Συστήματα αποζημίωσης των παροχών πρωτοβάθμιας φροντίδας υγείας (Doctoral thesis)

Καρακόλιας, Στέφανος Ε.

This thesis aimed at identifying internationally applied remuneration models, probably more appropriate for -and more acceptable by- Greek PHC providers, so as to provide services of higher quality and accessibility. The methodology included a dual research part (main survey and case study). Main survey recorded through questionnaires the public PHC medical staff’s views on limiting factors of quality and accessibility. The participants were also asked to assess the current remuneration system for themselves and their units separately, and express their preferences regarding alternative schemes. The sample consisted of 284 doctors employed at the National PHC Network (PEDY). Complementarily, the case study was developed in the Evros prefecture in order to evaluate the PHC network and organisation. The so called “International Family Practice Maturity Matrix” was applied and the approach was qualitative. The results of the main survey revealed that major barriers to quality were deemed the tight financial resources and the lack of incentives for staff, and major barriers to access were deemed the absence of additional services (home care, phone consultation etc.) along with the co-payments and co-insurance unaffordability on behalf of patients. 90% of doctors agreed that their salary is lower than work produced and 41% of them considered their salary lower than that of private sector colleagues. Meanwhile, 43% of respondents argued that salary motivates them to have parallel-illegal employment. The majority of general practitioners (GPs) (24.5%) preferred a combination of capitation with fee-for-service, but most specialists stated preference in salary (38.6%). Only 1/3 of participants stated that their units run surplus budgets, however it is not used the unit to benefit the surplus. 32% of respondents would support the reimbursement of PEDY units on a cost-per-case basis similar to that of inpatient care (Diagnosis Related Groups), whereas the adequate staff training and safeguards against potential overpricing were picked as the more critical issues during its implementation. Case study results highlighted significant organisational differences between health centres and the units formerly owned by the National Organisation for Healthcare Provision (EOPYY), which have not been eliminated by PEDY so far. It is about payroll, information systems and operation divergences. The main conclusion is that public PHC doctors are intensively dissatisfied with the current reimbursement scheme, howbeit they do not reach a consensus to change it. Radical change in GPs remuneration, who have repeatedly expressed their preference on capitation, and adjustments to the remuneration of all medical specialties by introducing financial incentives (pay-for-performance), can lead to improved quality and access. The corresponding conclusion regarding PHC units is that their remuneration shall be similar-visit-groups-oriented in order to achieve autonomous management of global budgets. Greek PHC must converge with international standards starting with simultaneous interventions in its structure along with the providers’ remuneration methods.
Alternative title / Subtitle: διεθνής εμπειρία και εφαρμογή στην ελληνική πραγματικότητα
Institution and School/Department of submitter: Δημοκρίτειο Πανεπιστήμιο Θράκης. Σχολή Κοινωνικών, Πολιτικών και Οικονομικών Επιστημών
Subject classification: Public health
Keywords: Πρωτοβάθμια φροντίδα υγείας,Αποζημίωση παρόχων,Μισθός,Κατά κεφαλή,Κατά πράξη,Ομάδες περιπατητικών ασθενών,Primary health care,Reimbursement of providers,Salary,Per head,In practice,Ambulatory patient groups
URI: https://repo.lib.duth.gr/jspui/handle/123456789/17624
http://dx.doi.org/10.26257/heal.duth.16358
Appears in Collections:ΚΟΙΝΩΝΙΚΗΣ ΔΙΟΙΚΗΣΗΣ & ΠΟΛΙΤΙΚΗΣ ΕΠΙΣΤΗΜΗΣ

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http://dx.doi.org/10.26257/heal.duth.16358
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