The Need for Measurement of Efficiency in Greek Primary Healthcare

By Oikonomou, Nikolaos; Tountas, Yannis et al. | Applied Health Economics and Health Policy, March 2012 | Go to article overview

The Need for Measurement of Efficiency in Greek Primary Healthcare


Oikonomou, Nikolaos, Tountas, Yannis, Kyriopoulos, John, Applied Health Economics and Health Policy


As Greece faces its biggest financial crisis in its modern history, it is urgent to trace all areas where human and capital resources are not exploited to full capacity. There is evidence that sources of inefficiency are abundant in Greek primary care (PC).[1]

In Greece, PC is delivered by many different providers, both of the private and the public sector. The main public providers in rural areas are the Health Centres (HCs) of the National Health System, but the population often turns to private or distant, urban providers, due to unproductive organization frameworks of the HCs. The inefficiency of many HCs also leads to serious dissatisfaction. There are typical examples of such cases in many areas in the Health Prefecture of Southern and Western Greece.[2]

The measurement of efficiency in healthcare delivery is becoming common practice internationally and is gaining ground in PC. It is accomplished through a variety of parametric and non-parametric methods; all of which include the specification of inputs and outputs by methods such as panel data analysis.[3]

Some efforts to measure efficiency in Greek PC have already been performed. The following major obstacles have been encountered:

* It is not clear what the targets of Greek PC are, or what resources are used.

* The quality of data of inputs used and outputs produced in Greek PC is questionable, as there are inadequate systems of collecting, processing and evaluating data.

* Important parameters of the functions of HCs are not routinely measured.

Two leading institutes in Greek Health Services, the National School of Public Health and the Centre for Health Services Research of the Medical School of the University of Athens, are implementing a study to help overcome these shortcomings.

The first part of the study is model specification. It concerns clarifying through two consensus panels (a Delphi panel and a nominal group) what the key inputs and outputs in the production function are and the relative importance (weight) of each. Indices for severity and quality adjustment will also be produced.

The second part of the study is a pilot programme to measure the efficiency of the public HCs of the 6th Health Prefecture of Greece, which covers Southern and Western Greece. The biggest innovation of the study is that it is not based on data routinely collected by Greek health authorities, but on a new questionnaire based on the results of a panel analysis. An obligatory system of data collection has been established in cooperation with the 6th Health Prefecture. …

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