Filenews 17 April 2024 - by Marilena Panayi
It is not in danger of economic collapse, not even because of monoinsurance philosophy and architecture. The risks to the GHS are five and arise from external factors.
The descent of foreign investment funds may cause monopoly conditions, which will reduce the bargaining power of the Health Insurance Organization. The continuous increase in health service providers can lead to unnecessary actions, which will burden the system financially. The non-normalization of the operation of the SHSO may lead to great adventures for the GHS. The lack of legislation governing the modus operandi of different groups of professionals is already creating distortions. Finally, the mentality of a large portion of citizens, beneficiaries of the system and health service providers has already caused congestion and dysfunction in several cases.
The first GHS evaluation report made by the HIO records in detail both the risks and the impacts or potential impacts if the situation is not properly monitored.
At the forefront of the distortions is the lack of legislation, which is a result of the delay observed for several years in the preparation and voting by Parliament of bills that will provide for the operation of various groups of health service providers (some of the bills have been prepared and are expected to be submitted to Parliament very soon for discussion and voting).
"To date, the GHS contracts with all providers who comply with the provisions of existing legislation regarding obtaining the license to practice the profession," the evaluation report said, adding: "In many cases, however, it appears that either there are no legislations or the existing legislation does not meet modern needs."
For example:
>> The operation of radiodiagnostic centres is not regulated by law.
>> The law on private hospitals concerns only hospitals of the private sector and not of the public sector and the provisions for the operation of the Accident and Emergency Departments are rudimentary.
>> The issues of clinical laboratories about the operation or not of blood collection centers are chronic.
>> Bills to regulate recovery and rehabilitation centers and palliative care are pending.
>>Bills of ambulances and other services remain pending.
As noted in the report, "although the GHS can proceed with the definition of its own additional criteria, beyond those provided for by law, undoubtedly, the existence of modernized legislation that would regulate the above issues and contribute to improving the efficiency of the system would help greatly."
A blessing but also a curse for the GHS, the massive participation of health service providers. As noted, "in almost all categories (doctors, hospitals, pharmacies, clinical laboratories, radiodiagnostic centers, other health professionals) participation is over 90% while, in some categories, it reaches 100%".
This "increases healthy competition and strengthens the HIO's negotiating position, gives choices to beneficiaries, promotes healthy competition and allows easy access for patients to providers to receive services."
The concern arises about "whether the rate of registration of new providers will continue in a way that will lead to an oversupply of services, with the risk that providers in their effort to survive financially resort to bad practices with negative effects on the quality of services and of course on the efficiency of the system".
Already, as it is found, "the consequences of oversupply of services are presented in the category of pharmacies and clinical laboratories where there is pressure to increase the budget so that participating providers remain viable". At the same time, there is already concern due to indications that "some doctors subject patients to procedures/services, which may be unnecessary. This, in addition to waste, can be detrimental to patients' health." The report also identifies a trend of overconsumption on the part of citizens: "The existence of a large number of clinical laboratories, blood collection centres, radiodiagnostic centres creates the risk of induced demand, which will gradually if not addressed, create pressure on the budget."
What is most troubling, for the future, is the arrival of foreign investment funds. "The arrival of foreign investment funds has mainly brought positive changes in the way private hospitals operate. On the other hand, however, if in the future private hospitals are concentrated under the ownership of 2-3 investment funds, this will increase the dependence of the GHS on these funds, limit healthy competition and consequently negatively affect the efficiency of the system".
A fourth risk for the GHS is the huge gap that seems to be identified in the post-hospital management of patients, mainly people over 70 years of age. As stated in the evaluation report, from the first four years of operation of the GHS it is found that "there are many elderly patients who, especially after an operation, are unable to care for themselves. In many cases, relatives are pressuring hospitals to keep patients for longer than is justified by their clinical condition, until they can find a special center to take care of them."
This, as noted, "reduces the efficiency of the system, since hospital beds are not utilized in the best possible way and are reserved for services that are essentially outside the system. The greatest burden of these cases is borne by the SHSO as well, hence the fact that the average time patients stay in the SHSO is around 5 days compared to the private sector which is around 2.5 days". In the UK, it is noted, "this phenomenon is very intense and has created a huge problem in accessing inpatient services."
The economic relationship with the SHSO is a difficult equation
The particularities of the State Health Services Organisation and its financial cooperation with the HIO are extensively analysed in the GHS evaluation report.
"During the first years of operation of the GHS, the SHSO lost market share in sectors related to "normal/normal" health services. Undoubtedly, however, it continues to maintain a competitive advantage in specific sectors such as inpatient cases and several "difficult" cases, e.g. adult and paediatric intensive care, emergency departments, pathological cases of elderly and chronic patients, specialized low-demand clinics."
As far as the remuneration received by the SHSO is concerned, the issue "is a difficult equation". "In addition to the "normal" services where it is reasonable for the SHSO to be paid on the same basis as other hospitals, the SHSO is called upon to cover "special" needs inside and outside the GHS framework. These particularities need to be recognised by the HIO and the state and appropriately compensated."
The risk to the GHS "arises in the event that the GHS pays fees to the SHSO disproportionate to the services provided. This means that the principle of 'money follows the patient' will be circumvented, with negative consequences for the smooth functioning of the system."
