The short-term effect on technical and scale efficiency of establishing regional health systems and general management in Greek NHS hospitals

Abstract

Objectives: The Greek National Health System has been subjected to a reform initiative in 2001. The new legislation required hospitals to operate as administrative and economic decentralized units, under the control of newly established Regional Health Systems. In addition, Professional Managers have been appointed and signed "efficiency contracts", which supposedly committed them to run the hospitals effectively and efficiently. The present study aims at estimating the efficiency impact of this reform.

Methods: Data Envelopment Analysis was employed with included inputs being the number of medical staff employees, other hospital employees and staffed beds, whereas outputs were the case-mix adjusted inpatient cases, outpatient visits and surgical operations performed. The technical and scale efficiencies of a sample of 51 general acute National Health System hospitals have been comparatively examined before and after the reform.

Results: The analysis surprisingly indicates that technical and scale efficiency has been reduced following the policy changes.

Conclusions: It appears that the expected benefits from the reform have not in general been achieved, at least in the short-run. This result is examined in light of coexisting administrative and organizational factors, which are impeding the reform process.