Filenews 3 February 2021 - by Marilena Panagi
The plan of the Health Insurance Agency (OAC) for changes in the way of operation and the way personal doctors (adults) and children are compensated in the GHS is ready.
It provides, in the first instance, for the application of new criteria and in the second, for allowances to be granted on the basis of three different categories, since only 70% of doctors' earnings will be a per capita remuneration and will be calculated on the basis of the number of beneficiaries registered on their list.
The OAC, as reported by the "F", has already presented its design to the Minister of Health, Konstantinos Ioannou, however, before proceeding with its implementation, it is studying various other parameters, such as the fact that the personal doctors of the GHS, (541 doctors for adults and 196 paediatricians), maintain a three-year contract with the Agency and may arise legal issues if their conditions of cooperation are differentiated , before the expiry of their contracts.
In addition, the OA has decided that any changes that arise will be the result of consultation with the system's own doctors. Nor is it excluded that, even in the event of an agreement being reached, all planning may be applied gradually or on a pilot basis for some time in order to correct any distortions observed before final decisions are taken on all the individual points.
With regard to the changes in the way doctors are compensated, they will be based on the initial design of the GHS, as provided for by a proposal by the Minister of Health himself, namely:
- 70% will be granted as a per capita fee
- 20% will be a reward for other medical operations
- 10% will be allocated on the basis of quality and performance indicators.
(Existing contracts with personal doctors set the average per capita allowance at EUR 100 and EUR 130 for adults and children respectively).
At the moment, according to information provided by the 'F', the OA is in the process of processing what was provided for in the original design and concerns both the remuneration for specific medical operations and the remuneration on the basis of qualitative criteria.
During the design of the GHS, which was changed during consultations between the OAC and the Cyprus Medical Association before the implementation of the System in 2019, the criteria included actions to treat chronic conditions such as diabetes, hypertension, hyperlipidaemia, asthma/chronic obstructive pulmonary disease, chronic heart failure (for children related to childhood asthma), home visits to permanently inclined patients and participation in prevention programmes such as programmes to prevent breast, cervical and colon cancer as well as vaccinations in children.
However, in order to apply these criteria, it is first necessary for the Ministry of Health to define the preventive programmes falling within its competence. Currently, protocols are in place for the prevention of breast cancer which is expected to be updated and is working on a programme for the prevention of colorectal cancer. The preparation of a protocol for cervical cancer is pending.
An improvement in the rate and number of
From the results so far of the effort made since last Autumn, which concerned a reduction in the number of refer-ins to specialist doctors issued by the system's personal doctors, there appears to be a significant improvement. In particular, and while the personal doctors of the GHS until a few months ago referred to specialist doctors almost 70% of their beneficiaries, at the moment the rate has fallen significantly. As the director of the OA, Andreas Papakonstantinou, said in a statement, "at the moment our doctors refer only 4 out of ten beneficiaries and not 7 out of ten as before".
Mr Papakonstantinou pointed out, at the same time, that "this proves that the personal doctors of the system can work properly and serve their beneficiaries. Unfortunately, we've heard some voices in the past that our doctors aren't working. At the moment these rumours are being disproved." Perhaps, he admitted ,"and some system regulations would not allow them to do their job properly, such as prescribing specific medicines that should only be prescribed by specialist doctors".
It is stated that the Agency regularly sends to each personal doctor statistics relating to its own operations within the system in relation to the actions of the other doctors.
The C.I. in criminal complaints will be evaluated.
As regards remuneration on the basis of quality and performance, the initial design of the GHS defined: Registration of information and data in the data management system, number of referrals to specialist doctors, prescription of medicines, value of laboratory and diagnostic tests, percentage of beneficiaries examined by their doctor, at least once a year and number of referrals to other HEALTH professionals of the GHS.
With regard to the criteria concerning the way personal doctors operate within the System, the OSU has already taken the relevant actions while setting the relevant timetables.
- With the help of experts, it proceeds to evaluate the complaints issued by personal doctors, so that in the first stage errors and omissions can be identified and recorded. The whole process will last nine weeks.
- At the same time, the Agency intends to apply 'shadow' compensation for referrals of personal doctors, with the aim of rewarding doctors who refer less than average, and to 'punishing' those who refer above average.
The OPM plan is already on the table with the doctors themselves, through the scientific societies representing personal doctors, in order to determine by agreement all relevant parameters. As far as quality criteria are concerned, these will also be brought to the attention of the Primary Care Subcommittee of the OPM Doctors Advisory Committee, so that any implementation can begin without any particular outstanding issues.
