Pharmaceutical Expenditure in Greek public hospitals.

1. PHARMACEUTICAL EXPENDITURE IN GREEK PUBLIC
HOSPITALS. THE CASE OF THEBES GENERAL HOSPITAL
CHOLEVA MAGDALINI MSc, Phd Candidate
DOCTORANDO EN TRANSFERENCIAS INTERCULTURES E
HISTORICAS EN LA EUROPA MEDIEVAL MEDITERRANEA

2. Purpose and objectives of the study
 The main purpose of this research effort, which takes place in the context of
this diploma thesis, is to determine the total pharmaceutical expenditure of
the hospital of Thebes during the periods from 2008 to 2010 and from 2015 to
2017.
 The study of the above data will determine the extent to which the economic
crisis and its consequences led, or not, to the reduction of pharmaceutical
expenditure in the specific hospital.

3. Research questions
What is the total pharmaceutical expenditure of Thebes Hospital during the period 2008 –
2010 and how does it evolve in the period 2015 – 2017?
How is the total pharmaceutical expenditure of Thebes Hospital distributed during these
periods among the various clinics of the hospital?
How is the total pharmaceutical expenditure of Thebes Hospital distributed during these
periods among the most important categories of medicines available from the hospital to
its patients?
What is the relationship between the hospital's budgeted pharmaceutical costs and the
actual pharmaceutical costs in the years studied?
All the above research questions are affected in some way by the economic crisis, in the
sense that the period 2008-2010 has a clear difference compared to the period 2015-
2017, in the way in which the above research questions are answered?

4. Methodology
 Data collection from the public hospital of Thebes
 It was chosen to collect data relating to two different time periods. The first
of these refers to the years from 2008 to 2010, while the second refers to the
years from 2015 to 2017

5. Literature Review
 Pharmaceutical expenditure is defined as expenditure on medicines of all three
categories mentioned above, which are mainly allocated to primary care.
 More specifically, the trend of reducing health expenditure that took place during
the period of the economic crisis in Greece is evident. In this sense, the research
around the study of the evolution of public pharmaceutical expenditure of the
hospital of Thebes is of particular interest, in order to determine whether this
general trend observed by the study of the relevant literature corresponds to the
case study of this public hospital.
 Moreover, especially for public hospitals, it is noted that for 2016, according to
law 4447 of 2016, the claw back mechanism for hospital pharmaceutical
expenditure is set at 590,000,000 euros, while respectively for 2017, the limit falls
to 550,000,000 euros.

6. Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
The aims of Thebes Hospital
1. The provision of Primary and Secondary health care to the population under the responsibility of the 5th RES of Thessaly &
Central Greece, as well as to patients referred by other RES. Health care is provided equally to every citizen regardless of
their economic, social and professional status, in accordance with the rules of the National Health System and Social
Security
1. The specialization, continuous education and training of doctors, nurses and other health professions, with the development
and implementation of similar educational programs.
1. The development and promotion of health research. To this end, it implements and develops research programs and
collaborates with other relevant bodies, as well as with international organizations and scientific and research centers
1. The cooperation with hospitals and other health units of the health region for the development and upgrading of the health
care provided as a whole and especially in terms of the implementation of educational programs, as well as special
programs of study and evaluation of issues related to the field of health in the 5th Regional Unit of Thessaly & Central
Greece
1. The implementation of new methods and forms of care, aiming at the effective promotion of citizens' health
1. The development of procedures that facilitate the strategic goals set by the Ministry of Health, the 5th Regional Unit of
Macedonia and the Unified Collective Management Body of the Hospital

7. The central administrative bodies of Thebes Hospital are the following:
Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
The Single College
of Administration
The Joint
Governor of the
two hospitals
The Joint Deputy
Governor
The Board of
Directors and the
Deputy Governor
of Thebes
Hospital.

8. Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
Table 9. The structure of the three medical services sectors of Thiva Hospital
The three areas of medical services of the hospital
Department of Internal Medicine
• Internal Medicine
• Cardiology
• Pediatric and Neonatal
Surgical field
 Surgery
 Orthopedics
 Obstetrics and Gynecology
 Anesthesiology
 Otolaryngeal
Special units Intensive Care Units (ICUs)
Laboratory sector
 Microbiology and Biochemistry
 Hematology and Blood Donation
 Radiology
Cross-sectoral sections
 Short-Term Care Department Emergency
 Department (ED) Center for Physical Medicine and Rehabilitation
(KEFIAP)
Other sections
 Department of Social Work

9. Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
The revenues of the Hospital consist of:
1.Subsidies from the state budget and the public investment program
2.Receipts from hospitalizations, examination fees and other fees for the provision of
services
3.Income from own property. of the hospital and finally
4.Proceeds from donations, bequests, disposals of assets and
5.Any other income arising from its activity.

10. Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
Figure 4. The comparison of hospitalization days and admission hospitalizations in
the two sectors of Thebes hospital in the three-year period 2008-2010 Source:
Author's calculations.
Figure 5. The comparison of hospitalization days and admission hospitalizations in
the two sectors of Thebes hospital in the three-year period 2015-2017 Source:
Author's calculations

11. Year Amount
2008 910.958
2009 1.142.974
2010 907.303
2015 289.112
2016 327.265
2017 337.764
Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
Table 18. Aggregated data on the consumption of medicines at Thebes Hospital for
the periods 2008-2010 and 2015-2017 in euro.
Figure 5. The value of the total annual consumption of medicines in the hospital
of Thebes, during the period 2008-2010. Source: Hospital of Thebes, 20172017.

12. Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
Figure 6. The value of the total annual consumption of medicines in the hospital
of Thebes, during the period 2015-2017. Source: Thebes Hospital, 2017.
Figure 7. The average value of the total annual consumption of medicines in the
hospital of Thebes, in the period 2008-2010 and the period 2015-2017. Source:
Author's calculations.

13. Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
Figure 8. The comparison of the average values of the total quantity and the total
value of antibiotics consumed in the hospital of Thebes, in the two time periods.
Source: Author's calculations.
Year Total quantity Total Value
2008 47.888 34.483
2009 50.656 39.538
2010 40.582 31.947
Average 46.375 35.323
Table 21. The total value of the consumption of neurological drugs in the hospital
of Thebes during the period 2008-2010.
Year Total quantity Total value
2015 33.796 19.112
2016 28.995 15.334
Average 31.396 17.224
Table 22. The total value of the consumption of neurological drugs in the hospital
of Thebes during the period 2015-2017.

14. Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
Figure 9. The comparison of the average prices of the total quantity and the total
value of neurological drugs consumed in the hospital of Thebes, in the two time
periods. Source: Author's calculations.
Year Total quantity Total Value
2008 3.830 91.261
2009 4.242 146.126
2010 3.923 118.531
Average 3.998 118.640
Table 23. The total value of the consumption of hematopoietic drugs in the
hospital of Thebes during the period 2008-2010.

15. Year Total quantity Total Value
2015 1.898 2.962
2016 1066 10.373
Average 1.482 6.668
Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
Table 24. The total value of the consumption of
hematopoietic drugs in the hospital of Thebes during the
period 2015-2017.
Figure 10. The comparison of the average prices of the total quantity and the total
value of hematopoietic drugs consumed in the hospital of Thebes, in the two time
periods. Source: Author's calculations.
Year Total quantity Total Value
2008 261.326 1.192.711
2009 295.455 764.311
2010 264.680 503.811
Average 273.820 820.278
Table25.The total value of outpatient drug consumption at Thebes
Hospital during the period 2008-2010.

16. Year Total quantity Total Value
2015 341.108 117.743
2016 279.732 194.821
2017 70.985 169.284
Average 230.608 160.616
Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
Table 26. The total value of outpatient drug consumption at Thebes Hospital
during the period 2015-2017.
Figure 11. The comparison of the average prices of the total quantity and the total
value of medicines consumed by outpatients at Thebes hospital, in the two time
periods. Source: Author's calculations.
Year
Antibiotic
drugs
Neurological
drugs
Hematopoieti
c drugs
Total
2008 8 33 0 42
2009 8 31 0 40
2010 0 55 0 55
Averages 6 40 0 46
Table 27. The total pharmaceutical expenditure of the gynecology – obstetrics
clinic of the hospital of Thebes for the period from 2008 to 2010 in euros.

17. Year
Antibiotic
drugs
Neurological
drugs
Hematopoiet
ic drugs
Total
2008 116.078 5.241 42.991 164.312
2009 116.078 8.394 63.408 187.882
2010 132.663 6.583 64.799 204.047
Averages 121.607 6.740 57.066 185.414
Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
Figure 12. The comparison of the average prices of the total value of drugs
consumed in the pathology clinic at the hospital of Thebes, in the two time
periods. Source: Author's calculations..
Table 32. The total pharmaceutical expenditure of the surgical clinic of Thebes
Hospital for the period from 2008 to 2010 in euros...
Year
Antibiotic
drugs
Neurological
drugs
Neurological
drugs
Total
2015 43.676 5.953 251 49.882
2016 45.733 4.247 4.112 54.094
Averages 44.705 5.101 2.182 51.988
Table 33. The total pharmaceutical expenditure of the surgical clinic of Thebes
Hospital for the period from 2015 to 2017 in euros.

18. Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
0
20.000
40.000
60.000
80.000
100.000
120.000
140.000
160.000
180.000
200.000
2008-2010 2015-2017
121.607
44.705
6.740
5.101
57.066
2.182
Αιμοποιητικά
Νευρολογικά
Αντιβιοτικά
Figure 13. The comparison of the average prices of the total value of drugs
consumed in the surgical clinic at the hospital of Thebes, in the two time periods.
Source: Author's calculations.
Year
Antibiotic
drugs
Neurological
drugs
Hematopoiet
ic drugs
Total
2008 6.620 7.523 91.261 105.405
2009 6.620 7.117 146.126 159.865
2010 2.744 4.862 118.531 126.140
Averages 5.329 6.501 118.640 130.470
Table 34. The total pharmaceutical expenditure of the Emergency Department of
Thebes Hospital for the period from 2008 to 2010 in euros
Year
Αntibiotic
drugs
Neurological
drugs
Hematopoiet
ic drugs
Total
2015 1.295 3.501 2.664 7.461
2016 974 3.544 10.373 14.892
Averages 1.135 3.523 6.519 11.177
Πίνακας 35. Το σύνολο της φαρμακευτικής δαπάνης του ΤΕΠ του νοσοκομείου
Θηβών την περίοδο από το 2015 μέχρι και το 2017 σε ευρώ.

19. Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
Figure 14. The comparison of the average prices of the total value of medicines
consumed in the Emergency Department of Thebes Hospital, in the two time
periods. Source: Author's calculations.
Group Total Quantity Total Value
No insurance 288 1.949
Destitute foreigners 100 14
Destitute Greeks 230.719 169.017
Public 499 47.500
ΙΚΑ 9.352 364.362
FANS 393 27.218
ΟGA 12.136 421.700
National Bank of Greece 156 13.864
PPC 80 9.548
ΟΤΕ 296 3.659
ΤΕΒΕ 1660 20.254
TSIMEDE 5.440 82.549
Other Categories 207 31.074
Total 261.326 1.192.711
Table 36. Aggregate Pharmaceutical Consumption Statement per client group at
Thiva Hospital for 2008 in number of pieces and in euros..

20. Group Total Quantity Total Value
Destitute foreigners 890 1.997
Destitute Greeks 64.649 25.156
EYDAP 678 9.865
IKA 2.001 53.202
ΟGA 1.832 38.461
ΤΕΒΕ 656 35.053
Other Categories 279 5.546
Total 70.985 169.284
Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
Table 41. Aggregate Pharmaceutical Consumption Statement per client group at
Thiva Hospital for 2017 in number of pieces and in euros..
Figure 15. The evolution over time of the total value of pharmaceutical
expenditure of outpatients of Thebes Hospital during the periods 2008 – 2010 and
2015 – 2017/ Source: Author's calculations..

21. Code Initial Budget
Amendme
nts
Configuratio
n
Accomplished Remainder
13.12.01 1.050.000 0 1.050.000 78 1.049.921
13.12.02 750.000 0 750.000,00 28.720 721.279
Σύνολο 1.800.000 0 1.800.000 28.799 1.771.200
Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
Figure 16. The presentation of the average drug cost per
patient in the surgical and pathology clinic of Thebes
Hospital during the periods 2008-2010 and 2015-2015.
Source: Author's calculations.
Table 46. The evolution of the pharmaceutical expenditure of the Hospital of
Thebes for 2008, in relation to the initial budget.
Code Initial Budget Amendments Configuration Accomplished Remainder
13.12.01 1.007.000 0 1.007.000 14.383 992.616
13.12.02 753.000 2.600.000 3.353.000 2.410.326 942.673
Σύνολο 1.760.000 2.600.000 4.360.000 2.424.709 1.935.290
Table 47. The evolution of the pharmaceutical expenditure of the hospital of
Thebes for 2009, compared to the initial budget.

22. Code Initial Budget Amendments Configuration Accomplished Remainder
13.12.01 1.302.000 4.250.000 5.552.000 4.548.314 1.003.685
13.12.02 501.000 2.250.000 2.751.000 2.102.838 648.161
Total 1.803.000 6.500.000 8.303.000 6.651.153 1.651.846
Field Research. The pharmaceutical
expenditure data of the Public Hospital of
Thebes
Table 48. The evolution of the pharmaceutical expenditure of the hospital of Thebes for 2010, in relation to
the initial budget
Code Initial Budget Amendments Configuration Accomplished Remainder
13.12.01 601.902 -109.577 492.324 293.637 198.687
13.12.02 582.263 -491.299 90.963 64.897 26.065
Total 1.184.165 -600.877 583.288 358.535 224.752
Table 49. The evolution of the pharmaceutical expenditure of Thebes Hospital for 2016, compared to
the initial budget.
Code Initial Budget Amendments Configuration Accomplished Remainder
13.12.01 495.000 55.000 550.000 250.587 299.412
13.12.02 69.948 27.744 97.692 83.807 13.885
13.12.03 97.722 0 97.722 97.722 0
Total 662.670 82.744 745.414 432.117 313.297
Table 50. The evolution of the pharmaceutical expenditure of the hospital of
Thebes for 2017, compared to the initial budget.

23. Discussion
 The overall conclusion of the overall reduction of pharmaceutical expenditure at Thebes
Hospital continues to be reinforced through the study of the pharmaceutical expenditure of
the individual clinics of the hospital. According to the data analyzed above, both the surgical
clinic and the pathology clinic, which are the most visited clinics of the hospital, the data are
revealing, as they show the large decrease that occurred within the two three years under
study.
 Specifically, in relation to the Internal Medicine Clinic, it is noted that the apparent drastic
reduction of its pharmaceutical expenditure in the second period compared to the first to
levels exceeding 60%, when the reduction of the total pharmaceutical expenditure of the
surgical clinic of the hospital reached 70%
 Finally, it is noted the confirmation of the main conclusion of the reduction of
pharmaceutical expenditure through the study of the average per capita pharmaceutical
expenditure of the surgical and pathology clinic of the hospital of Thebes in the periods 2008
– 2010 and 2015 – 2017, which was determined at approximately 40%.

24. Conclusions
 The main conclusion of this diploma thesis lies in the determination of the
large decrease in pharmaceutical expenditure of the Hospital of Thebes in the
period 2015 – 2017 compared to the period 2008 – 2010.
 This conclusion is in harmony with the conclusions drawn from a series of
researches, which deal with the issue of both the reduction of public
pharmaceutical expenditure, but also those dealing with the reduction of
total public expenditure on health, which took place in recent years, on the
occasion of the great economic crisis that broke out from 2009 onwards.