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.
In the current article we aim to describe and show the significance of evidence-based medicine (EBM) in surgical disciplines, as this is expressed through the application of clinical protocols and clinical indicators of quality and outcome. We also probe the questions of clinical protocols assisting in hospital management, and moreover of the political and political-ethical issues for the implementation of clinical protocols in the pursuit of better hospital management. Clinical protocols are guidelines with broader scientific acceptance, helping physicians, surgeons and health staff in general, to perform a procedure or combination of procedures with the best possible results at the lowest possible cost. Clinical indicators are implemented in order to assess the achieved results; such indicators are in-hospital mortality, frequency of adverse events such as stroke or venous thromboembolism, duration of hospitalization, incidence of reoperation, incidence of re-admittance etc. The article also includes, for reasons of better understanding, two examples of clinical protocols (coronary artery surgery and total hip arthroplasty).
Background. Aim of the current prospective study is to investigate and revise the basic information related to the coronary artery bypass graft (CABG) procedure, in an attempt to reevaluate the current Greek Diagnosis Related Groups (DRGs) system. Methods. In a Greek academic cardiothoracic surgical department, implementing clinical therapeutic protocols, we prospectively recruited 75 patients planned to undergo elective CABG. All basic demographic, medical and perioperative data were gathered in an extensive database, so as to be compared with data predicted by the DRG's system. Clinical indicators of performance aiming towards quality control were: perioperative mortality, postoperative myocardial infarct, postoperative stroke, postoperative renal failure, total hospital length of stay, rate of reoperation and rate of readmission. Results. None of the study patients deceased. No cases of perioperative myocardial infarct, stroke or renal failure were observed. Two of the patients developed respiratory failure, and one was reoperated for the control of perioperative bleeding. There were no cases of readmission to the hospital. The total length of stay was longer than the DRG's prediction (mean 11.5 vs 7 days), owed partially to the preoperative stay (mean 3.18 days) in the department, due to reasons of medical vigilance and organisatory problems that led to the postponement of the operation. Conclusions. A review of the CABG related DRG's in Greece seems appropriate, based on the findings of the current study, suggesting a longer than predicted hospital stay.
In continuation to our previous article 1 regarding the significance of clinical protocols in surgical disciplines, we would like to present the next two of our protocols, designed after meticulous study of the related literature and after the evaluation of worldwide experts opinion on the subject 2-12. We would like to emphasize again the fact that, clinical protocols act both as a medical as well as a managerial tool, aiming at the improvement of clinical services provided to our patients, with the application of the means available each time at the least possible cost The rationale behind is that since health treatments have a cost and resources are limited, the integration of managerial and financial efficiency within clinical efficiency is crucial 13, 14, 15,16. As Bachtsevani et al. 14 put it, it seems the use of evidence-based guidelines can improve outcomes in relation to organizations in the sense of decreased admission rates, length of stay, and less resource utilization, which reduces costs. Such monitoring mechanisms intend to evaluate, reassess and improve the clinical care not only in terms of outcomes but also in financial terms for the benefit of the patient welfare, and the hospital as an organization denoting in this way the significance of evidence-based medicine 15,17 Evidence has also shown that the greater the strength of the evidence incorporated, the greater the quality of the guideline and the greater its potential to maximize the use of resources and improve quality of healthcare18.
Aim. To evaluate the Greek Diagnosis Related Groups(DRG's)system in regard to the procedure of total hip arthroplasty. Methods. In a tertiary university orthopedics department implementing clinical protocols we recruited 75 consecutive patients planned to undergototal hip arthroplasty. Indicators of quality and performance were rates of mortality, pulmonary embolism, trauma dehiscence, disarticulation and readmission. Results. All rates of performance were excellent and equal to zero. The mean length of stay was almost identical to the one predicted by the Greek DRG's. Conclusions. Clinical protocols are connected with good clinical results. The predicted by the Greek DRG's hospital length of stay for total hip arthroplasty lies within pragmatic limits.Â
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