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Purpose: The purpose of this paper is to provide insights into the impact of agencification on the process of administrative reorganization in Greece. It is suggested that agencies tend to create a parallel administrative space that operates disjointly or even detached from the central bureaucracy. This hypothesis is tested and elaborated in relation to Greece's centralist administrative tradition. Design/methodology/approach: The analysis identifies the critical junctures of the domestic agencification pattern and seeks to explain its evolution on the basis of historical-cultural factors, rational choice explanations and country-specific variables. The methodology combines quantitative and qualitative research. Along with a review of existing literature, data were collected through semi-structured interviews and the Registry of Entities and Agencies. Findings: The findings show that agencification never became a coherent policy reform tool, while its outcomes were filtered by the centralist and politicized tradition of the Greek state. The effect of agencification was proved to be highly path-dependent and contingent upon the broader administrative tradition. The agencification policy does not follow a clear direction and has been shaped as a random combination of ad hoc decisions, external pressures and domestic politics. Research limitations/implications: The paper provides some generalizations of the agencification experience. However, they do not cover all specificities and particularities of agencies and their applicability varies. Further research could consider these variations. Originality/value: A novelty of this study is that it links the agencification effect with three key aspects of the administrative reform process, namely, decentralization, debureaucratization and depoliticization. In addition, no single study exists regarding agencification in Greece; thus, the paper is the first to provide an overall view of the Greek arm's length bodies. [ABSTRACT FROM AUTHOR]

The aim of this article is to explore the implications of the delegation of powers from central bureaucracies to semi-autonomous agencies for public administration under policy conditionality. Focusing on Greece, we argue that agencification reforms that were introduced during the economic adjustment programs (2010–2018) have changed the role of the administrative apparatus in policy-making and implementation. Based on two exemplary case studies, tax administration and state assets management, the empirical findings illustrate the political dynamics that induced organizational transformation and show how policy conditionality has changed the domestic agencification pattern and has rebalanced the institutional, functional, and democratic dimensions of agencies. [ABSTRACT FROM AUTHOR]

Introduction: Invasive candidiasis (IC) can be a life-threatening infection in immunocompromised patients, particularly those with cancer, hematologic diseases and/or hematopoietic stem cell transplantation (HSCT) recipients. The objective of this study was to evaluate the effectiveness of micafungin in patients with hematologic malignancies or HSCT recipients, relevant to clinical presentation of IC, in real-life practice in Greece. Methods: ASPIRE was a phase IV, multicenter, non-interventional, prospective cohort study, conducted at ten tertiary hospitals in Greece, in adults with hematologic disease. Micafungin treatment for IC or prophylaxis for Candida infection was administered per standard clinical practice until a clinical outcome (success or failure) was reached. Treatment success was defined by the EORTC/MSG criteria for invasive fungal infections (IFI) and was assessed by the investigator. Treatment discontinuation and safety were also evaluated. Results: One hundred forty-three patients were enrolled. Median age was 62; 85 (59.4%) patients were male, and 133 (93.0%) had Greek ethnicity. One hundred twenty-six (88.1%) patients had hematologic malignancies, and 21 (14.7%) had received HSCT. Prophylaxis was administered to 74 (51.7%) patients [median (range) dose: 50 (50–150) mg/day] with no signs of IFI. Overall, 52 (36.4%) patients with possible IFI at baseline received micafungin treatment [100 (50–125) mg/day] versus 12 (17.2%) with probable [100 (75–150) mg/day] and 5 (3.5%) with confirmed [125 (100–150) mg/day] IFI. Treatment success was 91.6% (95% CI 85.80–95.59; n = 131) overall and 90.5% (n = 67) in patients receiving prophylaxis. Median time on treatment was 13 days. Treatment discontinuation (n = 26; 18.2%) was not related to adverse events. No treatment-related serious adverse events were reported. Conclusion: Micafungin treatment for IC or prophylaxis for Candida infection was effective and well tolerated in patients with hematologic disorders in clinical practice in Greece. These results demonstrate that micafungin could be used more widely for prophylaxis. Further work is required to determine the efficacy and safety of micafungin for the management of IFIs in hematologic settings. Funding: Astellas Pharma Inc. [ABSTRACT FROM AUTHOR]

ABSTRACT: This paper provides an overview of the major State‐Owned Enterprises (SOEs) in Greece with the aim of identifying the key features of the dominant paradigm and the critical turning points in its evolution. The process of SOEs’ reform is analysed with reference to corporatization, restructuring, privatization and liberalization policies. Drawing on theoretical and empirical evidence, the paper explores the impact of these reforms on the ownership, governance and public mission of SOEs, also addressing their current social and economic role. The hypothesis of a ‘paradigm shift’ is tested within the changing context of government intervention, market structure, management relationships, public service and control and accountability of SOEs. The case studies include 15 major enterprises in key economic‐industrial and utility sectors. The paper concludes that over the past two decades the SOE sector has shifted towards new governance and organizational patterns that have substantially affected the traditional SOE paradigm. [ABSTRACT FROM AUTHOR]

Departing from the post-war Weberian-oriented bureaucratic model, the Greek administrative system has been subjected to several reform programmes with a view to its modernization. This article aims to explore the main shifts in the course of administrative change and relate this process with the broader theoretical developments in the field of public administration. It is argued that the Greek administration has been unable to follow and take advantage of a vigorously expanded constellation of ideal-types and hybrid models of state (re)organization. Transformations have diachronically produced weak results and failed to build a consistent conceptual and operational administrative paradigm. Even under the current economic contraction and the external conditionality pressure, there is no strong evidence of a paradigm shift in the administrative pattern but rather fragmented changes of limited ambit. Points for practitioners Despite the fact that the Greek public administration has undergone a series of transformations, interestingly almost none of these reform efforts seem to have incorporated a particular administrative pattern. This article summarizes old and more recent theoretical developments on models of administrative reorganization, with a view to broadening practitioners’ choices in the process of state reform. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that Greece is among the European countries with increased trend in HCV prevalence among injecting drug users (IDUs) from 2008 to 2014. Nonetheless, the access of IDUs to treatment for Hepatitis C Virus (HCV) is very limited while the risk of co-infection and transmission remains high. In an effort to better understand the inhibitors to HCV treatment, the present study aimed to investigate the main barriers to access in a sample of IDUs. Methods: The cross-sectional study was carried out between July and September 2015 using a 23-items questionnaire. Participants were recruited from urban primary services, mobile health vans, community health services, day-care centers as well as during street work, located in Athens, Greece. Inclusion criteria were age above 18 years, understanding and speaking Greek sufficiently, HCV diagnosis, intravenous drug use. Data collection was carried out by health professionals of Praksis, a non-governmental organization. For the comparisons of proportions chi-square and Fisher's exact tests were used. Results: The study sample consisted of 101 HCV patients, 68% male. More than 80% of study participants experienced barriers in accessing their doctor and medication during the past 12 months. The most common obstacles in accessing a doctor were "delay in making the appointment and "difficulties in going to the doctor due to health condition or lack of means of transport". Access to physician or medication was not differed according to gender, but significant differences were found according to economic status and health insurance coverage. 56.1% of participants reported loss or treatment delay due to barriers to treatment. The majority of participants had deteriorated financial status, health status, access to health services and medication, higher financial burden for health services, worse mental health and lower adherence to medical instructions in 2015 compared to 2009. Conclusions: The findings from the present study revealed that the vast majority of IDUs experience significant barriers in seeking HCV care in Greece, thus highlighting the need for immediate action in this particular area due to the high risk of co-infection and transmission. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is one of the top leading causes of death and disability, and its management is focused on reducing risk factors, relieving symptoms, and preventing exacerbations. The study aim was to describe COPD prescribing patterns in Greece by using existing health administrative data for outpatients. Methods: This is a retrospective cross-sectional study based on prescriptions collected by the largest social insurance fund, during the first and last trimester of 2012. Selection criteria were the prescription of specific active substances and a COPD diagnosis. Extracted information included active substance, strength, pharmaceutical form and number of packages prescribed, diagnosis, time of dispensing, as well as insurees’ age, gender, percentage of co-payment and social security unique number. Statistical analysis included descriptive statistics and logistic regression. Results: 174,357 patients received medicines for COPD during the study period. Patients were almost equally distributed between male and female, and age above 55 years was strongly correlated with COPD. Most patients received a long-acting beta agonist plus inhaled corticosteroid combination (LABA +ICS), followed by long-acting muscarinic agonist (LAMA). 63% patients belonging in the 35–54 age received LABA+ICS. LAMA was prescribed more frequently among males and was strongly correlated with COPD. Conclusion: The study provides big data analysis of Greek COPD prescribing patterns. It highlights the need for appropriate COPD classification in primary care illustrating the role of electronic prescribing in ensuring appropriate prescribing. Moreover, it indicates possible gender differences in treatment response or disease severity, and the impact of statutory co-payments on prescribing. [ABSTRACT FROM AUTHOR]

Background: While there is currently no cure for multiple sclerosis (MS), treatment with biologic diseasemodifying drugs (bDMDs) can reduce the impact of the condition on the lives of patients. In Greece, the regulatory change in the distribution system of bDMDs, limited their administration through the designated pharmacies of the National Organization for Healthcare Services Provision (EOPYY) or the National Health System (ESY) hospitals, thus potentially impacting access to MS treatment. In this context, the aim of this paper was to assess the barriers to bDMDs, by recording MS patients' experiences. Methods: A survey research was conducted between January and February 2014 in Athens and 5 other major Greek cities with the methods of personal and telephone interview. A structured questionnaire was used to elicit socio-economic and medical information, information related to obstacles in accessing bDMDs and medical treatment, from MS patients that visited EOPYY pharmacies during the study period. Results: During the last year 69% of 179 participants reported that the distribution system of bDMDs has improved. Thirteen percent of participants encountered problems in accessing their medication, and 16.9% of participants in accessing their physician, with the obstacles being more pronounced for non-Athens residents. Frequent obstacles to bDMDs were the distance from EOPYY pharmacies and difficulties in obtaining a diagnosis from an EOPYY/ESY physician, while obstacles to medical care were delays in appointment booking and travel difficulties. Conclusion: Even though the major weaknesses of the distribution system of bDMDs have improved, further amelioration of the system could be achieved through the home delivery of medicines to patients living in remote areas, and through the development of a national MS registry. [ABSTRACT FROM AUTHOR]

The latest regulatory change in the distribution system of biologic disease-modifying, antirheumatic drugs limited their sale only through the designated pharmacies of the National Organization for Healthcare Services Provision (EOPYY) or the National Health System (NHS) hospitals, adding to the complexity of access to effective treatment for rheumatoid arthritis (RA) in Greece. The aim of this paper was to assess the barriers to access RA treatment, by recording patients', rheumatologists' and EOPYY pharmacists' experiences. One twenty-three patients, 12 rheumatologists and 27 pharmacists from Athens and other urban areas in Greece participated in the study. Three types of standardized questionnaires were used to elicit information from each group of respondents using the method of personal interview for patients and the method of postal survey for doctors and pharmacists. During the last year, 26 % of patients encountered problems in accessing their rheumatologist and 49 % of patients experienced difficulties in accessing their medication. Ninety-two percent of rheumatologists and 96 % of pharmacists confirmed that patients experience difficulties in accessing RA medication. The most commonly reported reasons for reduced access to medical treatment were travel difficulties and long distance from doctor's clinic, as well as delays in booking an appointment. The most frequently reported barriers to access pharmaceutical treatment were difficulties in the prescription process, distance from EOPYY pharmacies and medicine shortages in NHS hospitals. The study showed that RA patients are facing increased barriers to access timely and effective treatment. Redesign of the current system of distribution ensuring the operation of additional points of sale is deemed necessary. [ABSTRACT FROM AUTHOR]

The Greek economy shifted towards privatization and liberalization after the mid 1990s. These policies were part of a broader process of state reform, which aimed at reducing government's involvement in major sectors of the economy, such as public utilities and the financial/banking sectors. However, this transition added new financial burdens to the state, generating substantial amounts of debt which peaked during the current financial crisis. The purpose of this contribution is to review the restructuring of the state via privatization policies and to assess the effect of the reforms on democracy, accountability and social equity. These questions are being addressed through a combination of theory and empirical evidence, by comparing and contrasting the energy and telecommunications sectors. [ABSTRACT FROM AUTHOR]

This paper explores the process of public sector reform in Greece through the lens of privatisation. It is suggested that the transformation of the domestic post-war interventionist state into the current market-oriented paradigm has been disrupted and dependent on changing reform rationales. Along with the effect of historical dynamics on the direction and scale of change, the explanatory power of external determinants of reform is stressed. Findings reflect a direct linkage between the intensity of external pressure and the pace of reforms. The sustainability of gradual privatisation reforms seems more certain than the outcomes of fast-track privatisations under policy conditionality. • Privatisation in Greece has been largely the result of the interplay between domestic politics and supranational agendas. • Different reform drivers and privatisation rationales have led to multi-speed adjustments of the public sector. • The implementation of radical privatisations required the creation of new institutions in the form of arm's length bodies. • The sustainability of fast-track privatisations seems less certain than the outcomes of gradual privatisation reforms. • Weak institutional capacity has slowed down the implementation or undermined the outcomes of privatisation. [ABSTRACT FROM AUTHOR]