Filenews 23 June 2021 - by Marilena Panagi
In the Police for further investigation will end up as many cases of abuses as evidenced by the Health Insurance Agency against health professionals, if it becomes apparent beyond any doubt that they tried or even managed to deceive the System for their own benefit by carrying out acts constituting criminal offences. Beneficiaries may also be called upon by the Police, who at a preliminary stage are reluctant to cooperate with the Health Insurance Agency in the initial investigation of certain cases, while the OAU appears determined to exhaust all means at its disposal in order to crack down on the phenomenon of abuses in the GHS.
On the side of the Agency and the organized patients who say that "the GHS is not free, the GHS operates from our own money, the money of all citizens and we must preserve it from those few who in various ways want to deceive the System". "As the Federation of Patients Associations of Cyprus (OSAC), we must safeguard the System and at the moment we consider it necessary to have a new campaign to properly inform the citizens to whom the GHS belongs," the president of the patients, Marios Kouloumas, told "F", explaining that "we have identified three different trends of abuse.
In the first, health professionals seek compensation for services they have not offered, in the second, professionals and beneficiaries with joint consent fool the System, and in the third trend we see beneficiaries requiring their doctor to refer them to various examinations at a time when he does not consider it necessary and unfortunately in several cases doctors are bowing to patient pressure."
According to information provided by the "F", there are currently specific cases under investigation by the OA, which will probably go the way of justice, but the Agency stresses that "in order to be able to carry out its work properly, the cooperation of the citizens is needed".
No matter how many measures the security takes and no matter how many restrictions it implements, "if our beneficiaries do not cooperate with us, if we do not understand that the GHS belongs to all of us and we must protect it and also if we do not protect it ourselves, the abuses will constantly put it at risk," stressed the deputy director general of the OAC Athos Tsinontidis, explaining that "the mechanisms to detect cases of abuse exist and the software system gives us the data we need. But we as an Agency alone in some cases cannot act as we should because we need the official and branded assistance of the citizens/beneficiaries of the System in the whole effort."
For example, said Mr. Tsinontidis, "when we find through the checks that a doctor or other provider has requested compensation for services that he did not offer to a patient and the patient if he admits it orally refuses to declare it in writing or does not cooperate at all, the OA cannot take further action."
At the same time, he added, "we have cases where patients agree with their doctor, receive a service that is not covered by the System and then the doctor applies for compensation for another service covered by the GHS." As much as there is strong evidence that this is the case "and as confident as we are from the data before us, such cases cannot be shown".
"We must stress that neither the majority of our professionals nor the majority of our beneficiaries take such actions. This is a very small portion of providers and a very small portion of beneficiaries, but the problem is great if it translates into costs and we have a responsibility to safeguard the GHS for the benefit of the many."
Bypassing the doctor's staff costs
The institution of the personal doctor "and the role of the personal doctor in the GHS must be further highlighted and must above all be based on the citizens", said the president of the OSAC giving as an example the data recorded in 2020 in the GHS.
Specifically, 443,058 visits of beneficiaries to specialist doctors without a personal doctor have been recorded in the software. In 292,624 cases, specialist doctors referred the beneficiary to other services such as laboratory or diagnostic tests and/or prescription of medicinal products.
"We find that we opened a "gate", a "side door" in the GHS. I mean, the people who designed the GHS said you can't get into the system except through a personal doctor, but we've distorted that and put direct access to the specialist doctor. This needs to be reviewed. We say that we must first and foremost strengthen the personal doctor because it is the pillar on which the GHS was built. We need to focus on primary care, strengthen the relationship between a patient and a personal doctor." "To reduce abuse rather than eradicate it because it is not possible no matter how many measures are taken," Mr. Kouloumas said, "everyone in their capacity must make their own effort. As an OSAC, we have chosen to launch a campaign to inform and raise awareness among citizens. It is to the citizens that we have to invest and the OAC has already started to inform the beneficiaries, after each service they receive and how much the service they received costs because many people think the GHS is free, nothing is free, it is our money."
