title: The short-term effect on technical and scale efficiency of establishing regional health systems and general management in Greek NHS hospitals.
abstract: OBJECTIVE
  The Greek National Health System has been subjected to a reform initiative in 2001. The new legislation required hospitals to operate as administrative and economic decentralized units, under the control of newly established Regional Health Systems. In addition, Professional Managers have been appointed and signed "efficiency contracts", which supposedly committed them to run the hospitals effectively and efficiently. The present study aims at estimating the efficiency impact of this reform.
  
  
  METHODS
  Data Envelopment Analysis was employed with included inputs being the number of medical staff employees, other hospital employees and staffed beds, whereas outputs were the case-mix adjusted inpatient cases, outpatient visits and surgical operations performed. The technical and scale efficiencies of a sample of 51 general acute National Health System hospitals have been comparatively examined before and after the reform.
  
  
  RESULTS
  The analysis surprisingly indicates that technical and scale efficiency has been reduced following the policy changes.
  
  
  CONCLUSIONS
  It appears that the expected benefits from the reform have not in general been achieved, at least in the short-run. This result is examined in light of coexisting administrative and organizational factors, which are impeding the reform process.
authors.affiliation: Business Excellence Laboratory, Department of Business Administration, University of Macedonia, Macedonia, Greece. valetras@uom.gr
authors.forename: Vassilios
authors.initials: V
authors.lastname: Aletras
authors.forename: Nick
authors.initials: N
authors.lastname: Kontodimopoulos
authors.forename: Athanasios
authors.initials: A
authors.lastname: Zagouldoudis
authors.forename: Dimitris
authors.initials: D
authors.lastname: Niakas
mesh_terms: D001509:Bed Occupancy; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D006115:Greece; D018166:Health Care Reform; D006302:Health Services Research; D006779:Hospitals, Public / Q000458:organization & administration*; D006801:Humans; D008505:Medical Staff, Hospital / Q000600:supply & distribution; D015397:Program Evaluation; D012041:Regional Medical Programs / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D013222:State Medicine / Q000458:organization & administration*