Filenews 12 December 2020 - by Marilena Panagi
The access of the beneficiaries of the General Health System physiotherapists and occupational therapists, as well as the number of visits that each beneficiary will be entitled to carry out within 12 months, include the relevant lists which the Health Insurance Agency has already posted on the website of the GHS.
The number of "sessions" (visits) to be covered by the General Health System is determined according to the health problem faced by the beneficiary and his age. Beneficiaries will be informed of this by their doctor or by the physiotherapist or occupational therapist they choose to serve them and in exceptional cases beneficiaries will be able to secure the right to a larger number of sessions upon a substantiated request and if their request is approved by the Agency.
The referrals will be issued by doctors who belong to designated specialties with the relevant list posted on the website of the GHS. The medical specialties eligible for referral for treatments vary depending on the specificity for which the referral is made.
With regard to the duration of referrals, they will include 3 or 6 visits and will be renewed in consultation with the referring doctor, who must also explain to the health professional the reasons for referral to the 'referral notes'.
It should be noted that, 'where a beneficiary has more than one diagnosis in need of treatment by a physiotherapist or occupational therapist, he is entitled to receive the largest number of sessions accompanying one of his diagnoses and not cumulatively'. When the number of sessions of the first referral has been reached and the maximum number of sessions covered by the System for this diagnosis has not been reached, 'the physiotherapist or occupational therapist will contact the referring doctor for the issue of a new referral of 3 or 6 sessions depending on the remaining sessions covered by the System'.
For physiotherapist services
The list of activities of the physiotherapists of the GHS includes three different categories of services:
Physiotherapeutic evaluation and treatment with a minimum duration of 60 minutes. It includes a physiotherapeutic evaluation based on the diagnosis of the referring physician and the preparation of the most appropriate treatment plan for the case.
Individual treatment with a minimum duration of 30 minutes. It includes providing therapeutic activities to the beneficiary based on his treatment plan and utilizing the full range of services offered by the physiotherapist.
Physiotherapeutic evaluation / re-evaluation or treatment with a minimum duration of 45 minutes.
The number of visits to which beneficiaries are entitled per year shall be fixed. For each visit the beneficiary will pay €10 as a supplement (the ceilings of €75 or €150 generally applicable to the services of the GHS apply).
For adults, the number of visits varies between 6 and 12 depending on the health problem and there is always the right (for adults and children) to request further coverage of the beneficiary by the GHS, if this is deemed absolutely necessary. In the event that no request is made or the request is rejected by the OSU because not all the criteria are met, the beneficiary is entitled to continue to receive services from the same professional by paying the price out of his own pocket.
The main categories of diseases include:
Musculoskeletal diseases of light form (6 visits).
Musculoskeletal diseases of severe form (9 visits).
Acute and Hypoxic neurological diseases (12 visits).
Chronic neurological diseases (12 visits).
Other diagnoses of serious diseases (12 visits).
For children the data are somewhat different, since special provisions are taken for the cases of children with mental, developmental or other disabilities. The number of visits, depending on the problem faced by the child from 0 to 18 years old is also set and reaches up to 48 visits.
The main categories of diseases include:
High-risk neonatal and infant diseases (36 visits).
Diseases of children and adolescents with specific developmental/motor disorders (12 visits).
Diseases of children and adolescents with neurological motor disorders (48 visits).
Diseases of children and adolescents with musculoskeletal system and peripheral nerve disorders (12 visits).
Diseases of children and adolescents with acquired motor disorders from malignancies of MS (24 visits).
Diseases of children and adolescents with mixed disorders (12 visits).
Diseases of children and adolescents with congenital and chronic disorders (24 visits).
Diseases of children and adolescents simple musculoskeletal disorders (3 visits).
For occupational therapist services
The list of activities of occupational therapists includes five activities:
Ergotherapeutic evaluation of the patient, based on the documented practice and training of the most suitable for the case of a treatment plan.
Brief evaluation and re-evaluation of the patient in relation to changes in his functionality and health status with the aim of creating or revising his treatment plan and setting or redefining therapeutic goals.
Treatment and provision of therapeutic activities to the patient based on the agreed treatment plan and utilizing the full range of services offered by the occupational therapist (duration 45 minutes).
Therapeutic activities, in a group of two or more people (maximum 4). The occupational therapist provides continuous monitoring but no one-to-one contact with the patient is required (60 minutes).
Home provision of therapeutic activities to the patient based on his treatment plan and utilizing the full range of services offered by the occupational therapist. Training of the patient and the patient's family/caregiver for the implementation of recommendations at home and the use of supporting equipment/ adjustments and ergonomic interventions (60 minutes). It is noted that this service can be used up to twice per beneficiary per year.
For adults, the main categories of diseases include:
Diseases of severe adult mental disorders (21 visits).
Adult mental disorders diseases (12 visits).
Adult diseases in general (9 visits).
For children, the main categories of diseases include:
High-risk newborns (36 visits).
Children with mental disorders (24 visits).
Children with sensory disorders - hearing (12 visits).
Children with sensory disorders - vision (12 visits).
Children with diffuse developmental disorders (48 visits).
Children with special developmental disorders (24 visits).
Children in need of early intervention (24 visits).
Children with acquired motor disorders (24 visits).
Children with acquired motor disorders - brain (24 visits).
Children with mixed disorders (24 visits).
Children with neurodevelopmental disorders (24 visits).
Children with mental disorders (24 visits).
Children with eating disorders (12 visits).
* List of diseases included in each category has been posted on the website of the GHSGESY English
