https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(13)62291-6.pdf

Greece's health crisis: from austerity to denialism

This article addresses the need to establish a comprehensive conceptual framework for analysing healthcare systems and their transformations. It begins by offering an overview of the current state of the art in the field, pointing to the literature's absence of conceptual robustness in the definition of system types. By exploring the dimensions ‘financing’, ‘provision’ and ‘regulation’ of healthcare, the article then proceeds deductively in line with the ‘Weberian method of ideal-types’ to establish a taxonomy of 27 healthcare systems, of which three can be identified as ‘ideal-types’. When applying this concept, not only can differences between healthcare systems be analysed, but also changes over time. The article concludes by identifying three forms of healthcare system transformation.

Healthcare System Types: A Conceptual Framework for Comparison

Healthcare systems have been institutionalized to provide healthcare for those in need. Therefore, comparisons should focus in particular on differences in healthcare provision and on how access to healthcare services is regulated. This article presents a typology of healthcare systems which simultaneously takes into account data on expenditures, financing, provision and access to healthcare in 15 European countries. On this basis, three types of healthcare system have been constructed using statistical cluster analysis: a health service provision-oriented type that is characterized by a high number of service providers and free access for patients to medical doctors; a universal coverage — controlled access type where healthcare provision has the status of a social citizenship right and equal access to healthcare is of higher importance than free access and freedom of choice; and a low budget — restricted access type where financial resources for healthcare are limited and patients’ access to healthcare ...

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Mapping European healthcare systems: a comparative analysis of financing, service provision and access to healthcare:

The goal of this article is to suggest that an extended family of Mediterranean welfare states exists and that it consists of eight different nations, some of which have been ignored in the ongoing discourse on Mediterranean welfare states. More specifically, it is claimed that the extended family of Mediterranean welfare states includes Cyprus, Greece, Israel, Italy, Malta, Spain, Portugal and Turkey. The article underscores a number of features common to members of this extended family of welfare states. Finally, three overarching themes that, in the past and present, appear to underlie the commonalities of Mediterranean welfare states and that can offer potential fruitful avenues for further study will be identified and discussed. These are religion, family and the role of clientelist—particularist relations in the structuring and functioning of welfare state institutions.

Is there an extended family of Mediterranean welfare states

The Greek health system does not yet offer universal coverage and has fragmented funding and delivery. Funding is regressive, with a reliance on informal payments, and there are inequities in access, supply and quality of services. Inefficiencies arise from an over reliance on relatively expensive inputs, as evidenced by the oversupply of specialists and under-supply of nurses. Resource allocation mechanisms are historical and political with no relation to performance or output, therefore providers have little incentive to improve productivity. Some options for future health system reform include focusing on coordinating funding by developing a monopsony purchaser with the aim of improving quality of services and efficiency in the health system and changing provider incentives to improve productivity.

Analysing the Greek health system: a tale of fragmentation and inertia

Background: Caesarean section (CS) rates have been increasing dramatically in the past decades around the world. The objective of our study was to investigate the factors increasing the likelihood of undergoing CS in two public hospitals and one private hospital in Athens, Greece. Specifically, the purpose was primarily to assess the impact of non-medical factors such as private health insurance, potential for making informal payments, physician convenience and socio-economic status on the rate of CS deliveries. Methods: All available demographic, socio-economic and medical information from the medical records of all deliveries in the three hospitals in January 2002 were analysed. The relative importance of the variables in predicting delivery with CS rather than normal vaginal delivery was calculated in multiple logistic regression models to generate odds ratios (OR). Results: The CS rate in the public hospitals was 41.6% (52.5% for Greeks and 26% for i mmigrants), while the CS rate in the private hospital was 53% (65.2% for women with private insurance and 23.9% for women who paid directly). In the public hospitals, after controlling for demographic and medical factors, Greek ethnic background, delivery between 8 a.m. and 4 p.m., between 4 p.m. and midnight, and on Monday, Wednesday and Friday were found to increase the likelihood of CS delivery. In the private hospital, having private health insurance is the strongest predictor of CS delivery, followed by delivery between 8 a.m. and 4 p.m., between 4 p.m. and midnight, delivery on a Saturday and being a housewife. Conclusion: The results of this study lend support to the hypothesis that physicians are motivated to perform CS for financial and convenience incentives. The recent commercialization of gynaecology services in Greece is discussed, along with its implications on physicians’ decisions to perform CS.

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An investigation of Caesarean sections in three Greek hospitals: the impact of financial incentives and convenience.

Changes in the health care sector in Greece since the pathbreaking introduction of the National Health System (NHS) in 1983 have been sluggish. Twenty years after its inception and a series of attempts to reform it, the NHS remains centralized, fragmented in terms of coverage, and quite far removed from its principles of equity and efficiency. Being part of an idiosyncratic welfare state, the health care system is bound to reflect the particularities of Greek society and economy, namely, clientelism, a weak formal-and a thriving informal-economy, the lack of a strong administrative class, a weak labor movement, and strong organized interests. As a result, several ambitious reform plans have failed repeatedly owing to an array of interrelated economic, political, and social factors that channel potential changes toward the trodden path. This constellation creates unfavorable conditions for the introduction and implementation of major reforms.

Plus ça change: health sector reforms in Greece.

Surrogacy is an increasingly common reproductive practice. Today, stories about surrogacy regularly appear in popular culture and news outlets, while the number of organisations offering surrogacy services is clearly on the rise, as is the number of cases involving surrogacy in courts across the EU. Surrogacy raises important legal issues, such as whether surrogacy contracts should be enforceable, as well as questions pertaining to the legal parenthood of a child born to a surrogate mother and his/her citizenship and nationality. There are also significant policy and regulatory concerns relating to: payment; autonomy; child welfare; gender, sexual orientation and socio-economic inequality; reproductive health; and globalisation

Comparative study on the regime of surrogacy in the EU member states

This study, commissioned by the European Parliament's Policy Department for Citizens' Rights and Constitutional Affairs at the request of the FEMM Committee, attempts to reveal the links between the different factors (access, skills, socio-economic and cultural), which prevent women from having equal access to digital technology. It then suggests ways of dealing with online and offline inequalities to the effect of closing the digital gender gap and improving women's and girls' digital inclusion and future technology-related career paths.

Konstantina Davaki

Papers

Analysing the Greek health system: a tale of fragmentation and inertia

An investigation of Caesarean sections in three Greek hospitals: the impact of financial incentives and convenience.

Plus ça change: health sector reforms in Greece.

Comparative study on the regime of surrogacy in the EU member states

The underlying causes of the digital gender gap and possible solutions for enhanced digital inclusion of women and girls