Filenews 12 July 2024 - by Marilena Panayi
One hole is being closed by the Health Insurance Organisation, another hole is being opened in the GHS, since measures taken by the Organisation in order to manage abuses, although they work, lead to new mentalities and practices, with the result that new interventions are needed in the process.
A typical case is the referrals to specialist doctors carried out by GHS beneficiaries, since, as it is established, although the measures taken by the HIO and the efforts made by personal doctors began to pay off and their number decreased by 10.5%, a new phenomenon developed in the System that has resulted in a skyrocketing number of long-term referrals requested by specialists, with the rate of increase reaching 53.8% and obliging the HIO to proceed with measures that will affect, this time, the reimbursements of specialist doctors.
The struggle to reduce referrals to specialist doctors seems to have started to pay off, especially after the inclusion of the number of referrals in the performance indicators taken into account for the purpose of calculating their compensation.
According to the official data of the HIO and regarding the referrals executed by the beneficiaries, a decrease of 13.3% was recorded between 2021-2022 and a further decrease of 7.68% was recorded in the following year, i.e. between 2022-2023. On average, a decrease of 10.5% was recorded per year.
To make this possible, personal doctors have reduced the number of referrals they issue to specialist doctors and it is now established that they serve their own patients in their practices without succumbing to blackmail or simple demands. At the same time, it seems that many citizens also began to cooperate more and trust their personal doctors more.
These data, however, show only half the picture, since the attitude that personal doctors now take has led to the phenomenon of skyrocketing the number of long-term referrals to specialists, which currently creates another problem in the proper functioning of the System.
According to the procedures followed, long-term referrals are issued when the specialist doctor considers that his patient must have direct access to him without the need to constantly issue a referral from his personal doctor. The long-term referral includes a maximum of 12 visits (depending on the judgement of the specialist) and not 2 as provided for in the short-term referral to a specialist.
In order for the beneficiary to secure a long-term referral, the specialist doctor must submit a request to the personal doctor and obtain the necessary approval.
As a result, in many cases, in the last year, when the personal doctor asks a beneficiary to visit him in order to investigate his problem before issuing a referral to a specialist, the beneficiary bypasses the procedure, visits a specialist doctor directly and thus obliges the personal doctor to approve his colleague's request for a long-term referral.
Indicative is the complaint that reached the HIO by a personal doctor who had received a request from a beneficiary to issue a referral to a specialist, refused to do so by asking the beneficiary to visit him in his office in order to first make the necessary evaluation and investigation of his problem, but the patient visited a specialist doctor on the same day, without a referral, who immediately submitted a request for a long-term referral.
What personal doctors denounce is also proven by what is recorded daily in the GHS software. Specifically, between 2021-2022 there was an increase of 67.4% in the number of long-term referrals and in the following year, i.e. between 2022 and 2023, an additional increase of 40.2% was recorded. That is, on average, there has been an annual increase of 53.8% in the number of long-term referrals.
In order to curb this increase, the HIO, as the general manager, Andreas Papaconstantinou, told "F", "is preparing to implement measures that will affect specialist doctors and/or their compensation. In particular, a limit will be set on the number of long-term referrals and doctors who exceed it will be required to pay a fine and at the same time doctors with the highest number of long-term referrals will see a reduction in their compensation."
