetic patients. METHODS: We enrolled 45 patients with DM and 63 non-diabetic patients who were undergoing percutaneous coronary interventions. The two groups were matched for age, type of clinical syndrome, statin and aspirin intake and angiographic stenosis (%). Coronary thermography was performed and the temperature difference (deltaT) between the atherosclerotic plaque and the proximal vessel wall was measured. RESULTS: Patients with DM had increased deltaT compared to non-diabetic patients (deltaT: 0.17 +/- 0.18 degrees C vs. 0.09 +/- 0.02 degrees C, p = 0.01). Patients with DM and acute coronary syndromes (ACS)(n=21) had increased deltaT compared to non-diabetic patients (n=22) (deltaT: 0.29 +/- 0.31 degrees C vs. 0.15 +/- 0.21 degrees C, p = 0.02). Similarly, patients with DM and stable angina (SA) had a higher deltaT than non-diabetics with SA (deltaT: 0.09 +/- 0.08 degrees C vs. 0.05 +/- 0.04 degrees C, p = 0.006). CONCLUSION: Patients with DM have increased deltaT compared to non-diabetic patients.

Increased heat generation from atherosclerotic plaques in patients with type 2 diabetes: an increased local inflammatory activation.

OBJECTIVE: Patients with coronary artery disease (CAD) and diabetes show increased inflammatory activation. Thermography detects local inflammatory involvement as heat generation. The aim of this study was to investigate whether patients with CAD and diabetes have increased local heat generation compared with nondiabetic patients. RESEARCH DESIGN AND METHODS: We enrolled patients undergoing percutaneous coronary interventions: 45 diabetic patients and 63 nondiabetic patients, serving as the control group, matched for age, type of clinical syndrome, statin and aspirin intake, and angiographic stenosis (%). Coronary thermography was performed, and temperature difference (DeltaT) between the atherosclerotic plaque and the proximal vessel wall was measured. RESULTS: Patients with diabetes had increased temperature difference compared with nondiabetic patients (DeltaT: 0.17 +/- 0.18 degrees C vs. 0.09 +/- 0.02 degrees C, P = 0.01). Twenty-one diabetic and 22 nondiabetic patients suffered from acute coronary syndromes (ACSs) (P = 0.22). Patients with diabetes and ACSs had increased temperature difference compared with nondiabetic patients with ACSs (DeltaT: 0.29 +/- 0.31 degrees C vs. 0.15 +/- 0.21 degrees C, P = 0.02), which is the same as patients with diabetes and chronic stable angina (DeltaT: 0.09 +/- 0.08 degrees C vs. 0.05 +/- 0.04 degrees C, P = 0.006). Twenty-three diabetic and 30 nondiabetic patients were under therapy with statins (P = 0.72). Patients with diabetes under statins had lower temperature difference compared with untreated patients (DeltaT: 0.11 +/- 0.12 degrees C vs. 0.22 +/- 0.21 degrees C, P = 0.02), which is the same as nondiabetic patients under statins (DeltaT: 0.05 +/- 0.04 degrees C vs. 0.13 +/- 0.18 degrees C, P = 0.01). CONCLUSIONS: Patients with diabetes have increased temperature difference compared with nondiabetic patients. Patients with diabetes under statins showed decreased temperature difference compared with untreated patients, suggesting that statins have a favorable effect in patients with diabetes and CAD.

Thermal heterogeneity in stable human coronary atherosclerotic plaques is underestimated in vivo: the "cooling effect" of blood flow.

OBJECTIVES: This study investigated whether temperature measurements are influenced by blood flow. BACKGROUND: Previous ex vivo studies showed marked thermal heterogeneity in atheromatic plaques. In stable lesions, however, trivial in vivo temperature variations are recorded, perhaps due to the "cooling effect" of blood flow. METHODS: Eighteen patients with effort angina were studied. Coronary flow velocity was continuously recorded; over another guidewire, temperature measurements were performed at the proximal vessel wall and at the lesion before, during, and after complete interruption of blood flow by inflation of a balloon. The DeltaTp was assigned as the difference between the proximal vessel wall temperature and the maximal temperature during and after balloon inflation. The DeltaTl was assigned as the difference between the atherosclerotic plaque and the proximal vessel wall. RESULTS: The procedure was not complicated. During and after complete interruption of flow, DeltaTp was 0.012 +/- 0.01 degrees C and -0.006 +/- -0.01 degrees C (p < 0.001), respectively. The DeltaTl was 0.08 +/- 0.04 degrees C at baseline and went to 0.18 +/- 0.05 degrees C (60.5 +/- 14.1% increase) during and 0.08 +/- 0.04 degrees C after flow interruption (p < 0.001). The DeltaTl was greater than DeltaTp during and after impairment of flow (p < 0.001). A correlation between the baseline average peak velocity and DeltaTl during flow interruption was found (R = 0.57, p = 0.01). In seven patients thermal heterogeneity was not detected at baseline, and during balloon inflation DeltaTl increased by 76.0 +/- 8.4%. CONCLUSIONS: Thermal heterogeneity is underestimated in atherosclerotic plaques in patients with effort angina. Potential in vivo underestimation of heat production locally in human atherosclerotic is due to the "cooling effect" of coronary blood flow.