Filenews 6 November 2021 - by Marilena Panagi
Remuneration based on performance and quality criteria comes for personal doctors and the changes both in their remuneration and in their contracts with the HIO must be decided in the next few months, since the contracts that are now in force expire in May 2022.
The processes in the OECD have been in progress for some time, with the dialogue between the Organization and the representatives of the personal doctors of the General Health System having already begun, at a time when the Health Insurance Organisation is preparing to announce an offer for the purchase of services by foreign experts who will be asked to give their recommendations and help develop reimbursement models based on performance / quality for the primary.
The ultimate goal of the OECD is to determine the remuneration of personal doctors by 70% on the basis of the number of beneficiaries who have registered in their list with the calculation being made per capita and by 30% on the basis of quality criteria and performance indicators. This is also provided for by the initial planning of the General Health System, which was then changed in order to satisfy the financial demands of doctors, before the start of the first phase of the GHS in June 2019.
At this moment, however, and given the fact that the personal doctors of the System have already received a reduction (10%) in their earnings, due to the blow suffered by the GHS fund due to the government decisions on the pandemic, the change will not be "abrupt" and the percentages that will be finally determined may differ (of 70%-30%) at an early stage, or even possibly to determine their staggered adaptation over time. Of course, the personal doctors have already requested the return of the 10% that has been cut off from them, but the matter is still up for discussion. Based on the initial plans of the OECD, which may be differentiated in the course of time:
► 70% of the remuneration will be granted as a per capita fee.
► 20% will be a fee for other medical operations.
► 10% will be allocated on the basis of quality and performance indicators.
(It is recalled that the existing contracts with personal doctors set the average per capita compensation at 100 and 130 euros for adults and children respectively).
As far as the 30% is concerned, according to the initial planning of the Health Insurance Organization and based on what is already provided for by the relevant Regulations of the General Health System and have not yet been implemented, specific medical operations and performance indicators are included:
Specific medical procedures:
► Management of chronic diseases.
► Promotion of specific preventive and screening programmes.
► Additional services provided (e.g. resident visits).
Performance indicators:
► Entry of information and data in the data management system.
► Number of referrals.
► Prescription of medicines.
► Value of laboratory and diagnostic tests.
For performance indicators, the HIO has long monitored and informs doctors, who receive monthly a status of use of services with the referrals they issue to medical specialists, referrals and the value of laboratory tests and the number and value of prescriptions for medicines and the comparison of their own activity with the activity of their colleagues in the System. Based on this practice, doctors every month know that if they are in the "green" category, then they are within the average of the category of providers they belong to, and those who are informed that they are classified in the "red" category, are at "dangerous" levels.
In fact, this practice, which is already being applied, seems to have brought the first positive results, since previously 7 out of 10 beneficiaries who visited a personal doctor provided a referral for specialist doctors, while the most recent data show that this ratio has changed and now only 4 out of 10 patients are referred to doctors of specialties.
According to information provided by "F", the Health Insurance Organisation has set its intention to proceed with the implementation of compensation based on performance indicators on a pilot basis to the representatives of the GHS's personal doctors and it is expected that a relevant consultation will begin.
As far as the purchase of services by experts is concerned, as we are informed, this is also a provision of the recovery plan and the aim is to define performance and quality criteria that will not only concern primary health care but also in-hospital care services. That is why the completion of the work of the experts is not linked to the time of the start of the new data on the way personal doctors are paid and cannot be an excuse for any delay in the implementation of the new rules on the way personal doctors of the GHS are paid.
There is no need for legislation
The way of remuneration of personal doctors has been raised in the last few days several times in the public debate because of the position expressed by DISY in parliament for its amendment, with the deputy president of the party Harris Georgiades having stated several times that if legislative regulation is needed for this change then it must be done.
However, as reported by information provided by "F", for the implementation of the plan of the Health Insurance Organization but generally for the modification of the way in which personal doctors are paid, no changes are provided for, and are not needed, in the Law governing the operation of the GHS.
Of course, the implementation of any planning will be preceded by an agreement with the doctors of the System, so that no problems arise along the way and the dialogue will also take place in the context of the consultation for the renewal of doctors' contracts in a few months. In any case, all procedures must be completed by the first quarter of 2022, in order to allow time for preparation until the signing of the new contracts of the personal doctors of the System next spring.
For the time being, at least publicly, no serious disagreements have been expressed between personal doctors and HIOs. However, it should be mentioned that the dialogue has not yet entered the depths of economic negotiations.
