Προληπτικές εξετάσεις στις περιοχές άγονης γραμμής από τις Κινητές Ιατρικές Μονάδες του ΙΣΝ : κόστος πραγματοποίησης και κοινωνικό-οικονομικό όφελος
Preventive health care examinations in rural areas by the Mobile Health Units of SNF : implementation cost and socio-economic benefits
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Keywords
Πρωτοβάθμια Φροντίδα Υγείας ; Κινητές Ιατρικές Μονάδες ; Προληπτικές εξετάσεις ; Απομακρυσμένες περιοχέςAbstract
Introduction: The Alma-Ata declaration in 1978 set the goals for strong and persistent Primary Health Care (PHC) worldwide. Since then, this declaration remains relevant. Unfortunately, healthcare systems exhibit inconsistencies in implementing the PHC’s fundamentals. In Greece, the first regulations were tracked back to 1983 but yet to these days, disfunctions in the operation of PHC hinder its full implementation. One of the main problems of PHC in Greece is the inequality in access. Due to its unique geographical characteristics, with numerous islands and mountain regions, population there face a lack of Primary Health Care Services. Mobile Health Units seem to be a solution to this inequality by eliminating the distance between Primary Health Care Services and remote areas.
Objective: The aim of this study is to examine the extent of absence of PHC in remote areas and to calculate the economic burden imposed on residents in seeking the nearest facilities offering PHC services. Additionally, occasioned by the Mobile Health Units of Stavros Niarchos Foundation we will investigate the socio-economic benefit they offer to the communities on remote areas. Moreover, we will shed light to if such actions are cost-effective for both residents and healthcare system.
Methodology: The preventive examinations/actions selected for investigation include: digital mammography, bone density measure, PAP test, transvaginal ultrasound, FoB test, ECG, cardiac triplex, radiography, ultrasound, emergency management, minor interventions, blood donation and hematological examinations. To estimate the cost for the residents without Mobile Health Units we will examine in how many occasions is it possible to undergo the examinations in the same area, using data from the 2023. If the examinations cannot be completed in the same area of living, we will search the closest public and private providers of these preventive examinations and we will estimate the transportation and accommodation costs that residents have to pay. To estimate the cost for the MHU of SNF for the years 2022-2023 we will take into account both capital expenditures as well as variable expenses. The data analysis will be carried out in Excel spreadsheets.
Results: The study enlightened the significant gap between major urban and remote areas regarding PHC. An important finding is that the lack of PHC appears in both public and private sector, as they follow the same trend by establishing primary care institutions in urban centers and highly touristic islands. There is no area where all the preventive examinations are conducted. Only in Kos and Istiaia the residents can undergo all of them privately. The biggest problem is found in Cyclades, with Ionian and Nothern Aegean islands following. As for the mountainous regions, the residents of Arcadia are the ones who have to travel the biggest distance. On average, 1 day of accommodation on another place is required and the average cost of transportation and daily accommodation was estimated to 90€ for public institution and 80€ in private ones, to which the cost of each examination is added. With the presence of the Mobile Health Units residents of remote areas undergo preventive examinations at zero cost. An encouraged finding in terms of expenses, is that the cost for MHU showed no significant changes over the two years, thus such actions can have a stable and firm financial plan. The percentage of examinations conducted exclusively on adult women amounts to 25,06%. The medical examinations aimed at checking the health of residents under 18 years old account for 0,35% and finally the percentage of examinations carried out without age and gender limit reaches 74,57%.
Conclusion: Residents of remote areas, in their effort to reach PHC services are facing financial and psychological burdens by the continuous traveling they are forced to undertake. Mobile Health Units, both in international literature and in the domestic example of MHU-SNF, seem to offer a permanent solution to this disparity by improving the general health of the inhabitants. Furthermore, they contribute to the reduction of expenses of the healthcare system by eliminating the need for installation of permanent PHC institutions and by decreasing the visits to tertiary hospital.