Health Review | May – August 2022

The role of Internal Audit (IA) is considered particularly important, especially in recent years when the economy of Greece, and not only, has been shaken by both the financial and recent pandemic crisis. In this new environment, IA emerges as a cognitive scientific subject -with practical professional orientation-, in which the executives, in both the public and the private sectors, should be trained in order to respond to the expanded needs and requirements of their role. This study aims to answer three linked research questions (RQ): - How are studies of IA in the public sector progressing? - What does the existing literature on public sector IΑ emphasize, and where do its critics lay? - The future of government-funded IA studies: what lies ahead? We conducted a literature review on the databases Scopus, Web of Science, and Google Scholar, using the terms “accounting fraud”, “internal audit”, “public governance”, and “external audit”, published in English, over the decade 2010-2019. Increased scholarly interest in the subject has been noted, although most publications focus on a single country, especially those of emerging markets. Research interest is conducted at all levels of government, albeit it has primarily focused on the municipal level. The studies' majority is focused on governance and business success through quantitative analysis and often ignores theory. It is clear, finally, that scholars must focus on comparative research, between countries and markets, which will take into account also the cultural, institutional, and demographic factors that influence the IA. The findings of this research would be of interest hopefully to academics, industry professionals, and executives with concerns about the pressing IA issues.

Public health services in Greece have been under persistent pressure, due to the constant fiscal crisis. Health policies related to Primary Health Care (PHC) in the country, despite long-term restructuring efforts, need to be reviewed and redefined. The aim of this study is to analyze the accessibility and satisfaction rates in Greece, as part of the health policies for the PHC of the country. We performed research for the analysis of data with respect to the accessibility to PHC and the investigated data included satisfaction, accessibility, and waiting times. Data were obtained from the European Statistical Authority (EuroStat). A literature search was performed also in the PubMed database, using as appropriate indexing words «quality indicators», «health care», «primary health care», «Greece», and «fiscal crisis». We found that, before the onset of the economic crisis (2004-2008) in Greece, the proportion of citizens unable to access the PHC structures ranged from 4% to 5.5% (2008). During the fiscal crisis period, this figure has almost doubled to 9% (2014). Similarly, the satisfaction of patients from PHC services showed a particularly downward trend. The pre-crisis rate ranged from 94.7% to 92.6% (2008), declining steadily over the crisis and dropping to just 88.8% (2013). The year 2016 appears to be a turning point, to the patterns found up to that time, where the accessibility improved. The Greek fiscal crisis has created many challenges in PHC in relation to the accessibility and satisfaction of citizens with the services provided. In conclusion, the goal of further improvement of the provided primary care services can be achieved by the Greek state through strategic planning, which will take into account the nowadays and particular socio-economic conditions.

At the end of 2019, the Chinese health authorities detected a new strain of coronavirus (SARS-CoV-2 ). This new strain seemed to cause a number of cases with serious complications and deaths. As the virus spread, health systems around the world were unprepared for the pandemic that followed. Here we study the coping strategies, in the form of government guidelines and/or scientific associations’ recommendations, for prioritizing patients due to the increased flow of patients in Intensive Care Units (ICUs), before the production and use of the vaccines, during the first year of the pandemic. Moreover, we study the ethical dilemmas of this period. A bibliographic review was conducted in the databases Pubmed, Researchgate, and GoogleScholar, in English, Italian, French, and Greek language using the keywords “COVID -19”, “ethics”/“etica”/“ethique”/“ηθική”,“bioethics”/“bioetica”/“bioethique”/“βιοηθική”,“ICU”/“UTI”/“USI”/ “ΜΕΘ”. The time limit for inclusion in the survey was the end of 2020. We found that for crisis management effectiveness, those involved, both directly and indirectly, were asked to consider options such as (a) the prioritization in ICU's admission of patients with the best prognosis, (b) the increase in the number of ICU beds, (c) the transfer of patients in need to ICUs in remote areas, where had available beds, and (d) the cessation of life support. Each option, whether chosen to be implemented alone or in combination with other, raises basic ethical dilemmas for health professionals working in the ICU. In conclusion, the adoption of boundary solutions in the provision of health care, where the common denominator is respect for human life, tests or contradicts the moral standards and personal ethics of those responsible for making the decision.

The first two positive cases of COVID-19 in Portugal were recorded on March 2, 2020, with the first death to be recorded two weeks later, on March 16. At the same time, WHO announced that Europe had become the epicenter of the pandemic, with more cases and deaths than the rest of the world (with the exception of China). A national response began in those early days. Travel to Italy was suspended on March 9 and, on March 18, the Government adopted more restrictive measures, declaring a state of emergency and the first confinement of the population. With the national state of emergency, it was verified a suspension of citizens' rights so that measures to protect public health could be implemented. Some measures were the confinement of people in the household, the establishment of sanitary fences, and the closure of commercial establishments and educational institutions, among others. In the first month of the pandemic in Portugal, on March 31, 2020, Portugal recorded 7.443 confirmed cases and 160 deaths.