Mamas Theodorou
Open University of Cyprus, Health Policy and Management, Faculty Member
- Mamas Theodorou is Professor of Health Policy at the Open University of Cyprus. His main areas of research interest a... moreMamas Theodorou is Professor of Health Policy at the Open University of Cyprus. His main areas of research interest are health services, national and international health policy and financing. The areas and topics include, among others: informal payments, co-payments, prescribing patterns of physicians, oral health, public participation in health policy and priority setting, migrant health, patient satisfaction and financial protection in health systems.edit
A mass vaccination strategy is estimated to be the long-term solution to control COVID-19. Different European countries have committed to vaccination strategies with variable population inoculation rates. We sought to investigate the... more
A mass vaccination strategy is estimated to be the long-term solution to control COVID-19. Different European countries have committed to vaccination strategies with variable population inoculation rates. We sought to investigate the extent to which the COVID-19 vaccination strategies, inoculation rate, and COVID-19 outcome differ between Cyprus and Malta. Data were obtained from the Ministry of Health websites and COVID-19 dashboards, while vaccination data were obtained from the European Centre for Disease Prevention and Control until mid-June, 2021. Comparative assessments were performed between the two countries using Microsoft® Excel for Mac, Version 16.54. Both islands took part in the European Union’s advanced purchase agreement and received their first batch of vaccines on 27 December 2020. The positivity rate and mortality between December and June differs between the two countries (average positivity rate Cyprus 1.34, Malta 3.37 p ≤ 0.01; average mortality Cyprus 7.29, Mal...
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It is really a paradox that 60 years were required to establish a modern health system in Cyprus, despite the expressed positive attitude οf all political parties and most governments. This article investigates the planning and... more
It is really a paradox that 60 years were required to establish a modern health system in Cyprus, despite the expressed positive attitude οf all political parties and most governments. This article investigates the planning and implementation of the National Health System (NHS) and its delay determinants, by employing qualitative research of published sources, audio material and 33 interviews with elite key informants. A major anti-reform alliance, consisting of private doctors, private hospitals and health insurance companies was identified, further supported by doctors of the “old” public system, whose benefits were threatened. Delay contributions additionally arose from media and patient groups, whilst the pharmaceutical sector imposed insignificant influence. Τhe prevailing political, economic and social environment, along with aspects of the proposed reform, fueled this anti-reform movement. However, climate in favour of the NHS implementation gradually developed, attributed to...
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This paper conducts a comparative review of the (curative) health systems’ response taken by Cyprus, Greece, Israel, Italy, Malta, Portugal, and Spain during the first six months of the COVID-19 pandemic. Prior to the COVID-19 pandemic,... more
This paper conducts a comparative review of the (curative) health systems’ response taken by Cyprus, Greece, Israel, Italy, Malta, Portugal, and Spain during the first six months of the COVID-19 pandemic. Prior to the COVID-19 pandemic, these Mediterranean countries shared similarities in terms of health system resources, which were low compared to the EU/OECD average. We distill key policy insights regarding the governance tools adopted to manage the pandemic, the means to secure sufficient physical infrastructure and workforce capacity and some financing and coverage aspects. We performed a qualitative analysis of the evidence reported to the ‘Health System Response Monitor’ platform of the European Observatory by country experts. We found that governance in the early stages of the pandemic was undertaken centrally in all the Mediterranean countries, even in Italy and Spain where regional authorities usually have autonomy over health matters. Stretched public resources prompted countries to deploy “flexible” intensive care unit capacity and health workforce resources as agile solutions. The private sector was also utilized to expand resources and health workforce capacity, through special public-private partnerships. Countries ensured universal coverage for COVID-19-related services, even for groups not usually entitled to free publicly financed health care, such as undocumented migrants. We conclude that flexibility, speed and adaptive management in health policy responses were key to responding to immediate needs during the COVID-19 pandemic. Financial barriers to accessing care as well as potentially higher mortality rates were avoided in most of the countries during the first wave. Yet it is still early to assess to what extent countries were able to maintain essential services without undermining equitable access to high quality care.
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Purpose The dominant role of the employer regarding the access and use of healthcare services by migrant domestic helpers (MDH) often has a negative impact on healthcare provision for migrants in Cyprus. Research relating to the... more
Purpose The dominant role of the employer regarding the access and use of healthcare services by migrant domestic helpers (MDH) often has a negative impact on healthcare provision for migrants in Cyprus. Research relating to the perceptions of MDH employers remains scarce. The purpose of this paper is to investigate the role of employers on the access and use of healthcare services by their MDH. Design/methodology/approach Three studies were carried out using semi-structured interviews with MDH (n=13) and employers of MDH (n=12) and structured questionnaires with MDH (n=625). Content analysis for qualitative findings was carried out using QSR Nvivo 10 and for quantitative using Statistical Package for Social Sciences version 17. Findings Findings provide information about migrant health needs from different views leading to improved documentation via multiple triangulation. Employers play a key gatekeeping role but are not in position to provide sufficient information and guidance t...
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Despite numerous studies on primary care doctors' remuneration and their job satisfaction, few of them have quantified their views and preferences on certain types of remuneration. This study aimed at reporting these views and... more
Despite numerous studies on primary care doctors' remuneration and their job satisfaction, few of them have quantified their views and preferences on certain types of remuneration. This study aimed at reporting these views and preferences on behalf of Greek doctors employed at public primary care. We applied a 13-item questionnaire to a random sample of 212 doctors at National Health Service health centers and their satellite clinics. The results showed that most doctors deem their salary lower than work produced and lower than that of private sector colleagues. Younger respondents highlighted that salary favors dual employment and claim of informal fees from patients. Older respondents underlined the negative impact of salary on productivity and quality of services. Both incentives to work at border areas and choose general practice were deemed unsatisfactory by the vast majority of doctors. Most participants desire a combination of per capita fee with fee-for-service; however,...
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Data on the effect of hormone replacement therapy (HRT) and tibolone on lipoprotein (a) [Lp(a)], an independent risk factor for cardiovascular disease, are heterogeneous and conflicting. Studies of the effect of HRT and tibolone on Lp(a)... more
Data on the effect of hormone replacement therapy (HRT) and tibolone on lipoprotein (a) [Lp(a)], an independent risk factor for cardiovascular disease, are heterogeneous and conflicting. Studies of the effect of HRT and tibolone on Lp(a) concentrations in post-menopausal women are reviewed in this meta-analysis. MEDLINE, Scopus, EMBASE and Cochrane databases were searched (up to February 10, 2017). Two researchers identified randomized controlled studies and extracted data. Potential controversies were resolved by a third reviewer. In 24 eligible studies, HRT caused a significant reduction in Lp(a) concentrations compared with placebo or no treatment [mean relative difference: -20.35%, 95% Confidence Interval (CI): -25.33% to -15.37%, p<0.0001], with significant heterogeneity between studies (I(2)=98.5%), but without evidence of publication bias. No significant effect was found for tibolone (n=7) (mean relative difference: -23.84%, 95% CI: -63.43% to 15.74%, p=0.238) (I(2)=98.7%,...
Research Interests: Menopause, Medicine, Cardiovascular Risk, Postmenopausal Women, Humans, and 15 moreFemale, Obstetrics Gynecology, Meta Analysis, Clinical Sciences, Estrogens, Coronary heart disease, Cardiovascular Diseases, Cardiovascular Risk Factors, Double Blind, Placebo Controlled Trial, Estradiol, Lipoprotein a, Medroxyprogesterone Acetate, Paediatrics and reproductive medicine, and postmenopause
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The mission of this paper is to investigate the economic viability and the workload imposed on nurses of the introduction of a cost sharing mechanism (€5/visit) in public primary health care units. The Ministry of Health provided... more
The mission of this paper is to investigate the economic viability and the workload imposed on nurses of the introduction of a cost sharing mechanism (€5/visit) in public primary health care units. The Ministry of Health provided administrative data for 2011 and 2012. Results highlighted the economic viability of the introduction of a cost sharing mechanism in Outpatient Departments of NHS Hospitals, as an annual economic benefit of €11.5 mil was reported. On the other hand, an annual deficit of €1.4 mil was estimated for Health Centers. Moreover, in the majority of Health Centers, nurses were put under altering employment in order to collect the fees. In times of economic recession, such as currently the case in Greece, negative consequences of cost sharing mechanisms may outweigh the positive ones. The decision on whether or not to introduce cost sharing arrangements is largely a political one and many factors (e.g. accessibility, equity, clinical outcomes) have to be taken into a...
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Introduction: Domestic workers constitute the largest group of legal migrants working in Cyprus. This research aims to examine the experiences of domestic workers in Cyprus with health and illness and explore any problems or barriers to... more
Introduction: Domestic workers constitute the largest group of legal migrants working in Cyprus. This research aims to examine the experiences of domestic workers in Cyprus with health and illness and explore any problems or barriers to access and utilization of health care services, focusing on evidence of gender discrimination and inequalities. Methods: Qualitative research methods were utilized in order to explore the domestic workers’ experiences. Face to face interviews with 13 female domestic workers took place using English and Greek. Results: All participants appeared to share a common experience with health and health care utilization in Cyprus. However, the role of the employer as gate-keeper to health care services and their control over women’s access raised the issue of autonomy – or lack of – among domestic workers. Issues of discrimination linked to autonomy emerged through absence of social integration, lack of information on health care services and entitlements, la...
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SUMMARY: Oral cancer is the sixth most common cancer in the world. Cyprus recorded 312 new cases between 1998 and 2009, which represent a significant percentage of all cancers reported in Cyprus.: This study aimed to evaluate the... more
SUMMARY: Oral cancer is the sixth most common cancer in the world. Cyprus recorded 312 new cases between 1998 and 2009, which represent a significant percentage of all cancers reported in Cyprus.: This study aimed to evaluate the knowledge and perceptions of group of Cypriots about oral cancer.: A convenience sample of 234 people was selected from those who came to mobile clinics in 4 major cities of Cyprus and received free dental examinations. The study used a self-completion questionnaire with questions about socio-demographics, habits (smoking, alcohol consumption, visits to the dentist), plus knowledge and perceptions of oral cancer.: 53% (n= 124) of the respondents had heard about oral cancer, 77.4% (n= 181) knew that smoking is a risk factor for oral cancer but only 59.4% (n= 139) identified alcohol, and 38.9% (n= 91) solar irradiation as other risk factors. Although 68.4% (n= 160) responded that changing the habits of everyday life can prevent oral cancer, 38.9% (n= 91) erro...
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Introduction: Inequalities in health constitute a complicated problem faced particularly by immigrants. However, among the countries of European Union, there is no uniform policy in the management of immigrants regarding their access to... more
Introduction: Inequalities in health constitute a complicated problem faced particularly by immigrants. However, among the countries of European Union, there is no uniform policy in the management of immigrants regarding their access to health services. Aim: The present review analyzes the access rights of migrants to health services in European countries. Methodology: Literature review in the databases Pubmed, Scopus, CINAHL and IATRONET using the following keywords: immigrants/migrants, asylum seekers, rights, access, health services, European Union. Results: In most countries, asylum seekers and minor children of immigrants are entitled to free access to health services as nationals. In most cases, the undocumented immigrants have limited rights of access to health services and only for urgent problems (e.g. infectious diseases, HIV / AIDS). However, there are countries (e.g. Sweden), where undocumented immigrants are totally excluded from health services. Conclusion: The access ...
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Purpose – This paper aims to discuss factors affecting temporary migrants’ ability to access and make effective use of public and private healthcare services in the Republic of Cyprus (hereafter referred to as Cyprus). These factors are... more
Purpose – This paper aims to discuss factors affecting temporary migrants’ ability to access and make effective use of public and private healthcare services in the Republic of Cyprus (hereafter referred to as Cyprus). These factors are raised in the context of a larger study focusing on the healthcare needs of temporary migrants from non-EU countries living and working in Cyprus. Design/methodology/approach – Semi-structured interviews with 13 domestic workers and 17 students from Sri Lanka, Pakistan, Bangladesh, India and the Philippines explored migrants’ experiences with accessing and utilizing healthcare services in Cyprus. The theoretical framework utilized is grounded in the health capability approach which focuses on individuals’ confidence and ability to be effective in achieving optimal health. Findings – The study highlights issues concerning the accessibility and acceptability of healthcare services which emerge as the result of both the organisation and delivery of healthcare services and social, political and economic structures. Research limitations/implications – The implications of this study are relevant in the current debate taking place at the EU level about the opportunities and challenges of temporary migration. Specifically, it is argued that governments and societies should promote individual freedoms and opportunities that empower people to lead the lives they want to live. Originality/value – Temporary migrants form a group whose experiences and needs have not been as extensively investigated as those of other migrant groups, particularly in Cyprus. The capability approach allows for assessing both policy and health systems taking into consideration equity and the impact of multi-sectoral influences on health.
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Immigrants have always been a very vulnerable group with severe inequalities in the access and utilisation of health services. The aim of this study was to investigate the conditions of access and utilization of health services from... more
Immigrants have always been a very vulnerable group with severe inequalities in the access and utilisation of health services. The aim of this study was to investigate the conditions of access and utilization of health services from domestic helpers in Cyprus. A cross-sectional study with 625 domestic helpers was carried out during October 2010-April 2011. The sampling method was snowball sampling. Statistical analysis included x(2) test, x(2) trend test, Mann-Whitney test, t-test and multivariate logistic regression analysis. The main reasons of health service utilization were blood tests, short-term illnesses and injuries/poisonings. Eighteen percent of domestic helpers reported a need for health services, which was not met. Ten percent responded that there was a need for pharmaceuticals that remained unmet. Sixty-two percent reported that their first action in case of a health problem is seeking advice and assistance from their employer. After adjustment, only increased length of...
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The Greek public is currently not represented at any level of the healthcare system's organisational structure. This study aimed to investigate the opinions of Greek citizens as well as doctors regarding their representation in... more
The Greek public is currently not represented at any level of the healthcare system's organisational structure. This study aimed to investigate the opinions of Greek citizens as well as doctors regarding their representation in priority setting and to compare these two groups' preferences when prioritising competing resources. A sample of 300 citizens and 100 doctors were asked by means of a standardised questionnaire: (a) whether their views should inform healthcare decisions; (b) to rank in terms of importance other groups that should participate in the process; and (c) to allocate competing resources to a series of alternative prevention programmes, medical procedures or across different population groups. As many as 83% of the citizens stated that their opinions should inform decisions regarding prevention and population-group programmes, while a slightly lower 70% believed their opinions should also be heard regarding medical procedures. However, when asked to rank six ...
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ABSTRACT There has been a major resurgence of tuberculosis (TB) in recent years worldwide. In Cyprus the tuberculin index is below 1%, in spite of an increase in the incidence of TB, particularly among foreign residents. The purpose of... more
ABSTRACT There has been a major resurgence of tuberculosis (TB) in recent years worldwide. In Cyprus the tuberculin index is below 1%, in spite of an increase in the incidence of TB, particularly among foreign residents. The purpose of this study, the first of its kind in Cyprus, was to calculate the total cost of TB in Cyprus in the year 2009. The calculation was based on complete, detailed data on patients with TB collected from the District of Nicosia, which were then used to extrapolate the cost of TB for the whole of Cyprus. The patients were divided into 5 groups: those with active and those with latent disease diagnosed in 2009, those with active and those with latent disease diagnosed in 2008 who continued treatment in 2009, and contacts in the patients’ close environment who were investigated for TB in 2009. The patient records were studied and cost assessment was made for all tests, hospital days and medication prescribed for each patient for the year 2009. The cost assessment was based on Cyprus Government tariffs used for non-beneficiaries of the system. The total cost for the whole of Cyprus was estimated at €661.937.52, of which €330,768.57 was incurred by the District of Nicosia. The highest costs were generated by those patients with active disease, a mean cost of €6,479.35 per patient from the long-term care programmes within the directly observed treatment short course (DOTS) framework. For the second most costly group, the patients with latent TB, the mean annual cost per patient was €1,171.77. According to the findings of this study the cost of TB in Cyprus closely resembles that in other developed countries. Pneumon 2012, 25(2):191-197.
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BackgroundCurrently there is a dual system of oral healthcare delivery in Cyprus: the public dental system (PDS) run by the Government and the private system provided by private dental practitioners. Although 83% of the population is... more
BackgroundCurrently there is a dual system of oral healthcare delivery in Cyprus: the public dental system (PDS) run by the Government and the private system provided by private dental practitioners. Although 83% of the population is entitled to free treatment by the PDS only 10% of the population make use of them. As Cyprus faces now the challenges of the introduction of a new health care system and rising healthcare costs in general, surveys that examine, among other things, the efficiency of the PDS become very important as tools to make important cost savings. The aims of this study are to assess trends regarding the number of visits and the age distribution of patients using PDS from 2004 to 2007, to measure the technical efficiency of the PDS and to investigate various factors that may affect it.MethodsNon-parametric Data Envelopment Analysis (DEA) was employed to assess technical efficiency. Two separate cases were examined. Efficiency was calculated, firstly using as inputs ...
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Research Interests: Migration, Migration Studies, Public Health, Health Administration, Medicine, and 14 moreImmigrants and Emigrants, Greece, Library and Information Studies, Humans, Health Services, Female, Male, Health Status, Questionnaires, Adult, Public health systems and services research, Cross sectional Study, Cross Sectional Studies, and Socioeconomic Factors
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In countries such as Cyprus the financial crisis and the recession have severely affected the funding and priority setting of the health care system. There is evidence highlighting the importance of population' preferences in... more
In countries such as Cyprus the financial crisis and the recession have severely affected the funding and priority setting of the health care system. There is evidence highlighting the importance of population' preferences in designing priorities for health care settings. Although public preferences have been thorough analysed in many countries, there is a research gap in terms of simultaneously investigating the relative importance and the weight of differing and competing criteria for determining healthcare priority settings. The main objective of the study was tο investigate public preferences for the relative utility and weight of differing and competing criteria for health care priority setting in Cyprus. The 'conjoint analysis' technique was applied to develop a ranking exercise. The aim of the study was to identify the preferences of the participants for alternative options. Participants were asked to grade in a priority order 16 hypothetical case scenarios of pat...
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Conflict among health-care personnel has been identified as an issue within health-care settings around the world. To investigate the existence and management of conflict among health-care personnel in public hospitals in Cyprus; to... more
Conflict among health-care personnel has been identified as an issue within health-care settings around the world. To investigate the existence and management of conflict among health-care personnel in public hospitals in Cyprus; to assess the factors leading to conflict among staff members; to evaluate the consequences of conflict arising; and to consider the management strategies. A self-administered questionnaire was completed by a random sample of 1037 health-care professionals in all (seven) state-run hospitals in Cyprus in 2008. Mean age of respondents was 41 years, and 75% were female. Sixty-four per cent of respondents reported that they had never been informed about conflict management strategies, with physicians being the least informed as the relative percentage was 79.8% (χ(2) = 33, P &lt; 0.001). Sixty per cent of health-care professionals reported conflict at work with other health-care personnel one to five times per week, and 37% of the respondents stated that they devote 90 min (mean value) from work during their shift in conflict resolution, meaning that managing conflicts may absorb 19% of working time daily. The majority of respondents agreed that organizational problems and communication gaps were the main issues creating conflict. Avoidance and collaboration were the preferable strategies for conflict resolution, used by 36.6% and 37.5% of the respondents, respectively. Better communication, fair management practices and clear job descriptions and expectations may be needed in order to facilitate change and reverse the negative atmosphere that exists. Further education in conflict management for physicians, nurses and their managers may also be needed.
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at the end of the article Ικανοποίηση ασθενών στην Κύπρο από την 24ωρη καταγραφή της αρτηριακής πίεσης και σύγκριση με τις μετρήσεις στο ιατρείο και κατ' οίκον ΣΚΟΠΟΣ Η εκτίμηση της ικανοποίησης ασθενών από την 24ωρη καταγραφή της... more
at the end of the article Ικανοποίηση ασθενών στην Κύπρο από την 24ωρη καταγραφή της αρτηριακής πίεσης και σύγκριση με τις μετρήσεις στο ιατρείο και κατ' οίκον ΣΚΟΠΟΣ Η εκτίμηση της ικανοποίησης ασθενών από την 24ωρη καταγραφή της αρτηριακής πίεσης. Επί πλέον, η σύγκριση των μετρήσεων της 24ωρης καταγραφής της αρτηριακής πίεσης με τις μετρήσεις στο ιατρείο και τις μετρή-σεις κατ' οίκον. ΥΛΙΚΟ-ΜΕΘΟΔΟΣ Διεξήχθη μια συγχρονική μελέτη στο ιατρείο υπέρτασης του Γενικού Νοσοκομείου Λεμεσού. Ο μελετώμενος πληθυσμός αποτελείτο από 102 ασθενείς και η συλλογή των δεδομένων πραγματοποιή-θηκε από τον Νοέμβριο του 2013 έως τον Απρίλιο του 2014. Καταχωρήθηκε η αρτηριακή πίεση των ασθενών μέσω της 24ωρης καταγραφής, των μετρήσεων κατ' οίκον και των μετρήσεων στο ιατρείο. Η ικανοποίηση των ασθενών από την 24ωρη καταγραφή της αρτηριακής πίεσης εκτιμήθηκε με 13 ερωτήσεις. Εκτιμήθηκε η ευαισθησία και η ειδικότητα των μετρήσεων κατ' οίκον και των μετρήσεων στο ιατρείο. ΑΠΟΤΕΛΕΣΜΑΤΑ Η συνολική ικανοποίηση των ασθενών από την 24ωρη μέτρηση της αρτηριακής πίεσης ήταν αρκετά υψηλή. Το 62% των ασθενών δήλωσαν ότι προτιμούν την 24ωρη καταγραφή έναντι των μετρήσεων κατ' οίκον για επανεκτίμηση της αρτηριακής τους πίεσης. Η μέση συστολική πίεση στο ιατρείο ήταν στατιστικώς σημαντικά μεγαλύτερη σε σχέση με τη μέση συστολική πίεση της 24ωρης καταγραφής (146,4 mmHg έναντι 141,1 mmHg, p<0,001, διαφορά μέσων τιμών=5,3, 95% διάστημα εμπιστοσύνης [ΔΕ]: 2,4–8,2). Η μέση διαστολική πίεση στο ιατρείο δεν διέφερε στατιστικώς σημαντικά σε σχέση με τη μέση διαστολική πίεση στην 24ωρη καταγραφή (87,1 mmHg έναντι 85,9 mmHg, p=0,3, διαφορά μέσων τιμών=1,2, 95% ΔΕ:-0,8–3,0). Η ευαισθησία των μετρήσεων στο ιατρείο ήταν 68,7% και η ειδικότητα ήταν 42,1%, ενώ οι αντίστοιχες τιμές στην περίπτωση των μετρή-σεων κατ' οίκον ήταν 60% και 60%. ΣΥΜΠΕΡΑΣΜΑΤΑ Οι ασθενείς της παρούσας μελέτης προτιμούσαν την 24ωρη καταγραφή της αρτηριακής πίεσης έναντι των μετρήσεων κατ' οίκον. Οι μετρήσεις στο ιατρείο και οι μετρήσεις κατ' οίκον δεν είναι επαρκείς για τη διάγνωση της αρτηριακής υπέρτασης αλλά ούτε και για τον αποκλεισμό της, καθώς έχουν χαμηλή ευαισθησία και ειδικότητα, σε σχέση με την 24ωρη καταγραφή. Για τον λόγο αυτόν, η 24ωρη καταγραφή μπορεί να αποτελέσει μια ακόμη αξιόπιστη και έγκυρη διαγνωστική επιλογή.
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Although the importance of patient participation in the design and evaluation of health programs and services is well-documented, there is scarcity of research with regard to patient association (PA) participation in health policy... more
Although the importance of patient participation in the design and evaluation of health programs and services is well-documented, there is scarcity of research with regard to patient association (PA) participation in health policy decision-making processes. To this end, the present study aimed to validate further a previously developed instrument as well as to investigate the degree of PA participation in health policy decision-making in Cyprus. A convenient sample of 114 patients-members of patients associations took part in the study. Participants were recruited from an umbrella organization, the Pancyprian Federation of Patient Associations and Friends (PFPA). PA participation in health policy decision-making was assessed with the Health Democracy Index (HDI), an original 8-item tool. To explore its psychometric properties, Cronbach α was computed as regards to its internal consistency, while its convergent validity was tested against a self-rated question enquiring about the degree of PA participation in health policy decision-making. The findings revealed that the HDI has good internal consistency and convergent validity. Furthermore, PAs were found to participate more in consultations in health-related organizations and the Ministry of Health (MoH) as well as in reforms or crucial decisions in health policy. Lower levels were documented with regard to participation in hospital boards, ethics committees in clinical trials and health technology assessment (HTA) procedures. Overall, PA participation levels were found to be lower than the mid-point of the scale. Targeted interventions aiming to facilitate patients’ involvement in health policy decision-making processes and to increase its impact are greatly needed in Cyprus.
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No two markets for voluntary health insurance (VHI) are identical. All differ in some way because they are heavily shaped by the nature and performance of publicly financed health systems and by the contexts in which they have evolved.... more
No two markets for voluntary health insurance (VHI) are identical. All differ in some way because they are heavily shaped by the nature and performance of publicly financed health systems and by the contexts in which they have evolved. This volume contains short, structured profiles of markets for VHI in 34 countries in Europe. These are drawn from European Union member states plus Armenia, Iceland, Georgia, Norway, the Russian Federation, Switzerland and Ukraine. The book is aimed at policymakers and researchers interested in knowing more about how VHI works in practice in a wide range of contexts. Each profile, written by one or more local experts, identifies gaps in publicly financed health coverage, describes the role VHI plays, outlines the way in which the market for VHI operates, summarises public policy towards VHI, including major developments over time, and highlights national debates and challenges. The book is part of a study on VHI in Europe prepared jointly by the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe. A companion volume provides an analytical overview of VHI markets across the 34 countries.
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Background Measures taken over the past four years in Greece to reduce pharmaceutical expenditure have led to significant price reductions for medicines, but have also changed patient cost-sharing rates for prescription drugs. This study... more
Background
Measures taken over the past four years in Greece to reduce pharmaceutical expenditure have led to significant price reductions for medicines, but have also changed patient cost-sharing rates for prescription drugs. This study attempts to capture the resulting increase in patients’ out-of-pocket (OOP) expenses for prescription drugs during the 2011-2014 period.
Methods
The authors conducted a retrospective review of financial data derived from 39 883 prescriptions, dispensed at three randomly chosen pharmacies located in Lamia, central Greece.
Results
The study recorded an average contribution rate per prescription as follows: 11.28% for 2011 (95% CI: 10.76-11.80), 14.10% for 2012, 19.97% for 2013, and 29.08% for 2014. Correspondingly, the mean patient charge per prescription for 2011 was €6.58 (95% CI: 6.22-6.94), €8.28 for 2012, €8.35 for 2013, and €10.87 for 2014. During the 2011-2014 period, mean percentage rate of patient contribution increased by 157.75%, while average patient charge per prescription in current prices increased by 65.22%. The use of a newly introduced internal reference price (IRP) system increased the level of prescription charge at a rate of 2.41% for 2012 (100% surcharge on patients), 26.24% for 2013 (49.95% on patients and 50.04% on the appropriate health insurance funds), and 47.72% for 2014 (85.06% on patients and 14.94% on funds).
Conclusion
Increased cost-sharing rates for prescription drugs can reduce public pharmaceutical expenditure, but international experience shows that rising OOP expenses can compromise patients’ ability to pay, particularly when it comes to chronic diseases and vulnerable populations. Various suggestions could be effective in refining the costsharing approach by giving greater consideration to chronic patients, and to the poor and elderly.
Measures taken over the past four years in Greece to reduce pharmaceutical expenditure have led to significant price reductions for medicines, but have also changed patient cost-sharing rates for prescription drugs. This study attempts to capture the resulting increase in patients’ out-of-pocket (OOP) expenses for prescription drugs during the 2011-2014 period.
Methods
The authors conducted a retrospective review of financial data derived from 39 883 prescriptions, dispensed at three randomly chosen pharmacies located in Lamia, central Greece.
Results
The study recorded an average contribution rate per prescription as follows: 11.28% for 2011 (95% CI: 10.76-11.80), 14.10% for 2012, 19.97% for 2013, and 29.08% for 2014. Correspondingly, the mean patient charge per prescription for 2011 was €6.58 (95% CI: 6.22-6.94), €8.28 for 2012, €8.35 for 2013, and €10.87 for 2014. During the 2011-2014 period, mean percentage rate of patient contribution increased by 157.75%, while average patient charge per prescription in current prices increased by 65.22%. The use of a newly introduced internal reference price (IRP) system increased the level of prescription charge at a rate of 2.41% for 2012 (100% surcharge on patients), 26.24% for 2013 (49.95% on patients and 50.04% on the appropriate health insurance funds), and 47.72% for 2014 (85.06% on patients and 14.94% on funds).
Conclusion
Increased cost-sharing rates for prescription drugs can reduce public pharmaceutical expenditure, but international experience shows that rising OOP expenses can compromise patients’ ability to pay, particularly when it comes to chronic diseases and vulnerable populations. Various suggestions could be effective in refining the costsharing approach by giving greater consideration to chronic patients, and to the poor and elderly.
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Σκοπός: Να διερευνηθεί η εμφάνιση ή μη νέων ατομικών διαδικτυακών συμπεριφορών από χρόνιους ασθενείς (κυρίως με διαβήτη και καρκίνο) στο Ελληνόγλωσσο Facebook και η πιθανή σύνδεσή τους με την οικονομική κρίση και τις μεταρρυθμίσεις στον... more
Σκοπός: Να διερευνηθεί η εμφάνιση ή μη νέων ατομικών διαδικτυακών συμπεριφορών από χρόνιους ασθενείς (κυρίως με διαβήτη και καρκίνο) στο Ελληνόγλωσσο Facebook και η πιθανή σύνδεσή τους με την οικονομική κρίση και τις μεταρρυθμίσεις στον τομέα της υγείας.
Υλικό-Μέθοδος: Μεικτή μέθοδος. Χρησιμοποιήθηκε περιγραφική στατιστική και ανάλυση x2 για ανάλυση των ποσοτικών δεδομένων, ενώ η κριτική ανάλυση λόγου (CDA) ήταν η μέθοδος εκλογής για την επεξεργασία των ποιοτικών δεδομένων. Λογισμικά που χρησιμοποιήθηκαν: Web Scraper Extension for Google Chrome v.0.2.0.10, IBM SPSS Statistics v.22, και ATLAS.ti for Mac v.1.0.48 (231).
Αποτελέσματα: Βρέθηκαν συνολικά n=62 ομάδες (groups) και σελίδες (pages) από την Ελλάδα και την Κύπρο, εκ των οποίων nD=23 απευθύνονταν σε ασθενείς με διαβήτη και nc=16 σε ασθενείς με καρκίνο. Μετά την στατιστική ανάλυση, με χρήση ποσοτικών και ποιοτικών κριτηρίων, επιλέχθηκαν 5 ομάδες, στις πλέον δημοφιλείς αναρτήσεις (posts) των οποίων εφαρμόσθηκε κριτική ανάλυση λόγου.
Συμπεράσματα: Παρά το γεγονός ότι η προσωπική/ συναισθηματική υποστήριξη είναι ένας βασικός λόγος που οι χρόνιοι ασθενείς προσφεύγουν σε ομάδες στο Facebook, δεν είναι όμως πλέον ούτε ο μόνος, ούτε ο κυριότερος. Εξ αιτίας της οικονομικής κρίσης, αλλά και των δυνατοτήτων αλληλεπίδρασης που παρέχουν τα κοινωνικά μέσα, εμφανίζονται νέες, πιο ενημερωμένες και πιο διεκδικητικές ατομικές συμπεριφορές (βιολογικός πολίτης, ενημερωμένος καταναλωτής υπηρεσιών υγείας), που είναι ίσως περισσότερο συμβατές με ένα μοντέλο οικονομίας αγοράς και νεοφιλελεύθερων ιδεών. Η εμφάνιση αυτών των συμπεριφορών οδηγεί ίσως σταδιακά σε ρήξη τις παραδοσιακές σχέσεις αντιπροσώπευσης ασθενή-επαγγελματία υγείας.
Πέραν αυτών, η οικονομική κρίση και η ανεργία απ’ τη μια δημιουργούν νέες ευάλωτες κοινωνικές ομάδες (ανασφάλιστοι άνεργοι, χρόνιοι ασθενείς), απ’ την άλλη τις οδηγούν στην αναζήτηση νέων, εναλλακτικών μορφών πρόσβασης στις υπηρεσίες υγείας.
DOI: 10.13140/RG.2.2.35396.42888
Υλικό-Μέθοδος: Μεικτή μέθοδος. Χρησιμοποιήθηκε περιγραφική στατιστική και ανάλυση x2 για ανάλυση των ποσοτικών δεδομένων, ενώ η κριτική ανάλυση λόγου (CDA) ήταν η μέθοδος εκλογής για την επεξεργασία των ποιοτικών δεδομένων. Λογισμικά που χρησιμοποιήθηκαν: Web Scraper Extension for Google Chrome v.0.2.0.10, IBM SPSS Statistics v.22, και ATLAS.ti for Mac v.1.0.48 (231).
Αποτελέσματα: Βρέθηκαν συνολικά n=62 ομάδες (groups) και σελίδες (pages) από την Ελλάδα και την Κύπρο, εκ των οποίων nD=23 απευθύνονταν σε ασθενείς με διαβήτη και nc=16 σε ασθενείς με καρκίνο. Μετά την στατιστική ανάλυση, με χρήση ποσοτικών και ποιοτικών κριτηρίων, επιλέχθηκαν 5 ομάδες, στις πλέον δημοφιλείς αναρτήσεις (posts) των οποίων εφαρμόσθηκε κριτική ανάλυση λόγου.
Συμπεράσματα: Παρά το γεγονός ότι η προσωπική/ συναισθηματική υποστήριξη είναι ένας βασικός λόγος που οι χρόνιοι ασθενείς προσφεύγουν σε ομάδες στο Facebook, δεν είναι όμως πλέον ούτε ο μόνος, ούτε ο κυριότερος. Εξ αιτίας της οικονομικής κρίσης, αλλά και των δυνατοτήτων αλληλεπίδρασης που παρέχουν τα κοινωνικά μέσα, εμφανίζονται νέες, πιο ενημερωμένες και πιο διεκδικητικές ατομικές συμπεριφορές (βιολογικός πολίτης, ενημερωμένος καταναλωτής υπηρεσιών υγείας), που είναι ίσως περισσότερο συμβατές με ένα μοντέλο οικονομίας αγοράς και νεοφιλελεύθερων ιδεών. Η εμφάνιση αυτών των συμπεριφορών οδηγεί ίσως σταδιακά σε ρήξη τις παραδοσιακές σχέσεις αντιπροσώπευσης ασθενή-επαγγελματία υγείας.
Πέραν αυτών, η οικονομική κρίση και η ανεργία απ’ τη μια δημιουργούν νέες ευάλωτες κοινωνικές ομάδες (ανασφάλιστοι άνεργοι, χρόνιοι ασθενείς), απ’ την άλλη τις οδηγούν στην αναζήτηση νέων, εναλλακτικών μορφών πρόσβασης στις υπηρεσίες υγείας.
DOI: 10.13140/RG.2.2.35396.42888