Filenews 9 May 2024 - by Marilena Panayi
They got to work and are preparing guidelines, plans and training seminars for the Health Insurance Organisation and doctors in order to tidy up the General Health System and to facilitate, with the changes that will be made, both professionals – service providers of the system and beneficiaries of the GHS.
Today, the second round of training seminars begins, in which the personal doctors of the system participate and are trained in the correct way to issue referrals to specialists.
At the same time, the Health Insurance Organization and the various medical scientific societies of all specialties are in the process of preparing guidelines regarding when and the conditions that must exist, per diagnosis, in order to issue a referral with the designation "urgent" and when not.
The aim of the HIO is, through the implementation of the guidelines, to further restrain the issuance of referrals to specialist doctors and to strengthen personal doctors who in many cases find themselves in a difficult position when beneficiaries pressure them to issue referrals, which they consider unnecessary.
The institution of the emergency, which counts only four months of implementation, is also under the microscope of the HIO, which studies the data, as recorded in the GHS software, in order to proceed with differentiations, if necessary. Of course, from the initial stages of the implementation of the institution of urgent and non-urgent referrals, it was found that, at least from the point of view of doctors, there was no abuse. The percentage of emergencies issued in the first two months of its implementation was just under 5% of the total referrals to specialists registered in the system at that time.
In addition, the HIO promotes the necessary procedures for the inclusion of quality criteria and performance indicators in the way of reimbursement of GHS specialists. To date, qualitative criteria and performance indicators have been included in the way personal doctors of the system and hospitals are calculated.
According to the same standards, the HIO is working on various proposals before it in order to first decide on the type of criteria and indicators that should be included in the way personal doctors are compensated, so that then the process of determining them can follow, always in cooperation with the scientific societies of medical specialties.
The inclusion of quality criteria and performance indicators in the reimbursements of specialist doctors will probably take some time to achieve as there is no uniformity between medical specialties and certainly in each specialty the conditions and criteria cannot be the same.
As far as personal doctors are concerned, the HIO will soon begin evaluating the implementation of the first quality criteria that had been put in place and, in cooperation with the scientific societies of doctors, will proceed, if necessary, to relevant improvements.
At the moment, at the end of its implementation, for this year, the criterion concerning the administration of influenza vaccines is reached and the HIO is preparing to evaluate the data. Of course, as we are informed, this evaluation will also take into account the fact that this year the Ministry of Health had operated vaccination centres in which several citizens came to be vaccinated, resulting in a decrease in the number of GHS beneficiaries vaccinated by their personal doctors.
Regarding the other criteria taken into account in the calculation of the compensation of personal doctors, based on the design of the HIO, an evaluation will be made at the end of the first year of their implementation. It is recalled that the application of the criteria was gradual and therefore the date of completion of one year differs.
However, with the completion of one year for all criteria, HIO and doctors will proceed to a dialogue on the inclusion of additional criteria and performance indicators in the way compensation is calculated. It is recalled that at the moment personal doctors receive 80% of their compensation on the basis of per capita income and depending on the number of beneficiaries registered in their lists and the remaining 20% on the basis of quality criteria and performance indicators. The HIO's goal is to diversify and stabilize these percentages at the ratio of 70% – 30%.
Finally, and again in relation to personal doctors, the HIO has very recently implemented the procedure of "telephone visit" in the GHS calculus. As we are informed, the organization, fearing abuses mainly on the part of GHS beneficiaries, monitors very closely what is registered in the system's software in order to make the necessary interventions in time if the need arises.
