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126 Economic crisis, health systems and health in Europe: country experience
4.3 Impact on hospital sector efficiency
A recent university research study examining the performance of public
hospitals in terms of their efficiency during the recession found that despite
serious cost-containment efforts, only 28% of the 90 hospitals analysed were
found to be efficient (Kaitelidou et al., 2012a). However using bootstrapping
methodology, none of the hospitals appeared to be efficient while the
utilization of the available inputs did not exceed 80%. Nevertheless, among the
best practices used were effective procurement policies, e-auctions, tendering
and renegotiation of contracts with a number of suppliers. In 2011, general
hospitals focused only on cost-containment efforts, which, in fact, did not
have the expected results. Expenditures were indeed cut by approximately
€680 million (from 2009 to 2011) but this was mostly the result of cuts in “easily
identified supplies” such as pharmaceutical, orthopaedic or medical supplies.
Two more studies presented similar findings, highlighting that public hospitals
have succeeded in reducing their budgets but at the same time not increasing
substantially, their efficiency scores (Katharakis et al., 2013; Tsavalias, 2013).
4.4 Quality of care
Several initiatives have been implemented in attempts to improve quality
of care. According to Law 3868/2010, all hospitals are now obliged to set
up quality assurance departments and quality assurance committees. Their
roles are to monitor and evaluate whether procedures on patient safety
(e.g. incidence of hospital infections and control of antibiotic-resistant bacteria)
and laboratory accreditation are being met. They report to the Ministry of Health
and Social Solidarity on a quarterly basis. Additionally, patient satisfaction surveys
are being conducted in hospitals on a compulsory basis. The Ministry of Health
and Social Solidarity also organizes conferences on various aspects of health care
quality which are compulsory for hospital employees, with the aim of promoting
continuous education in the field. Lastly, a new agency, the National Evaluation
Centre of Quality & Technology in Health (EKAPTY, http://www.ekapty.gr/)
was established in 2010 for the certification of quality management systems,
evolving from the Research Centre for Biomaterials (EKEVYL).
Although these measures are expected to have a positive impact, some other
aspects of the functioning of the health system raise questions about the quality
of services. For example, shortages in nursing personnel are a permanent
characteristic of the public hospital sector, and staffing level problems have
worsened since the application of the MoU as many health care professionals
chose retirement in order to ensure better pensions. The impact on staff
reductions on both efficiency and quality of services is not known but it is
expected that both will decline.