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Identifier 000421388
Title Περιφερειακή οργάνωση των υπηρεσιών υγείας : η ελληνική πραγματικότητα
Alternative Title Regionalization of health services
Author Αθανασιάδης, Αθανάσιος
Thesis advisor Φιλαλήθης, Αναστάσιος
Λιονής, Χρήστος
Τρομπούκης, Κωνσταντίνος
Reviewer Οικονόμου, Χαράλαμπος
Σουλιώτης, Κυράκος
Κωστοπούλου Στυλιανή
Ράτσικα Νικολέτα
Abstract The regional organization of the health system has been achieved by several countries. Regional organization emerged as a more effective approach to improve the delivery of health services than could be achieved by a single central authority. The decentralization of health services is a process of transferring central powers and responsibilities to local or regional authorities or bodies so that public services can better respond to the health needs of citizens. This thesis attempts to answer why the regional organization and decentralization of health services in Greece was not successful, why it did not have the expected results and why it failed to meet its legislative objectives. The first part of the thesis describes the legislative reforms made in Greece to decentralize health services at a regional level. More specifically, the health system decentralization attempts in the country are reviewed in three phases. The first phase includes legislative efforts from the 1920s (establishment of the first Ministry of Health in 1922) until the late 1970s. The second phase includes the efforts made during the decades of 1980 (establishment of the National Health System in 1983) and 1990. Finally, the third period includes the reforms for regional decentralization in the 2000s, with the establishment of the Regional Health System (Pe.S.Y.) in 2001, the Regional Health and Welfare System (Pe.S.Y.P.) in 2003, the Regional Health Directorate (D.Y.PE.) in 2005 and finally the Health Region (Y.PE.) in 2007 until today. The second part of the thesis presents the results of qualitative primary research. A purposive sampling was used, due to the nature of the matter being investigated. Elite interviews were conducted with the directors of health regions, in great depth and high detail. For the purposes of this study, the designation of elite was applied to all the persons who served as directors of the health regions from 2001 to 2009 and a total of 50 persons fulfilled this criterion. The 37 respondents (34 men and 3 women) who participated in the study, gave their informed consent and were assured about the confidentiality of the views expressed by any single participant in the study. The interviews were conducted between 2009 and 2012, lasted an average of 55min (40–70 min), were tape-recorded and usually took place in a private space that the participant was comfortable with (most often their office).Then the interviews were transcribed and analyzed with thematic analysis. The aim of the thematic analysis was to select the key-points of the interviews, to understand the text based on the research questions, focusing on the key issues, and to find common ground between the participants’ experiences. The data contained in the transcript of each of the 37 interviews were organized into categories within tables by theme to compare and analyze the perspectives of the directors of the health regions. The questions were divided into four (4) main themes depending on the thematic analysis. The first theme includes the answers given to the conceptual framework of health decentralization (regional organization and decentralization of health services) as well as the purpose and needs that health decentralization attempts to serve. The second theme includes the answers regarding the Greek experience of the regional decentralization of health services with sub-categories regarding the transfer of (administrative, political and economic) power to health regions, the effectiveness regarding the operation of the health regions, changes to improve the functioning of health regions and the overall experience in the division of health and administrative regions. The third theme includes the personal experiences and relations with local stakeholders, the Ministry of Health and other health regions and the problems faced during the tenure of each director. Finally, the fourth theme refers to achievements and failures during the tenure of the directors. Based on the results of the survey, the reasons why regional decentralization in Greece was not successful include: • Lack of political support for the process of regional decentralization. The state either never “believed” in real decentralization or was afraid of it and did not politically support it. • The unwillingness and inability of the state to successfully overcome the dominant mentality of centralized control. • The country lacked any long-standing experience in decentralized administration, nor any relevant culture and tradition in regional and local government. The difficulties in communication and cooperation of health directors with the officials of the Ministry of Health and the shared responsibilities for services between the Ministry and the health regions resulted in delays in decision-making. • The non-substantive transfer of power (mainly fiscal and less political and administrative) and the lack of financial independence of the health regions. • The continuously changing legislative environment for the number of health regions (initially 17 and subsequently 7) and the problems with the non-alignment of their official boundaries with those of the 13 administrative regions of the country. • The bureaucracy in the public administration as a factor that resulted in delays in the implementation and application of decentralization policies in the health care sector. • The discontinuity in health policies every time governments, ministers and directors of health regions changed. The Greek health system has so far failed to integrate a regional organization strategy and to achieve a truly decentralized health care system. The results of the survey showed that the role of regional and local government in designing, organizing and delivering health services was and still is extremely limited. Also, the regional organization depends on the degree of decentralization of decision-making, responsibility and accountability procedures for these decisions. But its success will be judged by the extent to which it will demonstrate equality, accessibility and effectiveness of health services, and the integration of a regional-decentralized logic into the wider public administration system. In conclusion, it can be argued that the regional organization and the decentralization of health services, is an important public administration issue and despite the laudable efforts at times, remains an unachieved goal of health policy in Greece.
Language Greek
Subject Decentralization
Health system
Regional organization
Σύστημα υγείας
Issue date 2019-03-27
Collection   Faculty/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
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