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?

BMC Health Services Research

Eleutherios Thireos¹  Charalampos Tsairidis⁴  Christoforos Skamnakis⁴  Periklis Polizoidis⁴  Kalomira Mama⁴  Catherine Kastanioti³  Mamas Theodorou²  Costas Dikeos⁴  Stefanos Karakolias⁴  Nikos Polyzos⁴ 

[1] Health Center of Vari, Vari, Greece;Faculty of Economics and Management, Open University of Cyprus, Nicosia, Cyprus;Department of Management of Enterprises and Organizations, ATEI of Peloponnese, Kalamata, Greece;Department of Social Administration and Political Science, Democritus University of Thrace, Komotini, Greece

关键词: APGs;    Reimbursement;    Primary health care;    EOPYY;    Health funds;    Health systems;   

Others  :  1091004
DOI  :  10.1186/s12913-014-0583-4

 received in 2013-11-26, accepted in 2014-11-05,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Polyzos et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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