This study is an initial effort to examine the dynamics of efficiency and productivity in Greek public hospitals during the first phase of the crisis 2009–2012. Data were collected by the Ministry of Health after several quality controls ensuring comparability and validity of hospital inputs and outputs. Productivity is estimated using the Malmquist Indicator, decomposing the estimated values into efficiency and technological change. Hospital efficiency and productivity growth are calculated by bootstrapping the non-parametric Malmquist analysis. The advantage of this method is the estimation efficiency and productivity through the corresponding confidence intervals. Additionally, a Random-effects Tobit model is explored to investigate the impact of contextual factors on the magnitude of efficiency. Findings reveal substantial variations in hospital productivity over the period from 2009 to 2012. The economic crisis of 2009 had a negative impact in productivity. The average Malmquist Productivity Indicator (MPI) score is 0.72 with unity signifying stable production. Approximately 91% of the hospitals score lower than unity. Substantial increase is observed between 2010 and 2011, as indicated by the average MPI score which fluctuates to 1.52. Moreover, technology change scored more than unity in more than 75% of hospitals. The last period (2011–2012) has shown stabilization in the expansionary process of productivity. The main factors contributing to overall productivity gains are increases in occupancy rates, type and size of the hospital. This paper attempts to offer insights in efficiency and productivity growth for public hospitals in Greece. The results suggest that the average hospital experienced substantial productivity growth between 2009 and 2012 as indicated by variations in MPI. Almost all of the productivity increase was due to technology change which could be explained by the concurrent managerial and financing healthcare reforms. Hospitals operating under decreasing returns to scale could achieve higher efficiency rates by reducing their capacity. However, certain social objectives should also be considered. Emphasis perhaps should be placed in utilizing and advancing managerial and organizational reforms, so that the benefits of technological improvements will have a continuing positive impact in the future.

Many countries around the world are resorting to mandatory funded components in their multi-pillar pension systems with the purpose of catering for the financial pressure from ageing. This paper aims at analysing the possible replacement rates for such a scheme, by choosing different assumptions and setting the best combined area for the expected result. Then, an approach for analysing the potential for the implementation of such a scheme in Greece is presented along with the actuarially projected expected benefit expenditure and respective accrued capital. A result of the introduction of such a component is expected to be the elevated replacement rate at retirement with a concurrent alleviation of the fiscal burden for the state. The projected scale of savings will also provide domestic financing for investments generating growth.

Sex-specific data are limited regarding eligibility for hypolipidemic treatment. We aim to explore the sex-specific clinical utility of high sensitivity C-reactive protein(hsCRP) and carotid ultrasound as risk modifiers for hypolipidemic treatment in primary prevention for atherosclerotic cardiovascular disease(ASCVD). We aimed to explore these sex-specific trends in two pooled contemporary independent Greek cohorts (Athens Vascular Registry n=698, 50.9% women and Menopause Clinic n=373, 100% women) of individuals without overt ASCVD. Baseline ASCVD risk was estimated using the Systematic COronary Risk Evaluation-2(SCORE2) tools. Presence of carotid plaque and hsCRP≥2mg/L were integrated as risk-modifiers. Men had increased odds to achieve target LDL-C levels based on ASCVD risk(23.8% vs 17.7%, OR: 1.45 95%CI: 1.05-2.00, p=0.023, for men vs women). Additionally considering carotid plaque or high hsCRP levels did not change this association but reduced on-target LDL-C rate in both sexes. Women had decreased odds of being eligible for hypolipidemic treatment by ASCVD risk estimation(11.5% vs.26.4%, p<0.001) compared to men. The addition of carotid plaque presence or high hsCRP levels and their combination resulted in higher relative increase in hypolipidemic treatment eligibility in women(from 11.5% to 70.9% vs.26.4% to 61.4% for carotid plaque, from 11.5% to 38.5% vs.26.4% to 50.8% for hsCRP and from 11.5% to 79.1% vs.26.4% to 75% for their combination, all for women vs. men, p_interaction<0.001 for all) than men. Implementation of carotid plaque and hsCRP levels increases hypolipidemic treatment eligibility more prominently in women than men. The impact on clinical outcomes in these untreated patients merits further investigation.

Background/Objectives: This study introduces the Multi Group Cost Malmquist Index (CMgm), a novel tool for comparing and ranking the cost efficiency of multiple groups of similar decision-making units operating in different contexts. It was applied to Greek public hospitals to assess productivity change between 2009 and 2021, covering the period before the economic recession and after the second lockdown during the COVID-19 pandemic. The study aimed to determine the impact of these external shocks on hospital efficiency and to identify differences in cost productivity based on hospital size and regional location. Methods: Data envelopment analysis was employed to compute the Malmquist indices for productivity change and ranking. Overall, 109 Greek public hospitals were analysed using three models: as a single group, classified by bed capacity, and classified by regional health authority (RHA). Cost productivity was decomposed into its core measures. Results: During the economic crisis, hospitals improved their cost productivity by 13.2%, whereas during the pandemic, it declined by 32.1%, primarily due to cost frontier deterioration resulting from increased healthcare demand and strained resources. Medium-sized hospitals exhibited higher cost efficiency than small and large hospitals. Regional disparities were also observed, with hospitals in the 5th and 7th RHAs outperforming those in 1st and 2nd RHAs. Conclusions: The findings highlight the pandemic’s disruptive impact on hospital cost productivity compared to the efficiency gains during the economic crisis. It is encouraging, though, that hospitals are recovering again after the lifting of strict lockdown measures. The CMgm is a valuable tool for policymakers, offering insights into hospital performance across multiple groups. Future healthcare policies should prioritise resource optimisation and address regional disparities to enhance system-wide efficiency and resilience in times of crisis.

Background: Development Assistance for Health (DAH) plays a vital role in health financing across Sub-Saharan Africa, particularly in tackling communicable diseases such as HIV/AIDS, malaria, and tuberculosis. Despite its importance, the efficiency and equity of DAH allocation remain contested. Objectives: The study aims to evaluate the cost-effectiveness of DAH in Sub-Saharan Africa from 1995 to 2018, as well as to explore differences in efficiency across diseases and country contexts. Methods: Data were drawn from the Institute for Health Metrics and Evaluation and applied Generalized Cost-Effectiveness Analysis in conjunction with the Gross Domestic Product-based thresholds. Averted Disability-Adjusted Life Years were analyzed across countries and diseases, and countries were categorized by the Human Development Index (HDI) level to assess differential DAH performance. Results: DAH cost-effectiveness showed similar patterns across HDI groups, with roughly equal proportions of cost-effective and dominated outcomes in both low- and middle-HDI countries. Thirteen countries were identified as very cost-effective, nine as cost-effective, and two as non-cost-effective. Twenty-one countries were dominated, reflecting persistent inefficiencies in aid impact that transcends the various levels of development. Conclusions: Tailoring DAH allocation to specific disease burdens and development levels enhances its impact. The study underscores the need for targeted investment and a strategic shift toward integrated health system strengthening. Additionally, microinsurance is highlighted as a key mechanism for improving healthcare access and financial protection in low-income settings.

In this study, we use experimental methods to probe how far individuals depart from choices consistent with “Rational Economic Man” and whether these departures are associated with financial and numeric literature on the one hand, and, more fundamentally, with impulsive or analytical thinking—i.e., with cognitive reflection. We examine a purposely biased sample of Greek undergraduates enrolled in a course heavy on statistics and probability who participated in a battery of tests. Specifically, we use the Cognitive Reflection Test (CRT) jointly with numeric and financial literacy tools to understand how “irrational choices” result. Despite the expected bias, responders with lower CRT are more likely to be susceptible to behavioral biases, even when controlling for numeracy and financial literacy. In agreement with other studies, gender is associated with significance differences, which operate both independently and through the mediation of CRT.