Golna, Christina and Pashardes, Panos and Allin, Sara and Theodorou, Mamas and Merkur, Sherry and... more Golna, Christina and Pashardes, Panos and Allin, Sara and Theodorou, Mamas and Merkur, Sherry and Mossialos, Elias (2004) Health care systems in transition: Cyprus. Vol. 6 No. 5. World Health Organization, Copenhagen, Denmark.
Perspectives in Health Information Management Ahima American Health Information Management Association, Feb 1, 2008
ObjectivesThis study assesses the results of implementation of a software program that allows for... more ObjectivesThis study assesses the results of implementation of a software program that allows for input of admission/discharge summary data (including cost) in a neonatal intensive care unit (NICU) in Greece, based on the establishment of a baseline statistical database for infants treated in a NICU and the statistical analysis of epidemiological and resource utilization data thus collected.MethodsA software tool was designed, developed, and implemented between April 2004 and March 2005 in the NICU of the LITO private maternity hospital in Athens, Greece, to allow for the first time for step-by-step collection and management of summary treatment data. Data collected over this period were subsequently analyzed using defined indicators as a basis to extract results related to treatment options, treatment duration, and relative resource utilization.Results and discussionData for 499 babies were entered in the tool and processed. Information on medical costs (e.g., mean total cost ± SD of treatment was €310.44 ± 249.17 and €6704.27 ± 4079.53 for babies weighing more than 2500 g and 1000–1500 g respectively), incidence of complications or disease (e.g., 4.3 percent and 14.3 percent of study babies weighing 1,000 to 1,500 g suffered from cerebral bleeding [grade I] and bronchopulmonary dysplasia, respectively, while overall 6.0 percent had microbial infections), and medical statistics (e.g., perinatal mortality was 6.8 percent) was obtained in a quick and robust manner.ConclusionsThe software tool allowed for collection and analysis of data traditionally maintained in paper medical records in the NICU with greater ease and accuracy. Data codification and analysis led to significant findings at the epidemiological, medical resource utilization, and respective hospital cost levels that allowed comparisons with literature findings for the first time in Greece. The tool thus contributed to a clearer understanding of treatment practices in the NICU and set the baseline for the assessment of the impact of future interventions at the policy or hospital level.
is also important when identifying appropriate therapeutic options for patients who have progress... more is also important when identifying appropriate therapeutic options for patients who have progressed on trastuzumab (TZ). This study explores UK treatment patterns for women with HER2 + MBC who progress while on TZ, and have been previously treated with an anthracycline and a taxane (A&T). METHODS: Case histories from 2815 women with MBC seen January 2006 to December 2007 were retrieved from the IMS Advanced Disease Analyzer database: 421 had received TZ in the metastatic setting. Changes in therapy were used as a proxy for disease progression; patients receiving TZ monotherapy within 28 days of ending a previous regimen were excluded from this definition to ensure that TZ use as a maintenance treatment was not inappropriately characterised as progression. Therapeutic regimens received post-progression were characterised for 98 patients who had progressed on TZ. Results were compared with a UK treatment survey completed by oncologists with a specialist interest in breast cancer (n = 92). RESULTS: Of the 98 patients that progressed on TZ, 54 (55.1%) continued receiving a TZ-containing regimen, most commonly in combination with capecitabine (n = 21; 21.4%) or vinorelbine (n = 20; 20.4%). Capecitabine monotherapy was also commonly used (n = 31; 31.6%). Re-challenge with a taxane was uncommon (n = 1; 1.0%). Major regimens received post-progression on TZ, as identified from case histories, agreed closely with results from the treatment survey. CONCLUSIONS: This study demonstrates that, despite the lack of a robust evidence base in this population, a high proportion of patients continue to receive a TZ-containing regimen post-progression. This highlights a clear need for evidence-based HER2 targeted therapy in a patient population where effective treatment options are limited. OBJECTIVES: The objective of this study was to examine racial differences in total and prescription related health care costs and service utilization associated with adjuvant hormonal therapy in women with primary breast cancer. METHODS: This was a retrospective cohort study of Medicaid enrollees with hormone receptor positive breast cancer newly starting adjuvant hormonal therapy. The study used North Carolina Medicaid data, which was linked to the North Carolina Cancer Registry. The patients were followed for one year after commencing the index medication (tamoxifen or aromatase inhibitor) to collect the data on medication utilization, health care costs, hospitalization and emergency department (ED) visits. RESULTS: In this cohort of 609 women with primary breast cancer, mean total health care costs was $14,513.31 (SD = $15,233.17), which did not differ significantly across the racial groups [white = mean (SD) $15,261.13 ($16,225.15); black = mean (SD) $13,580.61 ($13,870.34); p > 0.05]. Overall mean prescription related costs were $4612.18 (SD = $3509.59) with white patients having a significantly higher costs [mean (SD) = $5000.51 ($3582.29)] as compared to black patients [mean (SD) = $4127.85 ($3360.83] (p < 0.05). After controlling for select background variables, prescription related costs remained significantly higher in white patients [p < 0.05]; however total health care costs did not differ significantly across the racial groups [p > 0.05]. The likelihood of hospitalization was significantly lower by 33% in black patients as compared to white patients after controlling for select background variables (p < 0.05). Black race was associated with a 3% increase in the likelihood of an ED visit; however the difference was statistically insignificant (p < 0.05). CONCLU-SIONS: In this study white patients had lower non-prescription related costs as a result of lower service utilization. Higher medication compliance in white patients may drive prescription related costs upwards but may consequently reduce the total health care costs.
Perspectives in health information management / AHIMA, American Health Information Management Association, 2008
This study assesses the results of implementation of a software program that allows for input of ... more This study assesses the results of implementation of a software program that allows for input of admission/discharge summary data (including cost) in a neonatal intensive care unit (NICU) in Greece, based on the establishment of a baseline statistical database for infants treated in a NICU and the statistical analysis of epidemiological and resource utilization data thus collected. A software tool was designed, developed, and implemented between April 2004 and March 2005 in the NICU of the LITO private maternity hospital in Athens, Greece, to allow for the first time for step-by-step collection and management of summary treatment data. Data collected over this period were subsequently analyzed using defined indicators as a basis to extract results related to treatment options, treatment duration, and relative resource utilization. Data for 499 babies were entered in the tool and processed. Information on medical costs (e.g., mean total cost +/- SD of treatment was euro310.44 +/- 249...
The European journal of health economics : HEPAC : health economics in prevention and care, Jan 3, 2015
Under-the-table informal payments are commonplace as reimbursements for health care services in G... more Under-the-table informal payments are commonplace as reimbursements for health care services in Greece. As the country faces a severe financial crisis, the need to investigate the extent of such payments, their incidence and their impact on household income is pressing. A survey of 2,741 persons from across the country was conducted between December 2011 and February 2012. The sample was defined via a multistage selection process using a quota for municipality of residence, sex and age. The maximum error margin was 2.41 % with a confidence interval of 95 %. The survey reports under-the-table payments for approximately 32.4 % of public hospital admissions. Private clinics, which display the bulk of out-of-pocket payments, naturally display the lowest under-the-table payments. The highest percentage of under-the-table payments in the private sector appears at visits to private practitioners and dentists (36 %). Informal payments are most frequently made upon request, prior to service ...
Scope: This article seeks to assess the economic impact of industrial accidents with reference to... more Scope: This article seeks to assess the economic impact of industrial accidents with reference to the incidence of opthalmological industrial injuries occurring in the Thriacion Plain industrial zone in Greece during the period 1991-2000. Material and Methods: Data provided by 53 industrial units have been collected and classified. During the study period, 2,011 adults and juveniles out of the 15,600 people employed in the area (a 13% aggregate) suffered opthalmological injuries occurring at the workplace. Results: The highest percentage of injuries were due to trauma (61% of adults, 67% of juveniles), followed by chemical burns. In the majority of cases (75% of adults and 50% of juveniles) treatment was provided at the local IKA (Social Security Fund) health care unit, in the town of Elefsis. It was estimated that a total of 10,192 working days were lost, with compensation costs (benefit payments) alone amounting to approximately € 118,000.00, not allowing for indirect employer costs such as loss of productivity, substitution and replacement costs. Conclusions: The high incidence of industrial accidents in combination with the high percentage of child labor in the area of Thriacion Industrial Plain were striking and contributed significantly to higher rates of work-related injuries of ocular interest in Greece. The latter were shown to result in a significant deterioration of the employees' health status, with the majority of the accidents being due to the lack of safety precautions at the workplace at a considerable financial burden on the social security system in direct benefit payments. The social security system needs to press for tighter work safety regulations and their proper implementation if to minimize the burden these accidents impose on its budget.
Intravenous (iv) infusion of biologic agents is a highly effective therapeutic option for active ... more Intravenous (iv) infusion of biologic agents is a highly effective therapeutic option for active rheumatoid arthritis (RA). In Greece, it is mandatory that all infusions are administered in a hospital setting; therefore, they are strongly correlated with the system's capacity in terms of resources. The objective of this paper was to assess the capacity of the Greek National Health System (NHS) hospitals to meet current/projected demand for iv treatment of RA patients. Semi-qualitative interviews on the basis of a strictly structured questionnaire were conducted with the Heads of all NHS RA infusion sites to record available resources, service utilization and ability to meet current/ projected demand. Out of 31 NHS infusion sites, 28 responded (90.3%). On average, 41.6% of Greek NHS RA patients are treated with a biologic agent and 61.5% of respondents stated that available resources are insufficient to meet current demand. The most important constraints in selection order were as follows: space (93%), staff (89.5%), equipment (61.5%) and working hours (57%). Fifty-six percent of respondents stated that they may decline treatment to patients due to constraints. Overall, respondents estimated that the number of iv patients could be increased by 104%, were there no capacity constraints. An important proportion of the estimated 40.000 RA patients in Greece, for whom iv biologic treatment in the hospital setting is essential for disease control, may be declined treatment due to constraints in RA-specific resources. Rationalization and reallocation of NHS resources is required to ensure equity in access to effective treatment for all RA patients.
This paper examines the economic, political and legal characteristics of the Greek pharmaceutical... more This paper examines the economic, political and legal characteristics of the Greek pharmaceutical market, which is largely affected by the paradox of state intervention: while pharmaceutical regulation is mainly directed towards a rationalisation of total pharmaceutical expenditure, all measures taken to date aim at exhaustive pricing controls, i.e. interventions on the supply side alone, disregarding the "balloon" effect of shrinking prices on the expanding volume of consumption.
Objectives: To investigate whether the long term lease of public hospital owned land could be an ... more Objectives: To investigate whether the long term lease of public hospital owned land could be an additional financing mechanism for Greek public (mental) health hospitals.
Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thela... more Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/
Golna, Christina and Pashardes, Panos and Allin, Sara and Theodorou, Mamas and Merkur, Sherry and... more Golna, Christina and Pashardes, Panos and Allin, Sara and Theodorou, Mamas and Merkur, Sherry and Mossialos, Elias (2004) Health care systems in transition: Cyprus. Vol. 6 No. 5. World Health Organization, Copenhagen, Denmark.
Perspectives in Health Information Management Ahima American Health Information Management Association, Feb 1, 2008
ObjectivesThis study assesses the results of implementation of a software program that allows for... more ObjectivesThis study assesses the results of implementation of a software program that allows for input of admission/discharge summary data (including cost) in a neonatal intensive care unit (NICU) in Greece, based on the establishment of a baseline statistical database for infants treated in a NICU and the statistical analysis of epidemiological and resource utilization data thus collected.MethodsA software tool was designed, developed, and implemented between April 2004 and March 2005 in the NICU of the LITO private maternity hospital in Athens, Greece, to allow for the first time for step-by-step collection and management of summary treatment data. Data collected over this period were subsequently analyzed using defined indicators as a basis to extract results related to treatment options, treatment duration, and relative resource utilization.Results and discussionData for 499 babies were entered in the tool and processed. Information on medical costs (e.g., mean total cost ± SD of treatment was €310.44 ± 249.17 and €6704.27 ± 4079.53 for babies weighing more than 2500 g and 1000–1500 g respectively), incidence of complications or disease (e.g., 4.3 percent and 14.3 percent of study babies weighing 1,000 to 1,500 g suffered from cerebral bleeding [grade I] and bronchopulmonary dysplasia, respectively, while overall 6.0 percent had microbial infections), and medical statistics (e.g., perinatal mortality was 6.8 percent) was obtained in a quick and robust manner.ConclusionsThe software tool allowed for collection and analysis of data traditionally maintained in paper medical records in the NICU with greater ease and accuracy. Data codification and analysis led to significant findings at the epidemiological, medical resource utilization, and respective hospital cost levels that allowed comparisons with literature findings for the first time in Greece. The tool thus contributed to a clearer understanding of treatment practices in the NICU and set the baseline for the assessment of the impact of future interventions at the policy or hospital level.
is also important when identifying appropriate therapeutic options for patients who have progress... more is also important when identifying appropriate therapeutic options for patients who have progressed on trastuzumab (TZ). This study explores UK treatment patterns for women with HER2 + MBC who progress while on TZ, and have been previously treated with an anthracycline and a taxane (A&T). METHODS: Case histories from 2815 women with MBC seen January 2006 to December 2007 were retrieved from the IMS Advanced Disease Analyzer database: 421 had received TZ in the metastatic setting. Changes in therapy were used as a proxy for disease progression; patients receiving TZ monotherapy within 28 days of ending a previous regimen were excluded from this definition to ensure that TZ use as a maintenance treatment was not inappropriately characterised as progression. Therapeutic regimens received post-progression were characterised for 98 patients who had progressed on TZ. Results were compared with a UK treatment survey completed by oncologists with a specialist interest in breast cancer (n = 92). RESULTS: Of the 98 patients that progressed on TZ, 54 (55.1%) continued receiving a TZ-containing regimen, most commonly in combination with capecitabine (n = 21; 21.4%) or vinorelbine (n = 20; 20.4%). Capecitabine monotherapy was also commonly used (n = 31; 31.6%). Re-challenge with a taxane was uncommon (n = 1; 1.0%). Major regimens received post-progression on TZ, as identified from case histories, agreed closely with results from the treatment survey. CONCLUSIONS: This study demonstrates that, despite the lack of a robust evidence base in this population, a high proportion of patients continue to receive a TZ-containing regimen post-progression. This highlights a clear need for evidence-based HER2 targeted therapy in a patient population where effective treatment options are limited. OBJECTIVES: The objective of this study was to examine racial differences in total and prescription related health care costs and service utilization associated with adjuvant hormonal therapy in women with primary breast cancer. METHODS: This was a retrospective cohort study of Medicaid enrollees with hormone receptor positive breast cancer newly starting adjuvant hormonal therapy. The study used North Carolina Medicaid data, which was linked to the North Carolina Cancer Registry. The patients were followed for one year after commencing the index medication (tamoxifen or aromatase inhibitor) to collect the data on medication utilization, health care costs, hospitalization and emergency department (ED) visits. RESULTS: In this cohort of 609 women with primary breast cancer, mean total health care costs was $14,513.31 (SD = $15,233.17), which did not differ significantly across the racial groups [white = mean (SD) $15,261.13 ($16,225.15); black = mean (SD) $13,580.61 ($13,870.34); p > 0.05]. Overall mean prescription related costs were $4612.18 (SD = $3509.59) with white patients having a significantly higher costs [mean (SD) = $5000.51 ($3582.29)] as compared to black patients [mean (SD) = $4127.85 ($3360.83] (p < 0.05). After controlling for select background variables, prescription related costs remained significantly higher in white patients [p < 0.05]; however total health care costs did not differ significantly across the racial groups [p > 0.05]. The likelihood of hospitalization was significantly lower by 33% in black patients as compared to white patients after controlling for select background variables (p < 0.05). Black race was associated with a 3% increase in the likelihood of an ED visit; however the difference was statistically insignificant (p < 0.05). CONCLU-SIONS: In this study white patients had lower non-prescription related costs as a result of lower service utilization. Higher medication compliance in white patients may drive prescription related costs upwards but may consequently reduce the total health care costs.
Perspectives in health information management / AHIMA, American Health Information Management Association, 2008
This study assesses the results of implementation of a software program that allows for input of ... more This study assesses the results of implementation of a software program that allows for input of admission/discharge summary data (including cost) in a neonatal intensive care unit (NICU) in Greece, based on the establishment of a baseline statistical database for infants treated in a NICU and the statistical analysis of epidemiological and resource utilization data thus collected. A software tool was designed, developed, and implemented between April 2004 and March 2005 in the NICU of the LITO private maternity hospital in Athens, Greece, to allow for the first time for step-by-step collection and management of summary treatment data. Data collected over this period were subsequently analyzed using defined indicators as a basis to extract results related to treatment options, treatment duration, and relative resource utilization. Data for 499 babies were entered in the tool and processed. Information on medical costs (e.g., mean total cost +/- SD of treatment was euro310.44 +/- 249...
The European journal of health economics : HEPAC : health economics in prevention and care, Jan 3, 2015
Under-the-table informal payments are commonplace as reimbursements for health care services in G... more Under-the-table informal payments are commonplace as reimbursements for health care services in Greece. As the country faces a severe financial crisis, the need to investigate the extent of such payments, their incidence and their impact on household income is pressing. A survey of 2,741 persons from across the country was conducted between December 2011 and February 2012. The sample was defined via a multistage selection process using a quota for municipality of residence, sex and age. The maximum error margin was 2.41 % with a confidence interval of 95 %. The survey reports under-the-table payments for approximately 32.4 % of public hospital admissions. Private clinics, which display the bulk of out-of-pocket payments, naturally display the lowest under-the-table payments. The highest percentage of under-the-table payments in the private sector appears at visits to private practitioners and dentists (36 %). Informal payments are most frequently made upon request, prior to service ...
Scope: This article seeks to assess the economic impact of industrial accidents with reference to... more Scope: This article seeks to assess the economic impact of industrial accidents with reference to the incidence of opthalmological industrial injuries occurring in the Thriacion Plain industrial zone in Greece during the period 1991-2000. Material and Methods: Data provided by 53 industrial units have been collected and classified. During the study period, 2,011 adults and juveniles out of the 15,600 people employed in the area (a 13% aggregate) suffered opthalmological injuries occurring at the workplace. Results: The highest percentage of injuries were due to trauma (61% of adults, 67% of juveniles), followed by chemical burns. In the majority of cases (75% of adults and 50% of juveniles) treatment was provided at the local IKA (Social Security Fund) health care unit, in the town of Elefsis. It was estimated that a total of 10,192 working days were lost, with compensation costs (benefit payments) alone amounting to approximately € 118,000.00, not allowing for indirect employer costs such as loss of productivity, substitution and replacement costs. Conclusions: The high incidence of industrial accidents in combination with the high percentage of child labor in the area of Thriacion Industrial Plain were striking and contributed significantly to higher rates of work-related injuries of ocular interest in Greece. The latter were shown to result in a significant deterioration of the employees' health status, with the majority of the accidents being due to the lack of safety precautions at the workplace at a considerable financial burden on the social security system in direct benefit payments. The social security system needs to press for tighter work safety regulations and their proper implementation if to minimize the burden these accidents impose on its budget.
Intravenous (iv) infusion of biologic agents is a highly effective therapeutic option for active ... more Intravenous (iv) infusion of biologic agents is a highly effective therapeutic option for active rheumatoid arthritis (RA). In Greece, it is mandatory that all infusions are administered in a hospital setting; therefore, they are strongly correlated with the system's capacity in terms of resources. The objective of this paper was to assess the capacity of the Greek National Health System (NHS) hospitals to meet current/projected demand for iv treatment of RA patients. Semi-qualitative interviews on the basis of a strictly structured questionnaire were conducted with the Heads of all NHS RA infusion sites to record available resources, service utilization and ability to meet current/ projected demand. Out of 31 NHS infusion sites, 28 responded (90.3%). On average, 41.6% of Greek NHS RA patients are treated with a biologic agent and 61.5% of respondents stated that available resources are insufficient to meet current demand. The most important constraints in selection order were as follows: space (93%), staff (89.5%), equipment (61.5%) and working hours (57%). Fifty-six percent of respondents stated that they may decline treatment to patients due to constraints. Overall, respondents estimated that the number of iv patients could be increased by 104%, were there no capacity constraints. An important proportion of the estimated 40.000 RA patients in Greece, for whom iv biologic treatment in the hospital setting is essential for disease control, may be declined treatment due to constraints in RA-specific resources. Rationalization and reallocation of NHS resources is required to ensure equity in access to effective treatment for all RA patients.
This paper examines the economic, political and legal characteristics of the Greek pharmaceutical... more This paper examines the economic, political and legal characteristics of the Greek pharmaceutical market, which is largely affected by the paradox of state intervention: while pharmaceutical regulation is mainly directed towards a rationalisation of total pharmaceutical expenditure, all measures taken to date aim at exhaustive pricing controls, i.e. interventions on the supply side alone, disregarding the "balloon" effect of shrinking prices on the expanding volume of consumption.
Objectives: To investigate whether the long term lease of public hospital owned land could be an ... more Objectives: To investigate whether the long term lease of public hospital owned land could be an additional financing mechanism for Greek public (mental) health hospitals.
Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thela... more Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/
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Papers by Christina Golna