Οικονομική ανάλυση και διοίκηση αποφάσεων στο χώρο της υγείας με εφαρμογή στην ασφάλεια του ασθενούς

Ρήγα, Μαρίνα

Doctoral Thesis

Author

Ρήγα, Μαρίνα

Date

2014-04-29

Abstract

The economic crisis in Greece uncovered chronic deficiencies and omissions in the health care sector and made it necessary to look into problems concerning the fiscal consolidation and cost containment in the Greek Health System. Based on our research in 680 cases of medical negligence, it was found that in Greece, as in many foreign countries, medical errors exist and can provoke discussion and debate about quality and patient safety issues of health care provision, with multiple and complex social and economic implications. The mean age of the patients who had a bad experience whilst in the healthcare system, was 31 years, while the average prolonged hospitalization reached 83 inpatient days. Medical errors resulting in death were in 38.8% of patients and permanent disability in 32.2%. It was found that the severity of a medical error was significantly influenced by the type of healthcare provider, the error phase of care, if it is surgical or medical incident, specialty involved, the ICD-10, etc. Medical errors, apart from the fact that they can seriously threaten patient safety, are associated with a significant financial burden on the healthcare system, mainly due to the use of additional health services, prolonged inpatient stay in specialist hospital and non-hospital units, extra visits to hospital outpatient departments and medical professionals in the private sector as well as extra drug prescriptions. It is also true that this cost (obvious and hidden) is passed down the whole of society.At the same time, the research showed that the claimed compensation for half of our sample, were € 600,000 and the mean compensation awarded by civil courts amounted to € 300,692. The amount of compensation awarded was found to be significantly influenced by the severity of medical error, the type of healthcare provider, etc. Realizing the need to acquire knowledge about the preventable errors or adverse incidents which can seriously threaten the patient safety in the Greek healthcare system and the need for health care cost containment, we developed and implemented a pilot program called MERIS, an integrated incident reporting system which detects, records and analyzes medical errors and adverse events.MERIS has a mandatory module for measuring adverse events and medical errors in Intensive Care Unit environment and a voluntary one which is accessible by anybody who wants to report an adverse event or a “near miss” about her/his experience in the Greek health system. Under the burden of serious economic and social implications of physical harms and the finding that the root causes are mainly systemic in the overall health system, it is vital to initiate a debate among health decision makers, health professionals and citizens about accurate reporting of medical errors. Systematic review of medical errors and a culture of openness can lead to continuous learning for the multi-professionals involved, improvement in quality of care, patients’ safety and experience in the Greek healthcare system as well as reduction in health care cost.