Filenews 10 June 2023 - by Marilena Panayi
There is turmoil among the GHS specialists. The effort of private hospitals to test in practice what the HIO includes in its proposal for the new way of compensating the hospitals of the system, has probably caused big problems.
Doctors warn even when they leave the GHS, while most argue that if what the organization proposes is adopted, then waiting lists will begin to form in surgeries as well. For its part, the HIO is currently reassuring, claiming that as many clarifications as necessary will be given and all views will be heard, without excluding that, if necessary, some changes will be made. Indeed, the HIO does not seem to have set strict timetables for the start of the implementation of the new way of compensating hospitals, since its goal is to hold the necessary consultation and reach an agreement that will leave at least most satisfied. Therefore, and given the strong disagreements recorded on the part of the associations representing the hospitals, the timetable of 1 July must be considered certain to be exceeded with the new timetable set somewhere in the autumn.
In the big picture, the equation for the HIO appears to be difficult. On Thursday, during the meeting of the parliamentary committee on Health, representatives of the Cyprus Health Organization and the Pancyprian Association of Private Hospitals exchanged fire, each claiming that the HIO favours the other, while controversy seems to exist in the background even between hospitals, since some hospitals claim that the HIO with its proposal strengthens other hospitals and vice versa.
On the substance of the protests and warnings, the main problem arose from the provision of the HIO proposal under which the various surgeries will be divided into specialized and non-specialized. For the purpose of understanding, it is stated that each hospital receives from the HIO a specific number of units depending on its capacity, while one unit corresponds to a specific amount of money which varies per hospital. Medical procedures correspond to units depending on the difficulty and complexity of each operation. For example, an appendicitis removal may take 0.7 points while an open-heart surgery may take 3 points. If the hospital unit is €4,000 then appendicitis will be rewarded with €2,800 and open heart surgery will be rewarded with €12,000.
The total number of units received by each hospital is usually distributed (by the hospital) to doctors or a group (e.g. specialty) of doctors who must perform operations corresponding to the number of units at their disposal. Under the current system, if a hospital exceeds its allotted units, i.e. performs more medical procedures than the units it received, its compensation for the additional operations is less than normal. However, because in the case of large hospitals the unit price at which they are reimbursed is high, doctors are usually free to perform surgical or other operations without much restriction since the impact on total revenue is small.
The new HIO proposal provides for the separation of specialized interventions from non-specialized ones and each category receives a different unit price with non-specialized interventions receiving a smaller amount. Some hospitals, in order to prepare for the new system, have already started implementing it. However, especially for non-specialized operations, they imposed restrictions on doctors in order not to exceed the specified number of units allocated to them, since any excesses will cause discounts on the already low amount of remuneration, rendering, according to them, the act not economically profitable. This has provoked reactions on the part of affected doctors, and may inevitably create waiting lists for non-specialist cases, since they will logically make an effort to save their units.
On Monday, a crucial meeting between the HIO and PASIN
Doctors representing the Association of Private Doctors Contracted with the GHS had also issued warnings during Thursday's session in Parliament, arguing that the HIO must make changes to avoid greater problems and distortions in the future.
In their statements after the meeting, they explained that the problem that has been caused is made even bigger by the fact that the HIO, (following suggestions by the Audit Office), recently removed consumables and medicines from the specialized lists of the GHS, forcing hospitals to absorb the cost and as they said, "the combination of the two will make the GHS unprofitable both for hospitals, as well as for doctors."
On Monday, the HIO will have a meeting with the Pancyprian Association of Private Hospitals, but for the time being no new meetings have been arranged, with private hospitals that do not belong to associations, nor with the Association of Small and Medium-sized Hospitals.
