Filenews 23 December 2022 - by Marilena Panayi
In three phases, the integration of rehabilitation services into the General Health System will take place, while the Health Insurance Organization has intensified its consultations with the candidate centres for accession, in order to catch up with the schedules and start on January 1, 2023. The HIO, as we are informed, has already sent to the four centres with which it is in consultation the proposal it has prepared and it is not excluded that in the coming days it will proceed to negotiations as there seem to be some objections.
In order to prepare its planning, the Organization proceeded in the previous period to the separation of services which will be gradually integrated into the GHS.
Specifically and based on this design, restoration is divided into five categories:
- Rehabilitation of neurological diseases including strokes, cerebral haemorrhage, traumatic brain injuries, nerve injuries, nervous system tumours, neurodegenerative diseases, etc.
- Rehabilitation of musculoskeletal disorders, including bone fractures, joint and ligament injuries, etc.
- Rehabilitation of cardiac diseases including postoperative rehabilitation after cardiac surgery, cardiopulmonary rehabilitation after infarction, etc.
- Rehabilitation of respiratory diseases including Chronic Obstructive Pulmonary Disease, pulmonary fibrosis, etc.
- Post-traumatic rehabilitation including amputations, quadriplegia and paraplegia, multi-traumatization, etc.
From the data obtained by the HIO, through the study conducted on behalf of the Organization by a specialized firm, in Cyprus, 37% of the patients who currently receive these services are neurological patients.
Therefore, the Agency decided to proceed with the gradual integration of rehabilitation services into the GHS, in order to meet the needs as a matter of priority.
According to information from "F", the three different phases have been defined as follows:
- First phase, will be implemented from 1 January 2023 and will be completed in September 2023 and will include the integration of rehabilitation services for neurological diseases and post-traumatic rehabilitation.
- Second phase, will be implemented from October 2023 to May 2024 in the services of the first phase will be added the inclusion of rehabilitation for musculoskeletal and cardiac diseases.
- Third phase, starting in June 2024, rehabilitation services for respiratory diseases will be added to the services of the previous two phases.
The rehabilitation services that will be offered by the HIO Contracted Centres to the beneficiaries of the GHS will include, among others:
- Respiratory function training.
- Balance and mobility training.
- Training in the use of wheelchairs and mobilization with wheelchairs and other walking aids.
- Training in the use of aids.
- Bladder and bowel training.
- Skin care and prevention of pressure ulcers and other complications.
- Providing psychological support.
- Ergonomic adjustments in the patient's environment.
- Patient education in activities of daily living (school, work, financial transactions, etc.).
- Education for reactivation in society.
- Training/advice of caregivers of the patient.
The centres, according to the conditions set by the Organization, are required to provide medical care to citizens throughout the 24-hour period. In particular, during non-working days and hours, they must provide medical coverage by an on-call doctor who will present himself within a reasonable time at the centre after the call he will receive.
In addition, each centre must have physiotherapists, occupational therapists, speech-language pathologists, clinical psychologists, and clinical dietitians, with their number being proportional to the number of beds operated by the centre, which at the same time must cooperate with a social worker.
Based on the HIO's proposal, the admission of patients to a rehabilitation centre will take place only after the approval of a relevant request by the Organization. The request will be submitted through the GHS IT system by the attending physician of each beneficiary. For monitoring purposes, the centre will send every six weeks, a progress report and an assessment of the beneficiary's operational status on the basis of a predetermined form for assessing and determining the prolongation of hospitalization or discharge. In the event that the discharge of the beneficiary is decided, the centre will proceed with all the specified procedures within a period of no more than three days. In fact, the HIO has added a provision based on which, the cost of the centre for further stay of the beneficiary will not be compensated in any case in cases where instructions have been given in writing for the issuance of a discharge to the patient.
Regarding the financial aspect of the HIO's cooperation with these centres, as reported by "F", this will be defined and will include all the services that a patient is likely to receive in the context of his hospitalization for the purpose of medical rehabilitation. This "package" will not include:
· Outpatient Medications
· Outpatient Consumables
· Imaging tests (CT, MRI, X-rays, DEXA)
· Routine blood test
· Electroencephalogram
· Electromyogram
The HIO's proposal also includes the minimum criteria that must be met in relation to the medical staff, the medical specialties that the center is required to have and the equipment that must be in the Centre's facilities to serve the patients.
Changes, after the adoption of legislation
As is well known in Cyprus, there is currently no legislation in force governing the operation of rehabilitation centres. That is why the HIO chose to proceed initially with the signing of contracts with Centres that operate with a hospital license and not with centres that may provide the specific services, but do not hold the relevant license. The bill for the operation of rehabilitation centres was submitted by the Ministry of Health to the Parliament, which, however, will resume its work after the presidential elections next March. Therefore, the HIO has included in the memorandum that will invite the centres to sign in order to integrate their services into the GHS, a relevant provision.
Specifically and based on this provision: "It is agreed that with the adoption by the Parliament of the law regulating the establishment, operation, control and supervision of rehabilitation centres, the provisions of the contracts as well as any other documents issued by the HIO and which will govern the provision of medical rehabilitation services within the framework of the GHS, may be amended by the Organization for the purposes of compliance and / or harmonization with the law. In order to comply, the HIO will make the necessary adjustments to the minimum in order to be able to continue to provide services within the framework of the GHS".
BACKSTAGE
Two centres have already responded
The consultation of the Ministry of Health with the centres that will include, in the first phase, the rehabilitation services they offer in the GHS is still ongoing. As we are informed, two of the Centres have already responded positively to the HIO's proposals, while the integration of the centre, which also operates within the Nicosia General Hospital and belongs to the State Health Services Organization, should probably be taken for granted. Third Centre, seems to have come back asking for more negotiation with the HIO while the processes by the Agency are being carried out amid protests by the associations representing independent rehabilitation centres, which are currently not part of the GHS in view of the adoption of the legislation by the Parliament. Regardless of the protests and the number of centres that will sign their contracts by the end of next week, the HIO appears determined to integrate rehabilitation services into the GHS on 1 January 2023.
