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UEHP News OCTOBER 2013


EUPOPEAN ECONOMY
The Second Economic Adjustment Programme for Greece- Fourth Review – April 2014


EUPOPEAN ECONOMY
The Second Economic Adjustment Programme for Greece- Second Review – May 2013


Health Professional Mobility in a Changing Europe
New dynamics, mobile individuals and diverse responses



UEHP General Assebly, Paris 8/2/2018

Πραγματοποιηθηκε στο Παρισι την Πεμπτη και την Παρασκευη 7 &8/6/2018 η συνεδριαση του Διοικητικου Συμβουλιου και η Γενικη Συνελευση των μελων της UEHP.

Κατα την διαρκεια της πρωινης συνεδριας της ΓΣ και στην ενοτητα Pricing Policy in Europe εγινε παρουσιαση απο τον Προεδρο της ΠΕΙΚ της καταστασης στην Ελλαδα.

Αναλυτικοτερα:

Pricing policy in Europe
The situation in Greece


The pricing policy applied in Greece from 2012 to date is the DRGs (Diagnosis-related group) pricing system.

• An Australia DRGs translation was conducted at the end of 2011, creating the Greek Fixed Consolidated Hospital Bills, as they are called, pricing about 380 diseases, differentiating the prices into diseases with co-existing health conditions and prices without co-existing health conditions and complications, and creating a list of about 750 diseases with the corresponding prices ​​and the corresponding average duration of hospitalization.

For example, we can see on the screen the bile open surgery without co-existing health conditions - complications, (H07X), which has a nominal value of 1.500€ and 6 days of hospitalization while the same operation with co-existing health conditions - complications and blocked bile duct  (H07M), a nominal value of 3.908 € and 11 days of hospitalization.



Also, on the next slide, a respiratory infection without co-existing diseases has a nominal value of 573€ and 5 days of hospitalization (A22X),

while the same respiratory infection with co-existing diseases - complications of moderate severity, a value of 1.040€ and 8 days (A22Mb) and

with disastrous co-existing diseases - complications a value of 1.762€ and 10 days of hospitalization (A22Ma).

Finally, cataract surgery (O16A) a value of 466 € and 1 day of hospitalization.

• All DRGs prices do not include medical fees and they refer to four-bed room hospitalization.

Let me note that if an extension of the days of hospitalization listed on DRGs is needed, then the daily hospital charge is 34,63 € plus 8€ as a daily pharmaceutical expenditure.

• What does the patient pay?

• I mentioned the nominal price because based on our contract with the State Insurance Fund EOPYY we provide a 10% discount for these prices, thus a nominal value of -10%.

 For the resulting figure the patient is charged:

A. with 30% participation of the above price or 50% if he/she is a farmer.

  • That is to say, for Bile patient pays 1.500€ - 10% = 1.350 € x 30% = 405 € and the remaining 945€ is paid by the insurance fund.

From 945€ we offer a discount to the fund as a 5% rebate and a compulsory discount CLAWBACK of 42% =424,30€ is imposed on us which is paid by EOPYY (National Organization for the Provision of Healthcare Services) and 405,00€ paid by the patient, so a total of 829,30 € is paid to the Clinic.

  • Respectively, for the simple respiratory infection the Clinic receives 364,08€ and
  • for the Cataract  296,50€.
  • The patient is charged with the doctor's fee and a surcharge for the clinic to upgrade the room from a four-bed room to a three-bed, double, single or luxury room, charges that vary for each Clinic.
  • All prices include VAT 24%

These prices, in many cases, do not cover the operating costs which involve a high labor cost, approximately 50% of the total cost, the cost of surgical and other consumables and the depreciation of the medical equipment.

For these reasons, either the Clinic is forced to discontinue its operation or to increase its prices according to the patients’ potential, in a difficult period for Greece, thus increasing the private payment.

  • In the years of the memorandum, from 2010 until today, 35 clinics have discontinued their operation in a total of 170 (21%) with 135 Clinics currently operating.

A month ago, the government decided to set up a Commission to consider a new pricing method based on the cost of surgeries and hospitalizations in public hospitals in general, believing that it would depress the costs but also forcing those who choose private clinics, that is the 39% of hospitalization expenses, to pay more.

  • Given that the EOPYY operates with a closed budget while the constantly increasing costs and the constant release of new, very expensive medical equipment lead us to the need for investment, then the economic balance has a negative sign.
  • A problem is, and it will concern us more over the coming years, the aging of the population, the low birth rate in my country, the increase in unemployment (4 million out of 10 million of the population cannot find a job), which means that reduced health contributions and at the same time new medical devices, new diagnostic methods and new drugs, all very expensive, change the landscape of hospital care in Greece, requiring from us to invest in an uncertain economic environment, without the possibility of a bank loan and without provision for depreciation in 3-5 years.
  • For this reason, for the last few months we have been watching the arrival of various funds, American, Chinese, and others of unknown origin.

Already, the well-known CVC fund, since the beginning of the year, has acquired 5 Clinics, accumulating the 27% of turnover, and the acquisition moves continue by changing the correlations in the private health sector in Greece in the coming months.

Latest news from Greece

It is being discussed in the Greek Parliament and it will be voted next week a draft law, which will be the new institutional framework for old and new clinics.

The Commission, which drafted and convened 25 times, was composed of 7 members, 5 Directors of the Ministry of Health, 1 Advocate of the Minister of Health and myself personally as the representative of all Clinics in Greece.

Unfortunately, despite my objections and my constant protests, the draft law lays down the strictest specifications for the operation of Clinics that have been passed so far, with inapplicable specifications for building equipment, medical equipment, medical, nursing and other personnel requirements which will lead immediately, with its adoption on June 15, to the closure of 35 out of the 135 currently operating Clinics.

It also makes any investment unprofitable because it is not possible to depreciate it no matter how many years of operation will pass.

I struggled in its drafting committee and also the next days in the parliament, trying to avert its power at least for current Clinics and asking to apply only to those that will be created in the future.

I hope I will make it.

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