Filenews 31 January 2024 - by Marilena Panayi
No later than 10 days after the issuance of an "urgent" referral, an appointment with a specialist doctor must be arranged, while the Health Insurance Organisation has promoted procedures for two other measures aimed at reducing the waiting time of patients for a visit to a GHS doctor.
The new "designated" referrals will be implemented from tomorrow. They will be issued by doctors (personal and specialists) to GHS specialists and their marking will be shown in the system's software.
Specifically, from 1 February onwards, two categories of referrals will be available at the GHS. The "urgent" and the "routine". Each doctor, depending on the characteristics, particularities and health problem of his patient, will give the referral the characterization he deems appropriate.
Referrals marked "urgent" will be prioritized by specialist doctors who, according to the HIO's design, must arrange an appointment for the specific patient within up to ten days.
Initially, the HIO, in consultation with GHS doctors, has drawn up general guidelines to be followed when classifying referrals as "urgent" or "routine". The urgency of an incident will be judged by the doctor who will take into account specific criteria and at the moment the Health Insurance Organisation is in contact with the Federation of Cyprus Patients' Associations, in order to properly inform citizens and follow the instructions of their doctors without pressuring them in order to secure an urgent referral.
At a later stage, the HIO, in collaboration with the scientific societies of doctors of various specialties, will proceed to the development of more specialized guidelines for different diseases and different categories of patients, so that the characterization of referrals to "urgent" and "routine" is done in an even more documented way.
The implementation of referrals of two categories had been decided last autumn during meetings held at the Ministry of Health and discussed the long time required to arrange appointments with GHS specialists.
In addition to referrals, the HIO will attempt to reduce patient waiting times by implementing two more measures.
As we are informed, the doctors of the system have already been asked to record the cases in which visits to specialist doctors could be avoided since the patient can safely be served by his personal doctor.
For example, some groups of chronic patients, whose condition is irreversible or variable, are currently required to visit specialist doctors to renew prescriptions for medicines or to issue referrals for specified laboratory tests which for them are a "routine of life".
With the new procedure that the HIO is trying to promote, these patients will be able to be served by their personal doctors without burdening the appointments of specialist doctors, if there are no other medical reasons.
According to information, several doctors have sent their recommendations to the HIO and the organization is currently processing all the data. This process will be time-consuming as, on the one hand, the HIO must study one by one the restrictions currently applied to the GHS and, on the other hand, it must consult with the scientific societies of doctors in order to make the right decisions.
Finally, the Health Insurance Organization continues the process of compiling patient registries in order to provide facilities to chronic patients who frequently need visits to specialists.
Already, in the context of patient registries, the issuance of referrals to oncologists for cancer patients who are in the process of their treatment and for thalassaemia patients who very often need monitoring by their doctors has been abolished.
According to our information, the next stage is the completion of the registries of patients undergoing haemodialysis and patients on peritoneal dialysis who will be given the right of direct access to nephrologists and day care for dialysis.
Quality criteria in doctors' compensation have been met
The introduction of quality criteria and performance indicators in the way personal doctors of the General Health System are compensated seems to have succeeded and "from this whole effort, we doctors and the GHS are winners", the vice president of the scientific society of personal and family doctors, Maria Avraamidou, told "F".
Mentioning that GHS personal doctors no longer receive 100% of their compensation as per capita income, i.e. depending on the number of beneficiaries registered in their list, but "only 80% per capita and the remaining 20% on the basis of quality criteria and performance indicators", Ms. Avraamidou explained that "two of the criteria applied concern the training of doctors and the cooperation of doctors for scientific analysis specific incidents. As we can see, our doctors have responded. The halls of educational scientific conferences are now filling up and this can only be a benefit for us doctors and certainly for the General Health System. At the same time, we see that doctors have proceeded to create teams among themselves and apply the qualitative criterion of case presentation and discussion."
The response of personal doctors to the implementation of quality criteria is also reflected in the requests they have submitted to the HIO for compensation. As the director of the organization, Efi Kamitsi, told "F", "we see that our doctors have submitted their requests claiming the amounts they are entitled to for the application of the quality criteria that we have included in the way they are paid and this is very positive".
In addition to the two criteria concerning training, a criterion is applied concerning the recording of the equipment of the clinics, the recording of the medicines available in their clinics by doctors and others.
According to Ms. Kamitsi, for some of the criteria it has been decided that "the remuneration to doctors would be made at the completion of 2023, while for others the evaluation time is 12 months. So the application process right now is about the criteria for which time has expired."
Some of the criteria for which doctors will be reimbursed after 12 months include, among others, vaccinating beneficiaries for influenza, measuring blood pressure for adults or measuring body mass index for children.
The HIO and personal doctors are expected to enter into dialogue with each other in the near future in order to agree on additional qualitative criteria that will be included in the way of reimbursement. It is recalled that the goal is that, over time, the remuneration of personal doctors will be paid by 70% per capita and by 30% on the basis of quality criteria and performance indicators".
