Efficiency and productivity assessment of public hospitals in Greece during the crisis period 2009-2012.

BACKGROUND: This study is an initial effort to examine the dynamics of efficiency and productivity in Greek public hospitals during the first phase of the crisis 2009-2012. Data were collected by the Ministry of Health after several quality controls ensuring comparability and validity of hospital inputs and outputs. Productivity is estimated using the Malmquist Indicator, decomposing the estimated values into efficiency and technological change. METHODS: Hospital efficiency and productivity growth are calculated by bootstrapping the non-parametric Malmquist analysis. The advantage of this method is the estimation efficiency and productivity through the corresponding confidence intervals. Additionally, a Random-effects Tobit model is explored to investigate the impact of contextual factors on the magnitude of efficiency. RESULTS: Findings reveal substantial variations in hospital productivity over the period from 2009 to 2012. The economic crisis of 2009 had a negative impact in productivity. The average Malmquist Productivity Indicator (MPI) score is 0.72 with unity signifying stable production. Approximately 91% of the hospitals score lower than unity. Substantial increase is observed between 2010 and 2011, as indicated by the average MPI score which fluctuates to 1.52. Moreover, technology change scored more than unity in more than 75% of hospitals. The last period (2011-2012) has shown stabilization in the expansionary process of productivity. The main factors contributing to overall productivity gains are increases in occupancy rates, type and size of the hospital. CONCLUSIONS: This paper attempts to offer insights in efficiency and productivity growth for public hospitals in Greece. The results suggest that the average hospital experienced substantial productivity growth between 2009 and 2012 as indicated by variations in MPI. Almost all of the productivity increase was due to technology change which could be explained by the concurrent managerial and financing healthcare reforms. Hospitals operating under decreasing returns to scale could achieve higher efficiency rates by reducing their capacity. However, certain social objectives should also be considered. Emphasis perhaps should be placed in utilizing and advancing managerial and organizational reforms, so that the benefits of technological improvements will have a continuing positive impact in the future.

Addressing barriers to the prevention, diagnosis and treatment of hepatitis B and C in the face of persisting fiscal constraints in Europe: report from a high level conference.

In the WHO-EURO region, around 28 million people are currently living with chronic viral hepatitis, and 120,000 people die every year because of it. Lack of awareness and understanding combined with the social stigma and discrimination exacerbate barriers related to access to prevention, diagnosis and treatment services for those most in need. In addition, the persisting economic crisis has impacted on public health spending, thus posing challenges on the sustainable investment in promotion, primary and secondary prevention, diagnosis and treatment of viral hepatitis across European countries. The Hepatitis B and C Public Policy Association in cooperation with the Hellenic Center for Disease Prevention and Control together with 10 partner organizations discussed at the Athens High Level Meeting held in June 2014 recent policy developments, persisting and emerging challenges related to the prevention and management of viral hepatitis and the need for a de minimis framework of urgent priorities for action, reflected in a Call to Action (Appendix S1). The discussion confirmed that persisting barriers do not allow the full realisation of the public health potential of diagnosing and preventing hepatitis B and C, treating hepatitis B and curing hepatitis C. Such barriers are related to (a) lack of evidence-based knowledge of hepatitis B and C, (b) limited access to prevention, diagnosis and treatment services with poor patient pathways, (c) declining resources and (d) the presence of social stigma and discrimination. The discussion also confirmed the emerging importance of fiscal constraints on the ability of policymakers to adequately address viral hepatitis challenges, particularly through increasing coverage of newer therapies. In Europe, it is critical that public policy bodies urgently agree on a conceptual framework for addressing the existing and emerging barriers to managing viral hepatitis. Such a framework would ensure all health systems share a common understanding of definitions and indicators and look to integrate their responses to manage policy spillovers in the most cost-effective manner, while forging wide partnerships to sustainably and successfully address viral hepatitis.

Oral health related quality of life of Greek adolescents: a cross-sectional study.

AIM: To investigate the impact of oral health status on the quality of life of a cross-section of adolescents belonging to different population groups in different regions of Greece, using the oral health impact profile-short form (OHIP-14), one of the most widely known instruments used for the measurement of disability and discomfort due to oral conditions. METHODS: A random sample consisting of a total of 515 Greek adolescents between the ages of 15-18 years (mean 16.1±0.9) were selected from different urban and rural areas according to the last census. A self-administrated questionnaire was designed including the OHIP-14 validated for the Greek language, and face to- face interviews were conducted by one dentist trained in oral health related quality of life (OHRQoL) terms. Associations of the total OHIP-14 score and its seven subscales along with the self-perceived quality of life were evaluated with Spearman correlations. RESULTS: Internal reliability returned a very good internal consistency with a Cronbach alpha of 0.86. The subjects had an overall weighted OHIP-14 score of 1.24 (SD 2.04) meaning that there was an impact of oral health on the overall quality of life. Five of the seven subscales of the OHIP-14 tool were found to have significant correlations for the inhabitants of the different areas. Specifically, important and significant correlations were discovered for functional limitation (p<0.01), handicap (p<0.05) and social disability (p<0.01) both for the metropolitan/non-metropolitan as well as the urban rural distinction. No correlations were found between the OHIP-14 scores, or of any of its sub-scales, with the parental education level and occupation. When self-assessed oral and general health statuses were considered to be 'bad' the OHIP-14 returned increased scores. CONCLUSIONS: Dental and oral health conditions are factors that do impact on the quality of life of adolescents.

Validation of a Greek version of the oral health impact profile (OHIP-14) in adolescents.

AIM: To evaluate the validity and reliability of the Greek version of the Oral Health Impact Profile (OHIP-14) (short form) in adolescents. METHODS: A total of 112 healthy adolescents (15-18 years) from various socioeconomic backgrounds were randomly selected and participated in a clinical oral examination conducted by a calibrated dentist and on the same day a face to face interview was held for assessing the psychometric properties of the OHIP-14 in Greek adolescents. RESULTS: Cronbach's coefficient, was used to evaluate the internal consistency of the instrument and a value of a=0.8 was found indicating exceptional internal consistency. Discriminant validity and convergent validity was assessed and the inter-item correlation coefficients ranged from -0.01 to 0.8 and the item-total correlation coefficients varied from 0.17 to 0.6. Important statistical correlations were also observed between the OHIP-14 and all the clinical measures, confirming that the questionnaire can distinguish between individuals with and without impacts on their oral health. The OHIP-14 total score proved to have high associations with both self-perceived oral health status (rs=0.36; p=0.01) and self-assessment of oral satisfaction (rs=0.4; p=0.01). Examination of the relationship between these parameters and the score of each domain also lead to similar results. CONCLUSIONS: The Greek version of OHIP-14 instrument was found to be a valid and reliable instrument for assessing oral health-related quality of life in Greek adolescents.

Quality of life and smoking among industrial workers in Greece.

BACKGROUND: Smoking is a predictor of quality of life, while socio-economic factors influence the prevalence of smoking habits. Occupational medical research has been fairly late in coming to study quality of life aspects in working populations. OBJECTIVES: The aim of the study is the assessment of smoking prevalence among blue- and white-collar workers industrial workers in Greece and its impact on health-related quality of life. METHODS: In a cross-sectional study the Euro-Qol 5D questionnaire was been used in a random sample of 472 blue and white-collar heavy industry workers. RESULTS: 57% of the study population were current smokers. The difference in prevalence of smoking across all the examined socio-demographic variables (sex, age, education and occupation) was not statistically significant. Smoking had a significant impact on the health-related quality of life. Smokers recorded significant lower scores (74.9) in the overall Visual Analogue Scale in comparison with non-smokers (79.1), (p = 0.007). Further analysis revealed that age, smoking and education were significant predictors of VAS score. A non-significant contribution was found for occupation and sex. Smokers reported significantly higher rates of problems regarding mobility, self-care and anxiety/depression than non-smokers. Logistic regression analysis showed an independent impact of smoking on mobility, self-care and anxiety/depression level. CONCLUSIONS: Smoking is a significant hazard and a strong predictor of poor quality of life among the blue- and white-collar workers under study. Anti-smoking policies integrated into a broader context of occupational health and safety at work could reduce smoking rates and thus improve worker's quality of life.

Developing an instrument to measure patient satisfaction with nursing care in Greece.

AIM: The main purpose of this study was to develop a reliable and valid instrument to measure patient satisfaction with nursing care. BACKGROUND: The interest in patient satisfaction is intense but there is an absence of instruments with proper psychometric properties. METHODS: A methodological exploratory design was employed with three phases: content development and critique, pilot study (N = 15) and final tryout (I = 103). FINDINGS: The reliability coefficient for the whole scale was high (alpha = 0.94). An exploratory factor analysis revealed six factors, explaining 68.8% of the variability. The first three factors referred to interpersonal relationships and available time, technical competence and response, and information. The qualitative data facilitated the interpretation of the quantitative data, increased the validity of the scale and gave useful information for improvements. CONCLUSIONS: Overall, the psychometric properties of the instruments were satisfactory but there is a need for continuous evaluation and verification of other studies.

Death of a child at home or in hospital: experiences of Greek mothers.

The purpose of this study was to investigate the experiences of Greek mothers who cared for a child dying of cancer at home or in the hospital, and to highlight some of their major needs during the terminal period. Fifteen mothers were interviewed and both quantitative and qualitative procedures were used to analyze the findings. Ten families (67%) chose to care for the child at home without having access to home care services, while the remaining five sought hospital care. Their decision was primarily based upon the child's expressed wish and parental preference. The family network played a significant role in supporting the mother-child unit, especially when death occurred at home. Mothers assessed positively the services provided by nurses and social workers, and had expectations that physicians would support them on a psychological level during the terminal period. The care of the dying child is influenced by cultural factors predominant in Greek society and some of the findings are discussed in this light.

Public knowledge of thalassemia in Greece and current concepts of the social status of the thalassemic patients.

Current concepts with regard to the social integration of the thalassemia patient worldwide require further evaluation. In this work we have investigated the concepts of the average citizen of continental Greece and Crete about the problem of thalassemia, his awareness of the basic characteristics of the disease and his attitudes towards some 'life-style' parameters of the thalassemic sufferer. We used the method of stratified random sampling and interviewed 3500 people aged 15-65 years. We carried out multivariate statistical analysis of responses to the items on thalassemia in relation to sex, age, educational level, place of residence and marital status. The results of this survey show that education was the factor with the greatest influence on the likelihood of being aware of thalassemia and of having accurate knowledge of the basic features of the disease. There was also a general effect of age with the highest awareness and the best knowledge being found in those aged 21-44 years, while place of residence was a significant factor for two items. The features known best were that thalassemia is non-infectious, that it calls for blood transfusion, and is inherited. Education had the strongest influence on the probability that a person holds the attitude that the sufferer from thalassemia can play a normal role in society as regards working and having a family, as well as generally living a normal life and, in the case of thalassemic children, playing and going to school. The attitude that thalassemics should work instead of receiving a state benefit depended on education, age and place of residence.(ABSTRACT TRUNCATED AT 250 WORDS)