The profile of patients receiving public and private surgical services in Greece during the economic crisis: a comparative study

Characteristics and differences of strabismus surgeries performed in private versus public settings: a national multicenter study

PURPOSE

To investigate and compare the demographics, diagnoses, and surgical procedure types of strabismus repair in public and private hospitals in Israel in order to highlight possible disparities between them.

METHODS

Retrospective descriptive study included all strabismus surgeries in seven private hospitals, compared with two large public university-affiliated hospitals from June 2016 to June 2021. Electronic medical records were directly retrieved to produce an anonymized database.

RESULTS

During the study period 2420 operations were performed. Patients who underwent strabismus surgery in public hospitals were older and had shorter procedures (p < 0.001 and p = 0.004, respectively). The median number of operated muscles and the prevalence of bilateral procedures were higher in private hospitals (p < 0.001 and p < 0.001, respectively). Surgery for common strabismus, especially esotropia, was more prevalent in private (p < 0.001), whereas surgery for vertical strabismus, cranial nerve palsies and complex syndromes were performed more often in public hospitals (p < 0.001, p = 0.008, and p < 0.001, respectively). Rectus recession and inferior oblique (IO) anteriorization were more predominant in private hospitals (p = 0.002 and p < 0.001, respectively), while recuts advancement and IO myectomies were more prevalent in public ones (p = 0.001 and p < 0.001, respectively). Reoperations were far more common in public hospitals (27.2% vs 6.2%, p < 0.0001). This was true across most age groups.

CONCLUSIONS

Candidates for strabismus surgery in private hospitals in Israel are often younger, with more common diagnoses, and are usually referred for simpler procedures.

Hospitals during economic crisis: a systematic review based on resilience system capacities framework

Background

Hospitals are the biggest users of the health system budgets. Policymakers are interested in improving hospital efficiency while maintaining their performance during the economic crisis. This study aims at analysing the hospitals’ policy solutions during the economic crisis using the resilience system capacities framework.

Method

This study is a systematic review. The search strategy was implemented on the Web of Science, PubMed, Embase, Scopus databases, and Econbiz search portal. Data were extracted and analysed through the comparative table of resilience system capacities framework and the World Health Organization (WHO) health system’s six building blocks (i.e., leadership and governance, service delivery, health workforce, health systems financing, health information systems, and medicines and equipment).

Findings

After the screening, 78 studies across 36 countries were reviewed. The economic crisis and adopted policies had a destructive effect on hospital contribution in achieving Universal Health Coverage (UHC). The short-term absorptive capacity policies were the most frequent policies against the economic crisis. Moreover, the least frequent and most effective policies were adaptive policies. Transformative policies mainly focused on moving from hospital-based to integrated and community-based services. The strength of primary care and community-based services, types and combination of hospital financing systems, hospital performance before the crisis, hospital managers’ competencies, and regional, specialties, and ownership differences between hospitals can affect the nature and success of adopted policies.

Conclusion

The focus of countries on short-term policies and undermining necessary contextual factors, prioritizing efficiency over quality, and ignoring the interrelation of policies compromised hospital contribution in UHC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08316-4.

Esophageal cancer surgery in Greece during the era of the financial crisis

The aim of this study is to describe outcomes of esophageal cancer surgery in a quaternary upper gastrointestinal (GI) center in Athens during the era of the Greek financial crisis. We performed a retrospective analysis of patients that underwent esophagectomy for esophageal or gastroesophageal junction (GEJ) cancer at an upper GI unit of the University of Athens, during the period January 2004-June 2019. Time-to-event analyses were performed to explore trends in survival and recurrence. A total of 146 patients were identified. Nearly half of the patients (49.3%) underwent surgery during the last 4 years of the financial crisis (2015-2018). Mean age at the time of surgery was 62.3 ± 10.3 years, and patients did not present at older ages during the recession (P = 0.50). Most patients were stage III at the time of surgery both prior to the recession (35%) and during the financial crisis (39.8%, P = 0.17). Ivor-Lewis was the most commonly performed procedure (67.1%) across all eras (P = 0.06). Gastric conduit was the most common form of GI reconstruction (95.9%) following all types of surgery (P < 0.001). Pre-recession anastomoses were usually performed using a circular stapler (65%). Both during (88.1%) and following the recession (100%), the vast majority of anastomoses were hand-sewn. R0 resection was achieved in 142 (97.9%) patients. Anastomosis technique did not affect postoperative leak (P = 0.3) or morbidity rates (P = 0.1). Morbidity rates were not significantly different prior to (25%), during (46.9%), and after (62.5%) the financial crisis, P = 0.16. Utilization of neoadjuvant chemotherapy (26.9%, P = 0.90) or radiation (8.4%, P = 0.44) as well as adjuvant chemotherapy (54.8%, P = 0.85) and irradiation (13.7%, P = 0.49) was the same across all eras. Disease-free survival (DFS) and all-cause mortality rates were 41.2 and 47.3%, respectively. Median DFS and observed survival (OS) were 11.3 and 22.7 months, respectively. The financial crisis did not influence relapse (P = 0.17) and survival rates (P = 0.91). The establishment of capital controls also had no impact on recurrence (P = 0.18) and survival (P = 0.94). Austerity measures during the Greek financial crisis did not influence long-term esophageal cancer outcomes. Therefore, achieving international standards in esophagectomy may be possible in resource-limited countries when centralizing care.

Over-the-counter medicines, economic conditions, and citizens most in need in Greece: Is it a challenge for primary care research?

INTRODUCTION

Recent austerity experiences in Greece suggest a plausible link between extensive use of over-the-counter (OTC) medicines and socio-economic peculiarities of life.

COMMENTARY

During the economic crisis in Greece, accessibility to healthcare services has been impacted, particularly for people with low income. However, this fact has not been systematically analyzed in conjunction with an observed increase in use of OTC medicines. Gaining a better understanding of the reasons leading to self-care may help to answer additional questions. Further research is needed to assess the gap between self-care and medically assisted care/treatment by designing pilot monitoring actions and focusing on behaviours related to OTC medicine use. Primary care can offer more collaboration between primary care physicians, community pharmacists, patients, and their families.

IMPLICATIONS

It is crucial to create a multimodal research plan to gain a better understanding of motivational reasons that eventually lead to increasing use of OTC medicines. Efforts should be made to develop data collection techniques that will elicit information from various social groups that focus on changeable behaviours and perceived needs in relation to medicine consumption.

From public vs. private to public/private mix in healthcare: lessons from the Israeli and the Spanish cases

BACKGROUND

Different forms of public/private mix have become a central mode of the privatization of healthcare, in both financing and provision. The present article compares the processes of these public/private amalgams in healthcare in Spain and Israel in order to better understand current developments in the privatization of healthcare.

MAIN TEXT

While in both Spain and Israel combinations between the public and the private sectors have become the main forms of privatization, the concrete institutional forms differ. In Spain, these institutional forms maintain relatively clear boundaries between the private and the public sectors. In Israel, the main forms of public/private mix have blurred such boundaries: nonprofit health funds sell private insurance; public nonprofit health funds own private for-profit hospitals; and public hospitals sell private services.

CONCLUSIONS

Comparison of the processes of privatization of healthcare in Spain and Israel shows their variegated characters. It reveals the active role played by national and regional state apparatuses as initiators and supporters of healthcare reforms that have adopted different forms of public/private mix. While in Israel, until recently, these processes have been perceived as mainly technical, in Spain they have created deep political rifts within both the medical community and the public. The present article contains lessons each country can learn from the other, to be adapted in each one's local context: The failure of the Alzira model in Spain warns us of the problems of for-profit HMOs and the Israeli private private/public mix shows the risk of eroding trust in the public system, thus reinforcing market failures and inefficient medical systems.

Lockdown During COVID-19: The Greek Success

BACKGROUND/AIM

Coronavirus is an ongoing pandemic challenging health systems worldwide. The aim of this report was to evaluate the effectiveness of lockdown in different countries, highlighting the performance of Greek society and authorities.

METHODS

We analyzed publicly available data from the "Worldometer". We evaluated the efficacy of lockdown at one month after implementation. Delta Days (DD) referred to the difference in the days of reaching 1 case/million people to the adoption of lockdown.

RESULTS

Higher healthcare expenditure as % of the national GDP was not correlated with better 30-day mortality outcomes. DD index was significantly correlated to the incidence of COVID-19 per million people at 30 days (p-value=0.001). The correlation between DD and 30-day mortality was not statistically significant (p-value=0.087).

CONCLUSION

Early lockdown was proven to be the appropriate policy to limit the spread of COVID-19. Greece was a success story in preventing spread despite limited resources.