Web-economic-crisis-health-systems-and-health-web

Chapter 4 | The impact of the crisis on the health system and health in Greece
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operating expenses (i.e. hospital expenditure excluding salaries and wages)
and these costs were cut by approximately 38.2% between 2009 and 2011
by streamlined procurement procedures, implementing pharmaceutical policy
reforms and through horizontal cuts decided by the Ministry of Health
and Social Solidarity. Expenditure for orthopaedics and prosthetic devices
was reduced by more than 67% during this period, followed by medical
supplies, pharmaceuticals and chemical reagents, which fell by 38.5%, 29%
and 30.5%, respectively (Ministry of Health and Social Solidarity, 2012b).
Counterbalancing these gains however, operating expenditures (e.g. consumables,
overheads, security) showed a considerable increase in many hospitals and the
immediate causes are not known. For example, in a sample of 40 general hospitals
(out of 90) for which all expenditure data were available for 2009–2011,
expenditure on various contracted-out services (e.g. legal services, counselling
services) recorded an increase of 40% in 2010 (compared with 2009) and a further
increase of 27% in 2011, while for the same periods the same hospitals managed
to achieve decreases for pharmaceuticals equalling 12% (in 2010) and 28%
(in 2011) and for medical supplies equalling 25% (in 2010) and 18% (2011).
The results for other overheads or outsourcing services are similar. Examples
include catering (an increase of 22% in 2010 and 12% in 2011 for the
19 hospitals for which data were available for the three-year period); cleaning
(16% increase in 2010 and 24% increase in 2011 for 50 hospitals); and security
services (23% increase in 2010 and a further 27% increase in 2011 for 34
hospitals). Considering the fact that overheads are among the first expenditures
to be cut during cost-containment efforts, such results highlight that this is
an area that should be examined more thoroughly in terms of identifying
impediments to the efficient allocation of resources (Kaitelidou et al., 2012a).
In the private hospital sector it is difficult to obtain a clear picture as yet since
the available data seem to be controversial. Anecdotal evidence is accumulating
that the demand for private hospital services has decreased. According to
ICAP (2011), private hospital revenues decreased by 14.1% between 2009
and 2010, which may reflect, among other things, delayed reimbursements
by EOPYY. Despite this negative trend, the number of private hospital beds
only slightly decreased (by 0.3%) between 2009 and 2010 and the number
of staff fell by 5.3% (ICAP 2010, 2011). However, according to OECD data
(OECD, 2013) private hospital expenditure (on a cash basis) slightly increased,
from approximately €1.98 billion in 2009 to €2.53 billion in 2011. The main
funding source was households since households contributed €921.6 million to
total private hospital expenditure in 2011, compared with €771 million derived
from general government and €360.6 million from PHI. The corresponding
figures in 2009 were similar: €852.4 million (households), €824.4 million
(general government) and €298.3 million (PHI).