Background: While hospital-based Palliative Care services are usually covered through the main funding healthcare framework, traditional reimbursement methods have been criticized for their appropriateness. The present study investigates for the first time the case of treating end-of-life cancer patients in a Greek public hospital in terms of cost and reimbursement. Methods: This retrospective observational study used health administrative data of 135 deceased cancer patients who were hospitalized in the end of their lives. Following the cost estimation procedure, which indentified both the individual patient and overhead costs, we compared the relevant billing data and reimbursement requests to the estimated costs. Results: The average total cost per patient per day was calculated to be 97 EUR, with equal participation of individual patient's and overhead costs. Length of stay was identified as the main cost driver. Reimbursement was performed either by per-diem fees or by Diagnosis Related Groups’ (DRGs), which were correspondingly associated with under or over reimbursement risks. In the case of the combined use of the two available reimbursement alternatives a cross-subsidization phenomenon was described. Conclusion: Although the cost of end-of-life care proved to be quite low, the national per-diem rate fails to cover it. DRGs designed for acute care needs are rather unsuitable for such sub acute hospitalizations. Policy summary: There is a concrete need for reconsidering the current reimbursement schemes for this group of patients as part of any national plan concerning the integration and reformation of Palliative Care services. Otherwise, there is a serious danger for public institutions’ reluctance to admit them with a serious impact on access and equity of end-of-life cancer care. © 2023 Elsevier Ltd

Purpose: Because of the 2008 global financial crisis aftermaths, economic downturn and prolonged recession, several OECD countries have adopted an austerity compound by significantly reducing public health expenditure (PHE) for dealing with their fiscal pressure and sovereign-debt challenges. Against this backdrop, this study aims to examine the responsiveness of PHE to macro-fiscal determinants, demography, as well to private health insurance (PHI) financing. Design/methodology/approach: The authors gather annual panel data from four international organizations databases for the total of OECD countries from a period lasting from 2000 to 2017. The authors apply static and dynamic econometric methodology to deal with panel data and assess the impact of several parameters on PHE. Findings: The authors’ findings indicate that gross domestic product, fiscal capacity, tax revenues and population aging have a positive effect on PHE. Further, the authors find that both unemployment rate and voluntary private health insurance financing present a negative statistically significant impact on our estimated outcome variable. Different specifications and sample periods applied in the regression models reveal how inseparably associated are PHE and OECD's economies compliance on macro-fiscal policies for offsetting public finances derailment. Practical implications: Providing more evidence on the responsiveness of PHE to several macro-fiscal drivers, it can be a helpful tool for governments to reconsider their persistence on fiscal adjustments measures and rank public health financing to the top of their political agenda. Health systems policies for meeting Universal Health Coverage (UHC) objectives, they should also take into consideration the voluntary PHI institution, especially for economies with insufficient fiscal capacity to raise public health financing. Originality/value: To the best of knowledge, the impact of unemployment and voluntary PHI funding on public health financing, apart from other macro-fiscal and demographical parameters effect, remains unnoticed in the existing published studies on the topic. © 2020, Emerald Publishing Limited.

The paper aims to examine the data envelopment analysis (DEA) and stochastic frontier analysis (SFA) results in order to facilitate a common understanding about the adequacy of these methods, defining any differences in healthcare efficiency estimation. A two-stage bootstrap DEA method and the Translog formula of the SFA were performed. Multi-inputs and multi-outputs were used in both of the approaches assuming two scenarios either including environmental variables or not. Thirty-two Greek public hospital units constitute the sample. DEA and SFA were found to yield divergent efficiency estimates due to many factors such as the nature of the environmental variables, the measurement error and other random factors. Environmental variables being hospital status and geographical position were found significantly correlating with inefficiency. The analysis concludes that the choice of the appropriate mathematical form depends on the expertise of the researcher and the purpose of the evaluation. Copyright © 2014 Inderscience Enterprises Ltd.

The study examines the performance of tax organizations in Greece, based on data obtained from a sample of 35 tax offices. Performance evaluation was conducted using DEA with bootstrap methods. In addition, Tobit regression analysis was employed to examine the environmental variables that impact on the efficiency performance of these tax offices. From the analysis, weaknesses, and management issues are derived from the tax offices inefficiency. The general conclusion is that a robust governance structure within the tax office operational framework is needed in order to improve organisational efficiency.

The study attempts to develop an outpatient service quality scale by investigating the key dimensions which assess parental satisfaction and provides a recommendation on an improved health service delivery system. The survey was conducted in an Ear-Nose-Throat outpatient clinic of a Greek public pediatric hospital. A total of 127 parents in outpatient waiting areas were chosen; 74.8% of the sampled parents were under 40, and 78% were mothers. A factor analysis was performed; while a Fischer's exact test and multinomial logistic regression analysis was conducted. All Cronbach's α exceeded 0.70 and all factor loadings exceeded 0.50. Twenty-three items were retained through the scale development process and seven factors were formed that appear to be statistically valid and clinically meaningful: access and convenience, doctor's attention, customization, reliability, assurance, satisfaction and loyalty. Findings were discussed in relation to parents' overall satisfaction and intention of reusing and recommending outpatient clinic. Satisfaction was found to be positively affected by access and convenience and doctors' attention. Staff attitude and the telephone procedure of scheduling the child's examination found positively correlated to the likelihood of recommending services to friends and relatives. Time and communication in the waiting room influenced parents' satisfaction. Overall, results reveal the measures that need to be taken in order to improve outpatient service quality. © 2011 Elsevier Ltd.

This paper describes an empirical study aiming to assess nursing students' perceptions on Electronic Health Record (EHR) concepts and their potential future attitude towards use. Based on the theoretical ground of Rogers' Innovation Diffusion Theory and other research works, a formulated model was empirically validated among ninety nursing undergraduates. Data analysis was based on partial least squares path modeling. Results highlighted the very strong significant effect of relative advantage and observability as well as the significant effect of perceived ease of use to attitude towards using EHR systems. The study findings are discussed along with limitations and future work in the current field. © 2011 European Federation for Medical Informatics. All rights reserved.

In part due to the increased demand for higher education, typical evaluation frameworks for universities often address the key issue of available resource utilisation. This study seeks to estimate the efficiency of 20 public universities in Greece through quantitative analysis (including performance indicators, data envelopment analysis (DEA) and econometric procedures). The findings show inefficiency in terms of human resources management while also identifying a clear opportunity to increase research activity and hence research income. In addition to the immediate findings, this paper more broadly discusses the methodology behind the evaluation process used in this investigation and its potential to more consistently and reliably evaluate the efficiency of resource management by public universities. This paper is set against, and hopes to contribute to, the broader debate on reforming the management and administration system of Greek universities. © 2010 Elsevier Ltd.

PurposeThe aim of this paper is to study the technical and scale efficiency of a set of tax offices (Inland Revenue) in Greece during the period 2001‐2006. Design/methodology/approachThe methodology used to estimate efficiency scores and Greek tax office ranking was the data envelopment analysis. In addition window analysis was used to detect efficiency trends and stability over time. Tobit analysis was applied to explain whether non‐discretionary factors play a role in tax office's performance. FindingsThe results underline that “scale size” and the structure of regional economy where tax offices operate are important factors affecting their efficiency. Research limitations/implicationsDespite the limitations related to the data set, the empirical work suggests that future research may need to concentrate on the dynamic factors i.e. characteristics of the regional where the tax office is situated which could play a significant role in a tax office performance. Practical implicationsThe analysis provides information on tailor‐made political and administrative measures that can lead to improvements in the general infrastructure behind the tax office system in Greece. Originality/valueConsidering that the emerging results needed to be evaluated and considered with a sceptical eye, the present study simply highlights the importance of the information (without sensationalizing it) from the policymakers' perspective and in so doing perhaps provide an additional information resource on which they can base their decisions and policies. © 2010, Emerald Group Publishing Limited.

Introduction: The adoption of e-learning platforms can offer a number of benefits including greater learning flexibility in several arenas including healthcare. The present study aims to explore the perceptions of healthcare postgraduate students regarding the adaptability of e-learning and Web-based courses. Methods: The research was based on the four dimensions of the Technology Acceptance Model, i.e. Perceived usefulness, Perceived ease of use, Attitude towards use and Behavioural intention. A questionnaire covering these 4 dimensions was created, uploaded on a website and the 39 MSc students enrolled in the Healthcare Management and Health Informatics at the Faculty of Nursing, University of Athens, Greece, invited to complete it. Completed questionnaires were analysed using Partial Least Squares and other statistical techniques. Results: A total of 20 questionnaires were fully completed. Analysis of the results demonstrated that postgraduate students appreciate and perceive usefulness and ease of use as key factors towards using e-learning platforms and online courses. Conclusion: The study has a number of limitations including the small sample size. For that reason, we conducted a downsized modeling scenario in order to produce observations and compare results, in terms of validity. Nevertheless despite these limitations, the current study can be useful in helping to guide the development and implementation of e-learning initiatives. © The Journal on Information Technology in Healthcare 2009.

Purpose - The paper aims to define the mission, characteristics, objectives and evaluation processes concerning a specific training seminar entitled "Business administration for public sector executives". Furthermore, the research intends to underline the evaluation criteria, set by trainees and training officers as necessary in order to maximize the seminar's overall impact on all those involved.Design/methodology/approach - The seminar was organized by the University of Athens, Greece, in order to contribute to the continuing education of public sector executives in the field of business administration. The educational methodology was based on adult education principles and the evaluation included the preparation, development, and delivery phases. The seminar's effectiveness was assessed based on predetermined criteria and parameters using methods such as questionnaires, comments, observation and team discussions. Finding - Through this process the seminar's strengths and weaknesses were revealed by making use of quantitative analysis methodological tools, such as statistics and econometric prototypes. The trainees' overall response to the seminar was "measured" and the results proved the high-calibre structure and content of the seminar sessions. The trainees stated that the seminar offered key essential knowledge and aided in skill development; furthermore, they expressed their willingness to attend further lifelong-learning seminars. Practical implications - The criteria set forth by trainees and training officers alike could pave the way for a new approach to lifelong learning/training seminar design, implementation, and evaluation in the short-term future. Originality/value - The paper highlights the assessment criteria that offer meaningful insight into the participants' perceived level of seminar-related satisfaction and can potentially be utilised for the design of future seminars. © Emerald Group Publishing Limited.

Controlling healthcare costs is a multifaceted problem for governments all over the world, as they have the difficult task of ensuring that patients receive high quality care, and that this is delivered as efficiently as possible. Through the use of quantitative analysis, an attempt is made to determine the areas of activity of 32 Greek Public Obstetrical and Gynaecological Units which present problems with regard to their performance. Based on the results that emerge from the application of Data Envelopment Analysis in the 32 hospital units of the sample, information is provided to their managers, which refer to: (i) the degree of utilization of their production factors, (ii) the particular weight of each factor of production in the formation of the relative efficiency score, (iii) the utilization level of each factor of production, and (iv) those hospital units that utilize their factors of production in an optimal way and constitute models for the exercising of effective management. The derived information assists in the formulation of an appropriate policy mix per hospital unit which should be applied by their management teams along with a set of administrative measures that need to be undertaken in order to promote efficiency. © 2007 Elsevier Ireland Ltd. All rights reserved.

Objective: Data exchange and interoperability are necessary to support modern healthcare. The purpose of this study was to use a data envelopment analysis (DEA) approach in order to evaluate the degree of efficiency and interoperability of Information Technology within Greek Regional Health Authorities. Methods: Publicly available data were collected from the Greek Information Society organisation regarding specific IT attributes of relevant Greek healthcare organisations for the period 2000 until 2006 and a DEA approach was applied against them. Inputs were network and software infrastructure and outputs were interoperability, data exchange mechanisms and ability to support open standards. Results: Results obtained for 15 of the 17 healthcare regions clearly demonstrated limited utilisation of the physical and software infrastructure for achieving interoperability. Conclusion: Based on the fact that the input data reflect a specific period of time, there is a need to increase the level of interoperability amongst existing healthcare information systems within the healthcare regions in Greece. Key factors in achieving this will be standardisation, and the adoption and introduction of new, open technologies. © The Journal on Information Technology in Healthcare 2008.

Objective: The geographic morphology of Greece has created inequalities in the provision of obstetric and gynaecology (O&G) services resulting in patients from rural areas having to travel to city hospitals to receive treatment. This study focuses on using quantitative analysis to evaluate the efficiency impact of introducing telemedicine services for O&G services in Greece. Setting: 32 O&G units located in rural and urban areas in Greece. Methods: Data envelopment analysis was used to evaluate the efficiency impact of introducing telemedicine services into the thirty-two O&G units Results: DEA indicated that substantial improvements in efficiency and cost savings could be achieved by introducing telemedicine for O&G services. It was estimated that efficiency could be improved by an overall reduction of approximately 6.5% in the number of beds, 10.6% in the number of obstetricians and gynaecologists, and 6.4% in overall expenditure. The improvements in efficiency were greatest in the peripheral regions where DEA suggested that beds could be reduced by 12.1% and the number of obstetricians and gynaecologists by 26.5%. Expenditure was predicted to increase in the peripheral regions due to the increased number of patients treated in them, but this increase was more than offset by a reduction in expenditure in city hospitals since these same patients no longer travelled to them for treatment. This produced estimated overall cost savings of more than 13 million Euros. DEA also enabled identification of the changes that needed to be made to individual units and the magnitude of these changes. This information is essential to policy and decision makers. Conclusion: The introduction of telemedicine to O&G services will produce significant patient, financial and healthcare benefits. These benefits include prevention of unnecessary travel by female patients, better geographical distribution of obstetric and gynaecology cases, increased provision of services and more efficient use of resources in rural areas. DEA enables identification of the changes that need to be made to individual units. © The Journal on Information Technology in Healthcare.

This paper uses a Data Envelopment Analysis (DEA) approach to explore the productivity impact of a telemedicine system for obstetrics and gynaecology (O-G) services in the Greek National Health Service (NHS). DEA is a technique that can provide valuable information to aid understanding of the complex relationship between investments in telemedicine and the efficient delivery of services. The study involved 32 (O-G) units located in both peripheral regions and the central area of Attica. Initially, DEA analysis was applied to the units without the use of telemedicine taking into consideration the number of beds, staffing numbers and total expenditure. The analysis indicated that overall improvements in efficiency of between 6-10% could be achieved. There was, however, a marked difference between the units in peripheral regions and Attica. To improve efficiency in the peripheral units would require a 26% reduction in staff and 12% reduction in beds, compared to less than 5% reduction for either beds or staff in Attica. Achievable cost savings were also much higher for peripheral regions compared to central areas. These figures reflect the current status of healthcare in Greece with female patients traveling from the peripheral regions to central areas to receive O-G services. As a consequence, there is overcapacity in peripheral regions. The effect of the introduction of telemedicine was next analysed. This demonstrated that its introduction produces a geographic redistribution of O-G cases with more cases being treated in the peripheral regions. Increased treatment in these regions is associated with increased expenditure for them of approximately 10-20%. This is, however, offset by a decrease of more than 50% in expenditure for the units in Attica due to less patients traveling from the peripheral regions to them for treatment. The introduction of telemedicine also produced significant improvements in efficiency permitting a reduction of approximately 15% in beds and 25% for staff in both peripheral regions and Attica. Improvements in efficiency were more profound in peripheral units with three units achieving a relative efficiency of 100% compared to zero before the introduction of telemedicine. Economically, the introduction of telemedicine was estimated to produce annual savings of 7.5 million Euros, and when combined with the recommendations obtained from DEA achieved total savings of over 13 million Euros or approximately 25% of current expenditure. In conclusion, the study indicates that the introduction of telemedicine would overcome the diagnostic-treatment gap that currently exists in non urban regions for the treatment of O-G cases and enable more patients to be treated in peripheral regions. Application of DEA methodology demonstrated that significant improvements in efficiency and utilisation of resources could also be achieved. © The Journal on Information Technology in Healthcare 2005.

Although frontier techniques have been used to measure healthcare efficiency, their utility in decision making process is limited by both methodological questions concerning their application. The present paper aims to examine the data envelopment analysis (DEA) and stochastic frontier analysis (SFA) results in order to facilitate a common understanding about the adequacy of these methods. A two-stage bootstrap DEA method and the Translog formula of the SFA were performed. Multi-inputs and multi-outputs were used in both of the approaches assuming two scenarios either including environmental variables or not. Thirty-two Greek public hospital units constitute the sample. The main output of the analysis was that the efficiency scores increased with the incorporation of environmental variables. Moreover, environmental variables being hospital status and geographical position were found significantly correlating with inefficiency, while patient mobility was not found strongly correlating. DEA and SFA were found to yield divergent efficiency estimates due to the nature of the environmental variables and the measurement error. The analysis concludes that there is a need for careful attention by stakeholders since the nature of the data and its availability influence the measurement of the efficiency and thus it is necessary to be specific when choosing the mathematical form.

The objective of this paper is to assess the future adaptability of e-Learning platforms within postgraduate modules. An ongoing empirical assessment was conducted amongst postgraduate students, based on the Technology Acceptance Model (TAM). The current paper presents the outcomes from the second phase of a survey, involving fifty six participants. Data analysis was performed using a structural equation model, based on partial least squares. Results highlighted the very strong effect of perceived usefulness and perceived ease of use to attitude towards using e-Learning platforms. Consequently, attitude towards use proved to be a very strong predictor of behavioral intention. Perceived usefulness, on the contrary, did not prove to have an effect to behavioral intention. Implications on the potential of using e-Learning platforms are discussed along with limitations and future directions of the study. © 2010 IMIA and SAHIA. All rights reserved.

Hospital institution's managers are called upon to combine and utilize efficiently the finite financial resources toward the goal of maximizing the number and quality of health services offered. The research aim of this study is to primarily estimate the relative technical efficiency by using a sample from public hospital units that provide obstetrical and gynaecological services in Greece and secondly, to emphasize the policy implications for health sector policy-makers. In order to effectively address the above goals, a comparative analysis of 32 Greek Public Hospital Units was conducted. The research was based on data collected from official public sources. Quantitative analysis, specifically data envelopment analysis (DEA) is used to estimate efficiency of hospital units. Based on the results that emerge from the application of Data Envelopment Analysis, information is provided to their managers, which refer to: (i) the degree of utilization of their production factors, (ii) the particular weight of each production factor in the modulation of the relative technical efficiency score, (iii) the utilization level of each production factor, and (iv) those hospital units that utilize their resources in an optimal way and constitute models for the exercising of effective management. Particular emphasis is given to the economic efficiency of central region hospital units' relative to those of the outlying regions. The derived information assists in the modulation of an appropriate policy mix per hospital unit which should be applied by their management teams along with a set of administrative measures that need to be undertaken in order to promote efficiency. © 2011 by Nova Science Publishers, Inc. All rights reserved.

Information and computer security are gaining continuous attention in the context of modern organizations across all domains of human activities. Emphasizing on behavioral factors toward the applicability of security measures and practices is an area under research, aiming to look beyond the strict technical peculiarities and investigate human attitudes in regards to security consciousness and familiarity. The aim of this chapter is to shed light on those aspects in relation with healthcare, by empirically assessing the intention of undergraduate nursing students to apply security concepts and practices. A research theoretical framework is proposed based on an empirical synthesis of constructs adopted from well established theories as the Health Belief Model and the Protection Motivation Theory along with a variety of previous research works. The model is then empirically tested and validated against a sample of 149 undergraduate nursing students. Data analysis was performed using partial least squares. The research findings highlighted the significant effects of perceived benefits, general security orientation and selfefficacy to behavioral intention along with the positive effect of general controllability to self-efficacy of nursing students in applying security concepts and practices, whereas a series of other constructs did not prove to be significant. The study outcomes contribute to further observations related with behavioral security. Despite the fact that the current empirical study was conducted under a specific context and settings, implications are discussed, regarding the security readiness of nursing students prior their engagement to a real healthcare environment. © 2011, IGI Global.