Filenews 26 February 2025 - by Marilena Panayi
The Health Insurance Organisation is attempting to put an end to unnecessary admissions of patients to hospitals and unnecessary surgeries, which is setting up the "admissions supervisor" team, which will consist of doctors and others and will carry out unannounced checks in all GHS hospitals.
Tomorrow, the HIO will inform the directors of all hospitals of the System accordingly, since its intention is to begin as soon as possible the whole process aimed at investigating whether patients admitted either for hospitalization or surgery, directly by doctors or through the Accident and Emergency Departments, really need these services.
As the director of the HIO, Konstantinos Panayides, explained to "F", "this decision of the HIO aims not to prohibit the admission of any patient for hospitalization or surgery, but to exercise the necessary control needed to ensure that within the General Health System there are no unnecessary patient admissions or unnecessary surgical or other operations".
"It is a fact and it is well known that hospitals often report that they do not have free beds. Within the GHS we have about 70 hospitals. When almost all, or at least the older ones, report overcrowding so often, then surely this is something we need to investigate. At the same time, we observe that the number of patient admissions is constantly increasing, as is the number of surgical and other procedures in proportion to the population (beneficiaries). It is imperative that the HIO investigates the reasons why we have these phenomena and in order to achieve this we must add, to all the other controls we carry out, import control."
This check, he added, "will concern both patients admitted directly by their doctors to hospitals, as well as patients admitted after visiting the Accident and Emergency Departments. We are all aware that reimbursements also increase depending on the process of admitting patients to a hospital. So this too needs to be monitored. In the team of inspectors there will of course be doctors who have both the knowledge and experience to identify patient admissions or surgical and other procedures that could be avoided without compromising patient safety."
From time to time, Mr. Panayides reminded, "they also come to the HIO but they also see the light of publicity and complaints from patients who subsequently found out that they underwent an operation without actually needing it. This is also one of the reasons why there is a need for import control. In order for proper control to take place, we, as HIO, must have the support of doctors who know what to check, what to take into account, etc. On the other hand, we must send a message to all doctors and all GHS hospitals that unnecessary admissions affect the very services they provide."
"It should also be recalled that based on the official data of the GHS, approximately 90,000 interventions per year have been carried out within the System for at least the last two years. If this number is compared to the almost one million beneficiaries, it is easy to understand that the resulting ratio should concern us and put us on alert."
Possibly, the director of the HIO continued, "our audit will not reveal anything wrong. Perhaps there is increased morbidity, perhaps there are still accumulated needs of the past. However, the indications are there, some data, as we have mentioned, are there and we must investigate them. With controls, we have no intention of limiting the way our doctors act. On the other hand, however, we aim to protect the GHS, to better manage the hospital beds operating within the System and to improve the level of services provided."
So, "what we are saying is that with the 'import supervisor' we are broadening the scope of control of the GHS. We believe that it will help us form a better picture of what is really happening and at the same time we will be able to modernize the way inpatient care operates within the GHS and upgrade the quality of services provided to our beneficiaries. If, for example, the overcrowding of hospitals and the lack of beds, which is often mentioned, can be better managed, as an HIO we must do so."
More than 100 cases are under investigation
The audit process of all GHS health service providers is ongoing "and certainly concerns the whole range of services. As far as hospitals are concerned, we have already imposed administrative fines or suspended contracts, we are already carrying out checks through the IT system but also with visits by our inspectors to the hospitals themselves and their records (patient files). The carrying out of checks by the import supervisor team is in addition to these checks."
The HIO, Mr. Panayides concluded, "has imposed in hundreds of cases fines on health service providers from the day of implementation of the GHS until today. Indicatively, since June 2024, when we began to publicize the imposition of fines or suspensions of contracts that the HIO proceeds with every month, we have published until January 2025 a total of 98 cases. These cases involved doctors, hospitals, pharmacists and other providers. Some are very serious cases, others concern non-application of the rules applied to the System and we certainly have cases that follow the path of justice. Some of these cases are now before the Courts following relevant complaints by the HIO to the Police. In other words, the competent directorate of the HIO is constantly vigilant and I believe that our results have already begun to be seen in practice".
