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BackgroundThis 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.MethodsHospital 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.ResultsFindings 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.ConclusionsThis 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12962-017-0068-5) contains supplementary material, which is available to authorized users.

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This chapter argues that reforming pensions can provide only partial fixes. It sheds light on why Greek pensions present special difficulties and maintains that reforms since 2010 have not disposed of pension problems, but in some respects seem to have made them worse. As such, this chapter outlines a reform that brings in elements of prefunding as well as providers other than the state. It sketches an explicit multipillar pension system, similar to that introduced in many European countries, which can establish a stronger link between contributions and pensions. Finally, this chapter deals with the transition period, which is thought to be the Achilles' heel of pension reform because of the “double payment contention,” and proposes a solution to the transition problem that spreads the costs of transition across all future generations.

Prime Minister's Office, GreeceWhile the construction of a rational case for pension reform is often straightforward, the political implementation of such reform can be somewhat more difficult. In large part, this can be attributed to sceptical public opinion. The precise role played by public opinion in constraining the political feasibility of pension reform is, however, unclear. The purpose of this paper is to distil the ways in which public attitudes influence pension reform. This is done through examining survey data from Greece, where progress with the implementation of pension reform has been particularly modest. Political opposition to pension reform appears to be rooted in a general lack of public appreciation of the case for reform combined with the desire to protect interest group privileges. Public ignorance and insecurity breed attitudes not conducive to reform. Public attitudes do not simply act as a given constraint on reform but are a product of the structure of the pension system and the reform process itself. In this path-dependent process, implementation of a reform agenda of rationalisation is more difficult from the starting point of a severely fragmented and distorted system. Spatial models of electoral competition grant public opinion a central role in explaining policy. The successful politician proposes the policy that is consistent with the preferences of the rational, well-informed median voter (Downs, 1957).