Health Insurance Organization targeting abuses in GESY system

The phenomena of abuses of the General Health System (GESS) that have emerged since its application, is one of the serious issues that concern the Health Insurance Organization (OAY). The complaints that had been made since the implementation of the first phase of GESS, as well as the confirmation from the investigations that followed, keep the Organization on high alert to date in an effort to combat the phenomenon which, as OAY director Andreas Papakonstantinou emphasizes, does not directly affect the finances of GESS, however it can cause short-term pressures on the Health System. In his interview with "K", Mr. Papakonstantinou admitted the existence of the problem, referring to the measures taken. "Abuses have existed and continue to exist. A great effort is being made by OAY. We will focus on better patient access and quality services. This includes the effort to crack down on any abuses. The measures taken are not one-dimensional. " To date, the OAY does not appear to have a clear picture of the extent of the abuse. The goal of the Organization, as it characteristically states, is to reduce the phenomenon, since, as it says, even more mature Health Systems compared to GESS face similar problems. "Financially (the abuses) have not burdened it (the GESS), to a large extent, due to the global budget. But it remains a crucial issue for OAY. We have an obligation to beat the abuses, it is not easy to measure terms, to determine the rate of abuses. With the data we have and the information from patients and providers, there is indeed a tendency to abuse, which we must curb. We will not eliminate it, no system has achieved this."

The offenders

According to the data available to the OAU for the cases of abuse that have been identified, responsibility is placed on medical service providers and patients. A typical case of abuse identified by OAY investigations concerned a physician who systematically made requests for service acts, which, as it turned out, did not confer on patients. Investigations into the abuses showed that they were serious, repetitive, so that the doctor was expelled from the system. However, as Mr. Papakonstantinou pointed out in his interview with "K", cases have been identified where patients are pressuring doctors for unnecessary services. "These abuses, although we consider them important and we are determined to reduce them, to the least extent possible do not affect, at least in the short term, the GESS budget. In other words, the expenses do not increase because the budget is global, almost every specialty has its own budget and knows that during the year it will receive a certain amount, regardless of the number of transactions ", Mr. Papakonstantinou emphasizes. In this light, the aim for OAY is to create a different culture of both medical providers and patients.

The measures

According to the director of OAY, from the first moment that the phenomena of abuses of the GESS appeared, the Organization proceeded with concrete measures. First, in collaboration with a British organization, an Institute strengthened the protocols of the Health System. Second, it collaborated with the Pancyprian Medical Association (PIS) and scientific companies, while strengthening the adjudication department within the OAY. Third, penalties for abuse have become more severe, and fourth, the separate budgets that have been adopted are believed to gradually help cultivate a different culture at both provider and patient levels.

Regulation of the agreement with individuals

The other issue that is high on the agenda of OAY and not only, is the agreement for the inclusion of private hospitals in the GESS, in the wake of the recent opinion of the Attorney General of the Republic. What is mentioned in the opinion has essentially created a serious problem with the doctors who are not included in the GESS. However, they operate in-hospital in private hospitals that are integrated into the System. In this case, the position of the OAY is that the whole issue should be resolved by regulation and not by amending the legislation. Specifically, as Mr. Papakonstantinou mentioned in "K", OAY is in consultation with the Minister of Health Michalis Hadjipandelas, who has undertaken to speak with the Attorney General in order to investigate whether the whole matter can be settled by regulation so that these doctors can continue to provide their services. "If the Attorney General turns on the green light, the Minister of Health will submit a proposal to us, which we will consider. Both we and PASIN ".

[This article was originally published in Greek on Kathimerini.com.cy]