Filenews 3 March 2022 - by Marilena Panagi
The Health Insurance Organization puts a brake on the easy change of personal doctor with regulations that are coming soon, while yesterday the Organization published and planned on how to deal with abuses in the GHS, including in it the holes found in the System and give the right to service providers and patients to exploit it.
At the same time, the HIO enters from tomorrow and officially in the dialogue with the personal doctors of adults with the object of discussing the change of the way of their compensation, having, however, as of now, knowledge of the intentions of the doctors who go to the Organization setting in advance their terms and conditions.
In his statements, moreover, the president of the personal doctors, Andreas Polyneikis, clarified the scene by saying that the doctors do not disagree with the separation of the total amount they receive "per capita" and "based on criteria" percentages, however, "they have already submitted their counter-proposal, for the application of percentages of 80% and 20% respectively, instead of 70% -30% as provided for in the HIO's proposal". At the same time, they set as a strict condition for the commencement of the consultation with the HIO, the end of the 12% cut-off from their earnings, which was imposed in the summer of 2020 due to the blow that the GHS fund had received due to the government's decisions in the context of the management of the pandemic.
"The more than 500 personal doctors are determined and set as a condition for the initiation of any dialogue the end of the 12% cut-off from their income and from then on, we have already told the HIO that we support rates of 20%-80% for the change in the way we are compensated," said the president of the personal doctors, adding at the same time, that "the HIO must proceed with other moves. We hear the word abuses. From personal doctors there can be no abuses, We need to see how we educate citizens and understand that abuses begin after the personal doctor."
The chapter "Personal doctors and abuses" is also included in the relevant planning of the HIO which, as it is found, does not disagree with the positions of doctors since it identifies a bigger problem in the way in which the beneficiaries themselves use their personal doctor. "Starting from the institution of the personal doctor, the first observation concerns the large number of referrals issued to the Special Doctors. More specifically, on average, about 40 referrals are issued to higher education institutions for every 100 visits and to developed systems with organized primary health. Another problem found in the referrals is their issuance by phone, without any prior examination by the PD. Usually this is done under conditions of pressure from the beneficiaries, resulting in the issuance of unnecessary referrals", says the HIO and adds: "This practice affects the viability of the System and at the same time the role and operation of the personal doctor. In addition, it also burdens the waiting lists of the special doctors at the expense of the beneficiaries who really need medical care," the HIO says.
The Agency goes on to say that "several complaints have been received from doctors, who say they are under pressure from beneficiaries to issue referrals. Otherwise, beneficiaries threaten to be removed from the doctor's list. To this end, there will be a change in the IT system in terms of the length of time that a beneficiary will be able to change personal doctor, as well as the obligation to state the reasons why it is deleted from the list of a personal doctor."
Data analysis and provider miscarriages
For the team of medical experts, the HIO states that "it has already revised the lists of activities, including the severities of each activity, but also to use the capabilities of the IT system to detect and prevent cases of abuse or fraud".
"To date, dozens of doctors have been investigated, whose investigation has led to recommendations and the imposition of administrative fines. In addition, the data analysis has led the HIO to suspend the contract of four specialists, a clinical laboratory, a pharmacy, a personal doctor, a health professional as well as the termination of the contract of 1 specialist doctor, 2 personal doctors and 2 laboratories. At the same time, at the moment, "the Agency is investigating the suspension of contracts of 10 other contracted providers", while "audits have identified hundreds of activity requirements that the Agency rejected". It is noted that more than 1,000,000 claims are received per month from providers.
In addition, the Adoption of a mandatory annual tax clearance for GHS providers is being studied by the Organization.
