Abstract
BackgroundThe National Organization for Healthcare Provision (EOPYY) originates from the recent reform in Greek healthcare, aiming amidst economic predicament, at the rationalization of health expenditure and reactivation of the pivotal role of Primary Health Care (PHC). Health funding (public/private) mix is examined, alongside the role of pre-existing health insurance funds. The main pursuit of this paper is to evaluate whether EOPYY has met its goals.MethodsThe article surveys for best practices in advanced health systems and similar sickness funds. The main benchmarks focus on PHC provision and providers’ reimbursement. It then turns to an analysis of EOPYY, focusing on specific questions and searching the relevant databases. It compares the best practice examples to the EOPYY (alongside further developments set by new legislation in L 4238/14), revealing weaknesses relevant to non-integrated PHC network, unbalanced manpower, non-gatekeeping, under-financing and other funding problems caused by the current crisis. Finally, a new model of medical procedures cost accounting was tested in health centers.ResultsAn alternative operation of EOPYY functioning primarily as an insurer whereas its proprietary units are integrated with these of the NHS is proposed. The paper claims it is critical to revise the current induced demand favorable reimbursement system, via per capita payments for physicians combined with extra pay-for-performance payments, while cost accounting corroborates a prospective system for NHS’s and EOPYY’s units, under a combination of global budgets and Ambulatory Patient Groups (APGs)ConclusionsSelf-critical points on the limitations of results due to lack of adequate data (not) given by EOPYY are initially raised. Then the issue concerning the debate between ‘copying’ benchmarks and ‘a la cart’ selectively adopting and adapting best practices from wider experience is discussed, with preference to the latter. The idea of an ‘a la cart’ choice of international examples is proposed. The ‘results’ discussing EOPYY’s dual function and induced-demand favorable reimbursement system are further critically examined. International experience shows evidence of effective alternatives, such as per capita and pay-for-performance payments for practicing doctors as well as per case reimbursement for health centers under global budget principles.
Highlights
The National Organization for Healthcare Provision (EOPYY) originates from the recent reform in Greek healthcare, aiming amidst economic predicament, at the rationalization of health expenditure and reactivation of the pivotal role of Primary Health Care (PHC)
A brief summary of some of the most important findings that are taken into account in our research follows in the subsection "A selective overview of health systems", leaving subsection "Overview and analysis of Greek Healthcare focusing upon the EOPYY and PHC" for a more detailed examination of the Greek case and "Cost accounting under Ambulatory Patient Groups (APGs) principles" for setting a standard costing procedure
Overview and analysis of Greek Healthcare focusing upon the EOPYY and PHC Evolution of healthcare provision in Greece follows the country’s social and political history with legislative tug-of-wars, drawbacks, expansions and collapses, whereas the dominant feature was the existence of many occupation-based and state-supported social and health insurance funds, usually compulsory, but leaving ample room for the private sector
Summary
The National Organization for Healthcare Provision (EOPYY) originates from the recent reform in Greek healthcare, aiming amidst economic predicament, at the rationalization of health expenditure and reactivation of the pivotal role of Primary Health Care (PHC). Taxation contributes 29.1% of total health expenditure, while health insurance accounts for 31.2%. It should be noted that private expenditure amounts for a very high percentage of the mixed financial resources, and this public/private mixture is a significant feature of the system. In a little more detail, out-of-pocket payments account for 37.6% of total health expenditure, whilst private insurance accounts for 2.1%, calling the social character of the health system into question [1]. Total (public and private) health expenditure has reduced since 2010 financial crisis (from almost 10 to 8% of GDP)
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