Filenews 27 September 2021
At least fifteen complaints per day from GHS beneficiaries, concerning doctors or providers, are received by the Call Center, according to the Director of the Health Insurance Organisation (OHI), Andreas Papakonstantinou, who says that the monthly complaints amount to about five hundred, among which there are very serious ones and which are examined immediately.
In his statements to the Cyprus News Agency, Mr. Papakonstantinou said that the call centre receives about 20 to 30,000 calls per month, however, he noted that most of them concern simple questions, which are given the appropriate guidance.
"The resulting complaints are around 15 a day and around 500 per month, which are being examined by the Service. Some serious and others of more minor importance", said Mr. Papakonstantinou in particular.
The most common complaints
As explained, the call centre receives complaints from beneficiaries about doctors or GHS providers, noting that "some complaints received are judged as serious cases, while others are investigated and closed without any other follow-up".
According to Andreas Papakonstantinou, complaints are made on a daily basis and it is normal, since we are talking about 870,000 beneficiaries, to add that complaints are of various forms.
In response to a question, he said that the most common complaints concern the non-response of personal doctors to phone calls from beneficiaries, but adds that until it is investigated by the HIO, the next day the case is closed, because the beneficiary reports to the Service that his personal doctor finally returned the inclination after a few hours.
"There are cases that don't even exist. We just collect them and they close on the same day," he continued.
Asked if the complaints received by the Agency are proven through its software, the DIRECTOR of the SOO said that the SOFTWARE of the SOO is used as an assistive tool to investigate a case.
However, he noted that he does not give all the answers, explaining that if the complaint concerns the non-response of a personal doctor to a beneficiary "this cannot be checked by the system".
He said that "the system is useful to extract some statistics that reflect the behaviour of the provider", to add that "if a provider is suspected of engaging in suspicious behaviours, statistics can help us and guide us".
He also mentioned that if the practice of a doctor he follows is very different from other colleagues then this may raise suspicions for investigation, however, he stressed that "this does not necessarily mean that this particular doctor is guilty", since there may be an excuse or there may have been mismanagement of GHS resources.
"Abuses exist in all GHS Services"
Regarding the abuses in inpatient care, Mr. Papakonstantinou said that "abuses exist in all GHS services as well as in all systems in the world".
"There is no Agency that we can safely say that no abuse is taking place. And when we say abuse we mean that resources could be better used, or perhaps there could be a violation of the law and it is something very serious and criminal. There are many gradations in bad behaviour and each case is different," he explained.
When asked if the CAO is taking corrective action to put a stop to these abuses, Mr. Papakonstantinou said that "various actions are being taken and we are trying to use the experience we gain by detecting these violations".
He also said controls are being stepped up, while the Board of Directors has codified administrative penalties, imposed on providers depending on the extent, duration, severity of the breach.
He further said that the Agency is trying to cultivate a culture both at the level of providers and at the level of beneficiaries.
In addition, he noted that data is being analyzed through the IT system, to add that "after two years of the system's life we have the ability to utilize a better picture of a provider's behaviour and some other measures that we are implementing to limit abuses".
Long road to curb abuses
"We recognize," he continued, "that it is a phenomenon that exists and we have to manage it. The indications that we have through the controls that are carried out and through the information that reaches us is that there is enough scope to further reduce the issue of abuses. I am not saying that we have reached a degree of satisfaction. We have a long way to go to limit the abuses", he underlined.
On the administrative fines imposed, he said an effort is being made to create a culture, expressing the belief that "although there is a long way to go, everyone can admit that there is an improvement compared to when we started".
Up to €30,000 the longest penalty
In relation to the penalties provided for, Mr Papakonstantinou said that they concern fines from small amounts to very large amounts, noting that the largest amount foreseen is €30,000, however, so far no such amount has been imposed.
The number of patients that a PD is entitled to enrol is not reduced
Asked to report whether the information that the ceiling imposed by the OSO will be lowered in relation to the number of patients that a personal doctor is entitled to enrol is untrue, Mr. Papakonstantinou said that "for the time being, no decision of the Board of Directors on such an issue is in the works".
"There is currently no such suggestion. But that is not out of the question in the future," he said.
Asked if a doctor is entitled to delete a patient, he replied: "Yes he is entitled. But the beneficiary may then come to complain and file a complaint that it was deleted. There are cases when a patient may want to leave a doctor and may not have completed the 6 months he is entitled to to leave. In such a case, in order for him to leave, the doctor must consent."
Cases of doctor irritation and wanting to delete a patient is a rare occurrence and has been done in too few cases, he noted, finally.
CNA
