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The introduction of Greek Central Health Fund: Has the reform met its goal in the sector of Primary Health Care or is there a new model needed?
BACKGROUND: 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). Health funding (public/pri...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4255662/ https://www.ncbi.nlm.nih.gov/pubmed/25421631 http://dx.doi.org/10.1186/s12913-014-0583-4 |
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author | Polyzos, Nikos Karakolias, Stefanos Dikeos, Costas Theodorou, Mamas Kastanioti, Catherine Mama, Kalomira Polizoidis, Periklis Skamnakis, Christoforos Tsairidis, Charalampos Thireos, Eleutherios |
author_facet | Polyzos, Nikos Karakolias, Stefanos Dikeos, Costas Theodorou, Mamas Kastanioti, Catherine Mama, Kalomira Polizoidis, Periklis Skamnakis, Christoforos Tsairidis, Charalampos Thireos, Eleutherios |
author_sort | Polyzos, Nikos |
collection | PubMed |
description | BACKGROUND: 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). 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. METHODS: The 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. RESULTS: An 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) CONCLUSIONS: Self-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. |
format | Online Article Text |
id | pubmed-4255662 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-42556622014-12-05 The introduction of Greek Central Health Fund: Has the reform met its goal in the sector of Primary Health Care or is there a new model needed? Polyzos, Nikos Karakolias, Stefanos Dikeos, Costas Theodorou, Mamas Kastanioti, Catherine Mama, Kalomira Polizoidis, Periklis Skamnakis, Christoforos Tsairidis, Charalampos Thireos, Eleutherios BMC Health Serv Res Research Article BACKGROUND: 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). 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. METHODS: The 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. RESULTS: An 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) CONCLUSIONS: Self-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. BioMed Central 2014-11-25 /pmc/articles/PMC4255662/ /pubmed/25421631 http://dx.doi.org/10.1186/s12913-014-0583-4 Text en © Polyzos et al.; licensee BioMed Central Ltd. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Polyzos, Nikos Karakolias, Stefanos Dikeos, Costas Theodorou, Mamas Kastanioti, Catherine Mama, Kalomira Polizoidis, Periklis Skamnakis, Christoforos Tsairidis, Charalampos Thireos, Eleutherios The introduction of Greek Central Health Fund: Has the reform met its goal in the sector of Primary Health Care or is there a new model needed? |
title | The introduction of Greek Central Health Fund: Has the reform met its goal in the sector of Primary Health Care or is there a new model needed? |
title_full | The introduction of Greek Central Health Fund: Has the reform met its goal in the sector of Primary Health Care or is there a new model needed? |
title_fullStr | The introduction of Greek Central Health Fund: Has the reform met its goal in the sector of Primary Health Care or is there a new model needed? |
title_full_unstemmed | The introduction of Greek Central Health Fund: Has the reform met its goal in the sector of Primary Health Care or is there a new model needed? |
title_short | The introduction of Greek Central Health Fund: Has the reform met its goal in the sector of Primary Health Care or is there a new model needed? |
title_sort | introduction of greek central health fund: has the reform met its goal in the sector of primary health care or is there a new model needed? |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4255662/ https://www.ncbi.nlm.nih.gov/pubmed/25421631 http://dx.doi.org/10.1186/s12913-014-0583-4 |
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