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DEPARTMENT of

UNIVERSITY of PIRAEUS

ECONOMICS

M.Sc. in Health Management

PRIMARY HEALTH CARE SYSTEM IN GREECE.

EVALUATION BY ITS FUNCTIONARIES

Georgios Xydis

Master Thesis submitted to the Department of Economics


of the University of Piraeus in partial fulfillment of the requirements
for the degree of M.Sc. in Health Management
Piraeus, Greece, 2014

vi

, ,

vii

viii


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,
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,
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ix

.

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..., , , ,

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... ,
1980 ,

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xi

xii

Primary Health System in Greece.


Evaluation by its functionaries

Keywords: Primary Health Care, National Primary Health Network, National Health
System, legislative framework of Primary Health Care, health politics, evaluation,

Abstract

efficiency, health promotion, health care staff, general practicioner (GP).

In this dissertation, the evaluation of Primary Health Care system in Greece is


attempted, as it is approached by its own stuff. The aim is to detect the necessity and the
importance of Primary Health Care system, the evaluation of its effectiveness, as well as
to record proposals in order to improve Primary Health Care services. The above
empirical research comes with an overview of the legislative framework for Primary

Health Care in Greece, as it has been shaped since the early 1980s until today, as well as
with an extensive critical literature review based on theoretical and empirical research

findings, publications and books.

xiii

xiv

xi
xiii

xix

xxi

Abstract

1:

1.1

1.2

1
1

Alma-Ata

1.3

2:

2.1

2.2


1397/1983:

2.2.2 2071/1992:

12

2.2.1

2.2.3 2194/1994:

15


2.2.4 2519/1997:

16

,
,
2.2.5

(2000)

xv

18

2.2.6 2889/2001:

20


2.2.7 3172/2003:

21


3235/2004:

21

2.2.9

23

2.2.8


(2008)

2.2.11 3918/2011:

27

2.2.10 3852/2010:

2.2.12 4238/2014:

28

30

(....), .....

33

2.3

3:


3.1

35

3.2

36

3.2.1

36

3.2.2 ,

39

3.2.3

49

...
3.2.4

60

... ...
3.2.5

xvi

62

3.3

66

4: .

4.1

69

4.2

70


4.3

75

4.4

78

4.4.2

79

4.4.3

85

4.4.4

4.5

4.4.1

xvii

78

120
125

129
135

xviii


4.1 (%)

85

(5)
... ;
4.2 (%)

86

(6)
... ;
4.3 (%)

88

(7) ,

4.4 (%)

90

(1)
... ;

4.5 (%)

91

(2)
;

... ,

4.6 (%)

94

(3)
... ,
;

4.7 (%)

98

(8)
...;
4.8 (%)

100

(4)
, ...;
4.9

101

... .
4.10 (%)

104

(9)
;
4.11 (%)

xix

106

(10)

4.12 (%)

108

(10) ,
, ;
4.13 (%)

110

(12)
...;
4.14 (%)

112

(13) ;
4.15 (%)

113

(14)
... ;

4.16 (%)

114

(15) ;

4.16 (%)

115

(15) ;,
.

4.17 (%)
(16)
,
...;

xx

118


4.1 (%)

80

.
4.2 (%)

81

.
4.3 (%)

82

.
82

4.5 (%) .

83

4.6 (%) (5)

86

4.4 (%) .

4.7 (%) (6)


.

4.8 (%) (7)


.
.

4.9 (%) (1)

4.10 (%) (2)

4.11 (%) (3)

87

89

90

92

95

4.12 (%) (8)

99

4.13 (%) (4)

101

4.14 (%) (9)

105

4.15 (%) (10)

106

.
4.16 (%) (11)

109

4.17 (%) (12)


.

xxi

111

4.18 (%) (13)

113

.
4.19 (%) (14)

114

.
4.20 (%) (15)

115

.
4.20 (%) (15)

116

, .
119

4.21 (%) (16)

xxii

1


1.1

Alma-Ata ,
1978, -
[World Health Organization ( WHO)]
.


,
.

Alma-Ata Primary Health


Care. Report of the International Conference on Primary Health Care (WHO 1978),

: ) , )

, )
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, )

, )
, ) )
.

1.2

:
Alma-Ata

Alma-Ata
(WHO 1978),


( 2008: 108).
Alma-Ata ,
1978,
,1 ( 2000):

, ,
,

(WHO 1978: 2), , ,

( 2000 & 2012: 106).


,

,
,

( , , )
(WHO 1978: 2 2000 &
2012: 11).

Alma-Ata (WHO 1978: 3, 5),

.
,

, 2000,

.2 ,

, - ,


1948:
, ,
, , ,
, , , , ,
,
. (United Nations 1948, 251).
2
2000 (WHO 1981).

,
(WHO 1978: 3 & 2012: 11).

, ,
70,

( 1992 2000 2008: 108).
( ...)

, ,


,
(WHO 1978: 3 & - 2008: 322).
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,

,
(WHO 1978: 3-4).3

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-

(WHO 1978: 4 2008: 108). ,
,
,
.

& (2012: 11), Alma-Ata,


...
.


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1978: 4 2000). , ,
( 2008: 108),
:
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(
, , , ...). , ,

, (WHO 1978: 4).


..., Alma-Ata,
,
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,
(WHO 1978: 4 2008: 108 &

- 2008: 322 2012: 106).


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( 2008: 108),

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1.3

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2


2.1

,
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,
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: ) 1397/1983 (
, ) 2071/1992 (
), ) 2194/1994 (

), ) 2519/1997 (
, ,

), ) 2889/2001 (
), ) 3172/2003 (
), ) 3235/2004 (
), ) 3852/2010 (

),

3918/2011

( ), ) 4238/2014
[ (....), .....
].
(2000)

(2008).


. ,

,
.

2.2

2.2.1

1397/1983:

... ,

Alma-Ata,
1397/1983,
( et. al. 2005: 108 et. al. 2008: 663 & 2012:
109 & 2012: 11). 1397/1983
,
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2012: 73).
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( 124).

11

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,

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2.2.2

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,
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2.2.3

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2194/1994:

,
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. 2194/1994
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, 1, 2, 3,

4, 14, 15, 17, 18 19 1397/1983, : )


, )
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) .14

14

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et. al. 2007: 56) ...
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[gatekeeper], 90%

15

, 5 2194/1994,

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( et. al. 2011: 143).15

.

2.2.4

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( 1).
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( 2012: 88),
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... ... ( ),

(), ...
... .... ( 311 & 2008: 109

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(Abel Smith et. al.
1994: 66).
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(Abel-Smith et. al. 1994: 72),
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et. al. 2011: 143).



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(2000).

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90). ,
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,

( 9).

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90).

2.2.7

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( 2012: 91).
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31-3).
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2.2.8

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..., 2004
3235/2004. , ...

( 11).
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( & 2012: 12).20

13 3235/2004, ... :

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(1397/1983, 2194/1994 2519/1997),

(Abel Smith et. al. 1994: 67, 69-70, 72-73).
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26
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(2008)

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2.2.10

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27

3329/2005,34 ,

943,).

(...).
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(. 3172/2003, . 3235/2004 . 3329/2005),

...

2.2.11 3918/2011:
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2012: 13).

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.

3.2

3.2.1

...
,
,

, , , ( & 2009: 38, 40).46 , ...,


(Hancock & Garret


1995, et. al. 2011: 141). ,
,
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, ( &

2003: 467 et. al. 2008: 670 Goodwin 2008, et. al. 2011: 141).
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( 2000),
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( et. al. 2006: 86-87).
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46

(2007: 11) ...


,
.

36


..., ... ( et. al. 2007: 55).47
, ,

,
(Abel
Smith et. al. 1994: 27 .. 2003, et. al. 2007: 64 et.

et. al. 2011: 143 & 2012: 111, 114).

al. 2006: 84 & - 2008: 223


,

... ...,
Alma-Ata,
1980

...
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,
,
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- 2008: 326 & 2012: 13
& 2012: 111). ,
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47

...
1980
1990. 1397/1983 , ...,
,
2071/1992, ,
, (
) .
,
( 1997, et. al. 2007: 56),
( 2012: 86).

37

,
( et. al. 2007: 63-64 Polyzos et. al.
2008 et. al. 2011: 141-142).

,
...
( & 1991, & 2012: 111 Abel
Smith et. al 1994: 28 2004, et. al. 2007: 64 et. al.

2006: 86-87 & 2012: 111).48

,
, 49 50
( et. al. 2006: 84-85 et. al. 2007: 63).

( 2004, et. al. 2006: 84).
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,51 , ,
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2006: 84-85 2008: 109).52 ,


48

1397/1983: ,
,
( 2012:
73).
49
et. al. (2006: 85),
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( et. al. 2006: 85-86).
50
1397/1983, ,

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( et. al. 2006: 85). ,
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51
& (1998, et. al. 2006: 87)
ad hoc
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52
3235/2004,
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,
( et. al. 2007: 63). , ...
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109). 2004

38

, ,
( 1996),
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3.2.2 ,


,
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,
(
et. al. 2007: 37, 52 et. al. 2005: 108 & -

2008: 223, 2009: 40 & 2012: 109


et. al. 2011: 143 & 2012: 11),
(Abel Smith et. al. 1994: 34 2012: 94-

95). , 1397/1983

,

(Tsalikis
1988 Liaropoulos 1998, 2012:84).53

( et. al. 2011: 144, 146).



..., ,
(2007-2009).
53
, , (2003, et. al. 2006: 84),
1980,
... ,
, ,
,
, . ,
1397/1983 , ,
( 2012: 84).

39

,
. 2071/1992
,


( 2012: 86). 2194/1994
...
1397/1983,

2071/1992,

( 2012: 86-87).
, (2012: 85), 1990

,
( ),
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, ...

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( 2012: 85-87).

...,

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et. al. 2010: 333-337, & 2012: 13 &
2012: 111). ...
, ,
,
( et. al. 2000: 171, 173 & -

40

2008: 324 et. al. 2008: 669 2012: 50, 59).54


... ( &
- 2008: 324 2012: 50):
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..., 3918/2011 .....,

... ,
.
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, .

, (
),

.
.
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, ,
,55

54


: )

( Beveridge), ) ,
, (
)
( Bismark), ) ,
( et. al. 2000: 170
2003: 76, 78, 83).
55
, ... ... .
... ,

.
, . ,
,
,
( ), ( et. al. 2000: 172
& 2003: 467 et. al. 2001 Tountas et. al. 2005, & 2009: 41 2012: 50, 57). ,

. ,
-
( 2012: 75).

41

56

( 2003: 79 & -
2008: 324, 2009: 41 2012: 59). ,

...,
( et. al. 2000: 173 et. al. 2006:
75 & - 2008: 324 &
2012: 111 2012: 85). ,

...,


( 2003: 218-219 & 2012:
111 & 2012: 13 2012: 59).

Abel Smith et. al.


(1994: 27),
.


, ... ...

1397/1983. , ...
, ...
,
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(.

4.4).

4.25

(%)
3,20%

30,70%

66,10%

82

42,3 , 64
30 . 4.5,

30-34,

45-49,

50-54

55-59

(18,1%, 14,2%, 16,2% 16,2% ).


, 8% .
4.26

(%)


60-64
55-59
50-54
45-49
40-44

30-34

5,00%

10,00%

15,00%

20,00%

0,00%

35-39

,123

.

, ,

... ,

16 , 12
( ,
, ,
Likert) 4 ,
.

123

. , .

83

( ) ,
.

...
.
...
, , : )
..., )

, ) ...

, ) ,
..., )
... ( 1-3).124 ,


... ( 4 8-11).125

, ,
... ,
...

( 5-7).126


... ( 12-13)127 , ,
... ( 14-16).128

,
,

. ,
...,

.
2014.
124

. , .
. , .
126
. , .
127
. , .
128
. , .
125

84


,

.
,

.
SPSS 17 (Statistical Package for Social Sciences),

4.4.3


... ,


(87,4% 91,1% . 4.1 & 4.2
4.6 & 4.7).

(3,15% 4,1%
),
(9,45% 4,9% ).
, , ,


, ,
.
4.18

(%) (5)
... ;
Frequency

Valid Percent

Cumulative Percent

111

87,4

91,0

3,15

94,3

12

9,45

100,0

127

100,0

/
Total

85

4.19
(%) (6)
... ;
Frequency

Valid Percent

Cumulative Percent

112

91,1

91,1

4,1

95,1

4,9

100,0

123

100,0

Total

4.27

(%) (5)

86

4.28

(%) (6)

, ..., ,

,
... (. 4.3 4.8).
... : )
(11,5%), )


(10,8% 7,5% ), )
(10,2%
8,4% ), ) ... (9,9%
9,6%) ) (7,2%
6,2% ),
(2,7%). ,
,
,
.
, ,

... .
87

...
(7%),
.
...
,
, (3,8%)
.
: ,


(,

[stakeholders]
).

, ...

(4,9%).

4.20

(%) (7)
,
;
Frequency

Valid Percent

Cumulative Percent

62

9,9

9,9

31

4,9

14,8

45

7,2

22,0

17

2,7

24,7

72

11,5

36,1

68

10,8

47,0

64

10,2

57,2

53

8,4

65,6

39

6,2

71,8

47

7,5

79,3

88

60

9,6

88,9

44

7,0

95,9

24

3,8

99,7

2
628

,3

100,0







Total

4.29

100,0

(%) (7)


... ,
( 65%
) ,

26% (. 4.4 4.9).


,
9,4% ...
. ,
...
89

...
,

... .129
4.21
(%) (1)
...
;

12

9,4

33

58

24
127

Total

Cumulative Percent

Valid Percent

Frequency

26,0

35,4

45,7

81,1

18,9

100,0

100,0

4.30

(%) (1)

129

. 4.2 4.3.

90

9,4


... : )
... (22,3%), )
,
(19,8%), ) (14%) (. 4.5
4.10).
: )
... (2,5%), )

(
, , , e-health,
..) (3,3%), )
... ... (4,1%) )
...,
(5% 5,8% ).

(8,3%) ...
(, ..) (9,9%).

4.22

(%) (2)
... ,
;
Frequency

Valid Percent

Cumulative Percent

27

22,3

22,3

12

9,9

32,2

3,3

35,5

3,3

38,8

17

14,0

52,9

10

8,3

61,2

...

24

19,8

81,0

...

5,0

86,0

5,8

91,7

4,1

95,9

/
( ..)

...
...

91


...

2,5

98,3

1,7

100,0

Total

121

100,0

4.31

(%) (2)



...
.


... (. 4.6
4.11). , , : )
...
(13,4%), ) (12,4%), )
(10,4%) )
... (10%),

92


... ( ... ),
, .

...,
,
. ,

... (2,5%), (2%),

(3,6%) (4,1%)

...

.

... (9%)
, , ...


...

(5,6%). , (8,8%)
...,


...

...

(13,4%),
... (5,8%). ,
...

(5,5% 6,5%),
93

(3,3% . 4.5), ,
,
,
... ,

, ,
,
(, ),

,
...

.

4.23

(%) (3)
... ,
;
Frequency

Valid Percent

Cumulative Percent

63

10,4

10,4

34

5,6

16,1

35

5,8

21,9

81

13,4

35,3

33

5,5

40,8

39

6,5

47,3

12

2,0

49,3

25

4,1

53,4

15

2,5

55,9

...

60

10,0

65,8

...

75

12,4

78,3

53

8,8

87,1

54

9,0

96,0

22

3,6

99,7

,3

100,0

Total

603

100,0

...
...

...

94

4.32

(%) (3)

4 8
130
...,

: : )
... (9% . 4.7 4.12) (

. 4,9%), )
(8,6% 6,6% .

4.7 & 4.8 4.12 & 4.13, ), )


... (8,4% 4,1%
. 4.7 & 4.8 4.12 & 4.13, ),131 )
,
...
(7% 2,5% . 4.7 & 4.8 4.12 & 4.13, )132 )

130

,
( 4 , 8 ),

...
131
, (2,5% . 4.8
4.13).
132
(4,1% . 4.8 4.13)
,

95

... ...
(6,4% 5,8% . 7 & 8
12 & 13, ).

(.
4.6). ,
... ,
()

: ) ..., )

,
(
...) )

, , ...


. : )
... (4,5% . 4.7 4.12), )


... (3,5% 6,6% . 4.7 &

4.8 4.12 & 4.13, ), )


(4,3% 0,8% . 4.7 & 4.8 4.12 & 4.13)
) (3,4% . 4.7
4.12).
: )

(. 4.6), )

... (. 4.5 4.6), )


(.
4.3) )
(. 4.3). ,
,
(4,1% . 4.7
4.12).

96

...,
.
,
... .
,

. ,
,


...



(. 4.5 4.6),
,

, ,
, , online ...
.. (5,7% 0,8% . 4.7 & 4.8 4.12 & 4.13). ,

/ (5,7% . 4.7 4.12), )

( ,
),
(5,7% 3,3% . 4.7 & 4.8

4.12 & 4.13, ), ,


(12,4% . 4.8 4.13), )

... (5,7% . 4.7


4.12), )
... (5,3% 15,7% . 4.7 &
4.8 4.12 & 4.13), )
... (4,4% 1,7% . 4.7 & 4.8
4.12 & 4.13), )
... (3,3% 0,8% . 4.7 & 4.8
4.12 & 4.13), ) ...
97

(9,9% . 4.8 4.13), )


... (3,3% .
4.8 4.13), )
..., ,
... (3,3% 1,7% .
4.8 4.13), ) (3,3% . 4.8
4.13), )
... (2,5% . 4.8 4.13), ) ...

(2,5% . 4.8 4.13),133 )

(1,7% .
4.8 4.13), ) (0,8% . 4.8
4.13), )
(0,8% . 4.8
4.13), )
(0,8% . 4.8 4.13) )

(0,8% . 4.8
4.13) (. 4.9).

4.24

(%) (8)

...;
Frequency

Valid Percent

Cumulative Percent

97

8,6

8,6

51

4,5

13,1

95

8,4

21,5

65

5,7

27,2

79

7,0

34,2

46

4,1

38,3


...

133

98


...

55

4,9

43,1

102

9,0

52,1

60

5,3

57,4

49

4,3

61,7

72

6,4

68,1

50

4,4

72,5

64

5,7

78,2

...


...

...




...


...

5,7

83,9

40

3,5

87,5

38

3,4

90,8

65

5,7

96,6

37

3,3

99,8

,2

100,0

2
1132

100,0

4.33

Total

65

...

(%) (8)

99

4.25
(%) (4)
,
...;
Frequency

Valid Percent

Cumulative Percent

.. ...

12

9,9

9,9

.. ...

19

15,7

25,6

3,3

28,9

...

6,6

35,5

4,1

39,7

2,5

5,8

47,9

3,3

51,2

4,1

55,4

3,3

58,7

2,5

61,2

,8

62,0

15

12,4

74,4

,8

75,2

,8

76,0

6,6

82,6

3,3

86,0

..

1,7

87,6

,8

88,4

2,5

90,9

2,5

93,4

1,7

95,0

,8

95,9

,8

96,7

- Online ..

,8

97,5

,8

98,3

1,7

100,0

121

100,0

.. ... ...
.. ...



.. ...

...

42,1




Total

100

4.34

(%) (4)

4.26


...
1.

...

2.

...
...

3.

4.

,
/

5.

...
.. ... ...

6.


- Online ..

7.

101

8.


/ /

9.

...

10. ...
.. ...
11.

12.

14.

13. ...

15. ...

16.
17. ...

18. .. ...

19. ...
20. .. ...

..

21. .. ...
22.

23.
24.
25.

26.
/

27.

28.

,
4.4 4.8
9 (
;) (. 4.11 4.14 . 4.7-4.9).
, , )
... (8,7%), )
(8,4%), )
102

... (7,9%) )
...
(7,3%)
.

...,
,
.

... .

: )
(6,2%), )
(5,9%), ) ... (5,7%), )

(5,6%), ) ... ...

(5,6%), ) (5,6%) )
... (5,1%).

...,
,
,
,
( ,
),
, ...
,
.

...

.
: )
(4,5%), )

(4,5%), )
103

... (4,3%), )
... (4,1%), )
(3,5%), )
(3,5%) )
... (3,4%).
4
8,
... .

...,
,
...
, ,
. ,
...,

...
.

4.27

(%) (9)
;
Frequency

Valid Percent

Cumulative Percent

54

7,9

7,9

28

4,1

12,0

57

8,4

20,4

38

5,6

26,0

50

7,3

33,3

31

4,5

37,8

40

5,9

43,7

...

59

8,7

52,3

39

5,7

58,1


...

104

...

31

4,5

62,6

38

5,6

68,2

29

4,3

72,4

38

5,6

78,0

42

6,2

84,2

24

3,5

87,7


...

...

...


...
...

3,5

91,2

35

5,1

96,3

23

3,4

99,7

2
682

,3

100,0

100,0

Total

24

4.35

(%) (9)


,
.
105

, 26,9%
, 38,5%
, 33,8%
(. 4.12
4.15).
4.28

35

50

45

Total

Valid Percent

Cumulative Percent

Frequency

(%) (10)

130

26,9

26,9

38,5

65,4

34,6

100,0

100,0

4.36

(%) (10)

11 ( )
, ,
,
106


(. 4.12 4.16).
, 29%

... , 5,2%
,

. , 5 (2010-2014)

...
. ,

(16,1%),
(1,3%),

(10,3%).
,
(0,6%).



,
(5,8%).

.
,
... (7,7%),

(1,3%),
... (7,1%),
(0,6%) (0,6%).


107

...,
.
, 3,2%

.., 3,9%
(
)
,

(.. ..,



), , ,
. ,
(3,2%),



(2,6%) (

.
4.7), (1,9%)
(1,3%). (0,3%)
,
...,
... .
4.29

(%) (10)
, ,
;
Frequency

Valid Percent

Cumulative Percent

16

10,3

10,3

3,2

13,5

25

16,1

29,7

108

45

29,0

58,7

11

7,1

65,8

,6

66,5

5,8

72,3

,6

72,9

,6

73,5

1,9

75,5

12

7,7

83,2

5,2

88,4

,6

89,0

/


/

Total

3,9

92,9

2,6

95,5

1,3

96,8

1,3

98,1

1,3

99,4

,6

100,0

155

100,0

4.37

(%) (11)

109

(.. , ,
, , , ..)
() , ,
(
: , ,
),134 , ,
,
, .

, 8 9

()
(. 4.7, 4.8 4.10).
,
, (81,5%)

4.17).

... (. 4.13

4.30

(%) (12)

...;
Frequency

Valid Percent

Cumulative Percent

49

39,5

39,5

52

41,9

81,5

11

8,9

90,3

4,8

95,2

4,8

100,0

124

100,0

Total

134

. 135-141.

110

4.38

(%) (12)

, () :
)

(17,3%), )
(15,2%), )

(14,3%),
[gatekeeper], )
(13,1%), )
,
(12,9%), ) ,
, (10,8%), )

(9,9%) )
(6,5%) (. 4.14 4.18). ,
, ,
()
..., : ) ,
, )
111

, )
, )
)
.
4.31
(%) (13)
;
Valid Percent

28

6,5

Cumulative Percent

Frequency

6,5

66

15,2

21,7

43

9,9

31,6

75

17,3

48,8

57

13,1

62,0

47

10,8

72,8

56

12,9

85,7

62

14,3

100,0

434

100,0


( ,
)

Total

112

4.39

(%) (13)

...
... , 37,9%
, 62,1%
(. 4.15 4.19).


, ,
.
4.32

(%) (14)
... ;
Frequency

Valid Percent

Cumulative Percent

47

37,9

37,9

77

62,1

100,0

124

100,0

Total

113

4.40

(%) (14)

, 37,9% ...
30,3% ... (. 4.16
4.20).

...: ) (26,9%), ) (19,2%), )


(11,5%), ) (7,7%), ) (7,7%), )
(3,8%), ) (3,8%), ) (3,8%), )
(3,8%), ) (3,8%), ) (3,8%) ) (3,8%) (.
4.16 4.20).

4.33
(%) (15)
;
Frequency

Valid Percent

Cumulative Percent

25

37,9

37,9

20

30,3

68,2

21

31,8

100,0

Total

66

100,0

114

4.16
(%) (15)
;,
Valid Percent

Cumulative Percent

...

19,2

19,2

11,5

30,8

7,7

38,5

3,8

42,3

3,8

46,2

3,8

50,0

3,8

53,8

Total

Frequency

26

26,9

80,8

3,8

84,6

3,8

88,5

3,8

92,3

7,7

100,0

100,0

4.41

(%) (15)

115

4.20

(%) (15) ,

16 ()

,
...
...,
. , : )
(28,9%),135 )
135

, , , ...
,
[gatekeepers]. , ,
, (Saltman, & Figueras 1997,
2003: 80 Health Canada 1999, 2003: 81). ,
[General Practitioners, GPs] ,
... (Paul 1995, 2003: 82): )
(Lister
1998 WHO 1999, & 2012: 107), ) ,
, ) , )
, (Brennan
et. al. 2000, & 2012: 107), )

116

,

...,136 ... (11,1%), )
, )

(6,7%), ) (6,7%),137 )
... (4,4%), 138 )
,

,139 )


, , )
[gatekeepers],
( 2003: 82 &
2012: 107).
136
, , Health and Medical Services Act (1982)
Dagmar (1985),
, 21 () 290
( 2003: 83 & 2012: 107).
() ,
...,
(European observatory on health care systems
2001, 2003: 83). ,
.
,
, 17 ,
(Center on strategies for public and civil entrepreneurs 2001,
2003: 80). , , ,
( )
, ( 2003: 80).
137
, , ,
[solo practice] [group practice].
, 1991,
- [GPs Fundholders],
,
( ) (Center on strategies
for public and civil entrepreneurs 2001, 2003: 82 Pollock 2004 et. al.
2005, & 2012: 107). 1999,
[Primary Care Groups, PCGs], : )
, )

) ,
(Bindman et. al. 2001, &
2012: 107). 2002, PCTs
[Primary Care Trusts],

( & 2012: 107). ,
... (Wolper 2001, 2003: 82 2003: 80).
138
. .
139
,
,
(Health Canada
1999, 2003: 81). ,

117

,
(4,4%),140 )
(4,4%),141 ) ,
... (2,2%), )
(2,2%), )
(2,2%), )
... (2,2%), )
, (

, ) (2,2%)142 )

, (2,2%) (.
4.17 4.21).

4.34

(%) (16)
,
...;
Valid Percent

Cumulative Percent

4,4

4,4

..

8,9

13,3

/E-health

6,7

20,0

2,2

22,2

2,2

24,4

.. (,

2,2

26,7

11,1

37,8

Frequency

...

, ,
(Wolper 2001, 2003: 83 2003: 82).
140
, , ,
. ,
,
. ,
:

.
141
,
(Brennan et. al. 2000, &
2012: 107).
142
, , ,
...
[community care]
[one-stop-shopping] (European observatory on health care systems 2001,
2003: 81). ... ,
, , ,
.. (Wieners 2001, 2003: 79).

118

...
.. /Gatekeeper/General

13

28,9

66,7

4,4

71,1

2,2

73,3

2,2

75,6

4,4

80,0

2,2

82,2

6,7

88,9

2,2

2,2

93,3

2,2

95,6

4,4

100,0

45

100,0

Practicioner

... ...





Total

91,1

4.42

(%) (16)

119

4.4.4

,
..., ,

. ...
,
... ...

: ) ,

)
, )
, )
... )
. ,
,

, ,

, . ,

2/3 ...

.
.143
: )
, ) )
. ,
: ) , )
, )
, )
.. ... )
.

143

. 4.2.

120

: )
,
) .
: )
..., )
) .
...
..., ...

..., .

,
...

.

...

,

: ) ... (

...),144 ) ,

( ,145

...,

/ ,146 ,147
,148 149 ..), )
144

, ...

, ,

( & - 2008: 329 2012: 95).
145
. et. al. (2000: 178), & - (2008:
328), (2010: 21), & (2012: 14) et. al. (2011: 146).
146
,
,
[gate-keeping] ( 2000: 181-186 &
2003: 469-470 & - 2008: 328-329 2010: 22).
147
,
...,
...
( & - 2008: 328 &
2012: 14).
148
, & (2012: 14)
,

121

(
...)150 ) ... (
..., ,151
,152 ,153
... ...,154
155 , 156
157 ..).

... ...
. & - (2008: 328)

( ),
/ ,
. ,
( , ) ( 2010: 22).
149
. (2012: 95).
150
. (2010: 21) & (2012: 14).
151
,
... ( & - 2008: 328).
152
,
, ,
... ( &
2012: 14). , ...
,
.., , ,
.. ( & - 2008: 329). .
et. al. (2000: 177).
153
. et. al. (2000: 182).
154
, et. al. (2011: 146) & (2012: 14)
...
. , et. al. (2000: 177)
, ...
..., . .
(2010: 22).
155

, ,
... (, ,
, , ,
, , ..) (
et. al. 2000: 182 & - 2008: 328 2010: 21-22
et. al. 2011: 146).
... .
156
. (2010: 21-22), & (2012: 14) (2012:
95).
157
. et. al. (2007: 64). ,
,
( & 2012: 14), ,
( & - 2008: 328
2010: 22 et. al. 2011: 146). , ,
, ,
.. ( et. al. 2000: 178
& 2003: 470 & 2012: 14 2012: 95-96).

122


...
, : )
..., )
,158 )
159 )
.160
... (

) ...

,
: )
, )

,161 )
, ) ,

158

, , , 162

,
,
,
( & - 2008: 328 et. al.
2011: 146 & 2012: 14). , ,
( & 2003: 470),
, [evidence-based
medicine] [medical audit] ( et. al. 2000: 178
& 2003: 470 & 2012: 14 2012: 85).
159
, ...
: ) , )
, )
)
(
& - 2008: 328 2010: 21-22 et. al. 2011: 146
2012: 95).
160
, & - (2008: 328), (2010: 21, 23)
et. al. (2011: 146) ...
(.. , ,
, ..) ,
. . et. al. (2000: 177-178)
, , ,
, ,
.
161
et. al. (2007: 64) (2010: 23)
,
.
162
& (2012: 14),
.....,
... ,

123

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