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\begin{document}

\title{Dynamics of Efficiency and Productivity in the Greek Hospital Sector}



\author[1]{John Yfantopoulos}%
\author[1]{Athanassios Constantopoulos}%
\author[1]{Athanasios Chantzaras}%
\affil[1]{Ethniko kai Kapodistriako Panepistemio Athenon Tmema Istorias kai Archaiologias}%


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  \date{May 24, 2024}


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\begin{abstract}
The objective of this study was to explore the dynamics of efficiency
and productivity of Greek public hospitals during the crisis, as well as
to review the effect of implemented policies on hospital efficiency
before and the implementation of the claw-back for hospital
pharmaceutical expenditure. We implemented Data Envelopment Analysis and
decomposed the Malmquist productivity index (MPI) to investigate the
fluctuations of the Greek public hospital productivity frontier and
therefore their technical efficiency between 2009 and 2019. The MPI
components allowed us to capture the frontier shift, as well as pure
efficiency changes and scale efficiency changes. Through the period
2009-2019 hospital inputs were reduced drastically. Doctors were reduced
by 54\% while beds were reduced by 15\%. Hospital expenditure was
decreasing between 2009 and 2015 but increased by 23\% since due to
fixed hospital budgets and the ``claw-back''. Moreover, output seems to
have increased. Patient discharges increased by 14\% while diagnostic
procedures were reduced by 10\% between 2009 and 2016 but have been
continuously rising since. Nonetheless, under variable returns to scale
(VRS) average hospital efficiency was stable (\textasciitilde{}75\%) for
most of the period under study while declining since 2016. Policymakers
in Greece have always chosen to implement cost- or input-oriented
policies, instead of opting to improve outputs and quality of services.
Our analysis indicated that fixed-budget-oriented reforms have impacted
hospital efficiency negatively by creating a counterincentive to
adopting best practices and improving hospital efficiency.
\textbf{Highlights} Technical Efficiency under CRS was stable in Greece
(0.70) over the period 2012-2016, and declined to 0.51 in 2019. Hospital
Fixed Budget reforms had a negative impact on hospital efficiency.
During the economic crisis 2009-2019 hospital inputs were reduced
drastically Memorandum Policies introduced by Troika focused exclusively
in reducing cost and not improving efficiency.%
\end{abstract}%



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\textbf{Hosted file}

\verb`Revised Dynamics of Efficiency and Productivity in the Greek Hospital Sector.docx`  available at \url{https://authorea.com/users/698643/articles/686270-dynamics-of-efficiency-and-productivity-in-the-greek-hospital-sector}

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