Comparison between two different measures of self-rated health: a single-question measure and a visual analogue scale.

INTRODUCTION: Self-rated health (SRH) is a useful concept for research and health planning, and an important indicator of population health. AIM: The present study aims to evaluate the appropriateness of two different measures used to assess SRH, a single question with a five-response Likert-type scale and a visual analogue scale (VAS), by studying the correlation between the two measures and the factors influencing response rates according to respondent characteristics. MATERIAL AND METHODS: A population-based postal survey was carried out within the framework of a World Health Organisation (WHO) project, with a national sample of randomly selected geographically stratified individuals. The factors influencing SRH using each measure were determined. The comparison of the two measures was also studied with respect to response frequencies and differences in association with potential determinants (age, sex, income, education). Answering to each measure depending upon answering to the other measure was also tested. RESULTS: The maximum correlation between the two measures was p = -0.78 (p < 0.001). Age, sex, income and education had an effect on SRH as measured using both measures. More people replies to the single question measure irrespective of any particular socio-economic characteristic. Generally, those completing the VAS were women of higher income. CONCLUSIONS: The two measures are moderately correlated, the structure of the questionnaire and sequence of questions seems to affect correlation, and the single question yields higher response rate than VAS does. Still, other factors may also play a significant explanatory role in SRH among the Greek population and in relation to which measure is used.

Determinants of healthcare utilization in Greece: implications for decision-making.

OBJECTIVE: To explore factors influencing the utilization of primary and secondary healthcare in Greece. METHODS: A national, geographically stratified sample was randomly selected. From November 2001 to March 2002, 5000 questionnaires were mailed, 4427 were actually received, and 1819 were completed and returned (response rate 41%). The questionnaire investigated respondents' characteristics and their health services utilization. A number of potential utilization determinants were explored, such as region, gender, age, education, income, insurance coverage, number of family members, self-rated health status, country of birth, and parents' country of birth. RESULTS: The utilization of primary healthcare services depended on self-rated health status, age, income, gender, and region. Individuals with moderate and poor self-rated health, older people, women, and residents of the region of Epirus showed increased utilization of primary healthcare services. Income was a factor affecting the utilization of primary healthcare only at lower income levels. The frequency of visits for primary healthcare was negatively correlated with self-rated health status and increased as self-evaluation of health status worsened. Hospitalization was associated with self-rated health and insurance coverage for primary healthcare. Individuals with better self-rated health status, as well as those who were covered by health insurance for primary care, showed decreased hospital care utilization. The frequency of hospitalization depended on region and lower evaluations of health status. CONCLUSION: The findings of our research are encouraging, since they suggest that the utilization of health services in Greece is mostly determined by health status rather than other socioeconomic factors. It is believed that similar studies should be conducted in the country, since they can improve health service planning and reinforce decision-making towards healthcare resource allocation according to healthcare needs.

Generics market in Greece: the pharmaceutical industry's beliefs.

The aim of this study was to investigate the beliefs and perspectives of the pharmaceutical industry on generic medication in Greece. Questionnaires were mailed to all 58 members of the Hellenic Association of Pharmaceutical Companies from November 2002 to February 2003. The response rate was 52%, namely 30 questionnaires were completed and returned. The questionnaire requested information on companies' involvement in generics, their opinion on generics' characteristics and on public policies affecting the demand and supply of generic medication. A descriptive analysis of the outcomes, that is percentage comparison through binomial tests and Fisher tests, was performed. According to our findings, 43% of the respondents were involved in the production and distribution of generics and the mean period of their involvement was 12 years. The majority of the respondents were in favor of their companies' involvement in generics, despite the relatively small market share of generics in Greece; 9.7% of total pharmaceutical market in 2003. Bearing in mind that in Greece the promotion of generics is not encouraged, pharmaceutical companies believe that the mandatory introduction of bioequivalence studies is an indirect promotional strategy towards generics. Additionally, the majority declared that their main competitive advantages are their safety, efficacy and effectiveness as well as their economic benefit to the society. Finally, the respondents expressed their preference for the introduction of pharmacoeconomic submissions for drugs' reimbursement by social insurance funds.

Trends of mortality rates during the last thirty years in Greece.

General mortality rates and specific mortality rates by major causes of death (coronary disease, cancer, tuberculosis, traffic accidents, suicide, vascular disorders of central neural system) in Greece have been studied throughout the 30-year period 1967--1996 and time trends have being calculated by nonlinear models of trend analysis. The results confirm the general pattern of decrease of mortality in Greece during the particular period of time as a result of the combination of the impact of two controversial trends: on one hand the decrease of infant mortality and mortality from infectious disorders and on the other the relatively slower and more gradual increase in mortality rates by disorders related to the western lifestyle culture, such as cardiovascular disorders and cancer. During the period under study in Greece the impact of the second trend seems to inflict less severe implication in the formulation of the pattern of general mortality especially as women are concerned. This statistically significant and gradually increasing difference in mortality between men and women in Greece has been confirmed in general mortality time trends as well as in the evaluation of the relatively better pattern of mortality trends of women from particular "western lifestyle" disorders.

Factors associated with self-rated health in Greece: a population-based postal survey.

BACKGROUND: Self-rated health (SRH), as an indicator of population health, is a concept useful both for research and planning. This study reports SRH, and factors related to it, in Greece. METHODS: Population-based postal survey, using World Health Organisation (WHO) questionnaires with a sample of randomly selected geographically stratified individuals. Response rate reached 41%. RESULTS: As expected, age, income and education were related to SRH, but accounted for only 20% of the variance. CONCLUSIONS: SRH in Greece is related to sociodemographic factors, but perhaps not as strongly as in other populations. Other explanatory variables will require further research.

Factors influencing dental utilisation in Greece.

OBJECTIVE: To identify factors that influence utilisation of dental services in Greece. METHODS AND MATERIALS: Data was obtained through the "WHO Multi-Country Survey Study on Health and Responsiveness", a survey organised by the WHO and locally executed by the National School of Public Health. A national random sample of 5,000 prospective participants was selected through the national phone directory. Of those, half (2,500 participants) were mailed the self-administered questionnaire designed to assess the general health status of the Greek population, while the other half were mailed the questionnaire designed to assess responsiveness of the Greek healthcare system. Both research instruments contained a question related to utilisation of dentists during the last month, and several potential predictors. 1,819 individuals answered the questions and participated in the analysis. Two main outcomes were identified: a) reporting of any utilisation vs. none, statistically analyzed using Logistic Regression, and b) frequency of utilisation (number of visits), analyzed using Poisson Regression. RESULTS: 25.1% reported at least one dental visit, while the mean number of visits during the last month was 0.48. Income gave an odds ratio of 1.139 (95% CI:1.038, 1.251). Dental visit frequency increased with increased income (b = 0.11, p = 0.004) and decreased whith improved self-rated health (b = 0.15, p = 0.003) and age (b = -0.006, p = 0.026). CONCLUSIONS: Income is an important determinant of dental utilisation in Greece; it influences both the percentages and the frequency of such utilisation. Additionally, increased age and high self-rated health are associated with less frequent dental utilisation.

Health and social care in aging population: an integrated care institution for the elderly in Greece.

PURPOSE: To describe the nature of the services actually offered to the elderly in Greece by an institution of integrated care, as opposed to those that should be offered according to the relevant law, and to investigate the factors influencing the supply of those services. BACKGROUND: By the year 2020 about 20 million people will be aged 80 and over in the European Union. People of third age consist 16.9% of the total Greek population. Population aging has major implications on health services, employment and society as a whole. "Open Care Centres for the Elderly" (KAPI) is a rapidly developing and expanding institution providing integrated care for the elderly. METHODS: A questionnaire to be completed by the staff was sent to all 370 KAPI. Response rate reached 66%. For the analysis of the data multiple logistic regression analysis was performed using SPSS 10.0. RESULTS: Both medical and social care is provided by the KAPI to the elderly with different magnitude all over the country. Factors such as number of members, medical, paramedical and non-medical staff and fund availability in the KAPI mainly influence the supply of services. CONCLUSIONS: Integrated care services are offered by the KAPI. However, more steps need to be taken towards the direction of other European countries' integrated care schemes, in order to improve both quality and quantity of the services provided.

Oral cancer treatment costs in Greece and the effect of advanced disease.

BACKGROUND: The main purpose of the study was to quantify the direct costs of oral cancer treatment to the healthcare system of Greece. Another aim was to identify factors that affect costs and potential cost reduction items. More specifically, we examined the relationship between stage of disease, modality of treatment and total direct costs. METHODS: The medical records and clinic files of the Oral and Maxillofacial Clinic of the Athens General Hospital "Genimatas" were abstracted to investigate clinical treatment characteristics, including length of hospitalization, modes of treatment, stage of disease etc. Records of 95 patients with oral squamous cell carcinoma (OSSC), with at least six months of follow-up, were examined. The clinical data was then used to calculate actual direct costs, based on 2001 market values. RESULTS: The mean total direct costs for OSSC treatment estimated at euro 8,450 or approximately US$ 7,450. Costs depended on the stage of the disease, with significant increases in stages III and IV, as compared with stages I and II (p < 0.05). Multi-modality treatment applied mainly to patients in stages III and IV was the factor that affected the cost. Disease stage was also associated with the total duration of hospitalization (p < 0.05). CONCLUSIONS: The clinical management of advanced oral cancer is strongly associated with higher costs. Although the ideal would be to prevent cancer, the combination of high-risk screening, early diagnosis and early treatment seems the most efficient way to reduce costs, and most importantly, prolong life.