GESY - PATIENT PAID FOR HOSPITAL STAY - Filenews 25/5 by Marilena Panayi
He underwent surgery in a hospital of the General Health System and cost him dearly. After the operation, he experienced severe pain and very high blood pressure, as a result of which he had to remain in hospital for three days.
His doctor, as the patient himself reported to the Patients' Rights Observatory, informed him that the Health Insurance Organization only covers a 24-hour hospitalization for this operation and therefore he would have to pay for the two additional days. The bill reached €400, which of course the patient also paid out of his own pocket.
After his discharge, he contacted the Cyprus Federation of Patients' Associations asking for guidance on the actions he should take in order to get back the money he gave.
OSAK, as we are informed, contacted the HIO asking for explanations, but without receiving a response. "This case is particularly serious and the HIO must, without any further delay, proceed with a detailed investigation," OSAK spokesman Dimitris Lambrianidis told "F". "On the one hand we have the hospital/GHS provider who allegedly charged a beneficiary of the System and on the other hand we have the patient, a beneficiary of the GHS, who was obliged and accepted the payment of €400 for the two additional days of his hospitalization." First, he said, "to make it clear that the patient should not be burdened with any amount when he needs and receives services through the System and based on this, we must look at the rest of the data".
"The HIO applies the system of Homogeneous Diagnostic Categories (DRG). Through this, the time of hospitalization is determined for each inpatient act. Within the framework of the restrictions imposed by the Organization in order to contain possible abuses, when the specified time of hospitalization is exceeded, it pays smaller compensations. Therefore, it is not in the interest of hospitals to extend the hospitalization of patients."
However, this fact, he stressed, "cannot be punitive towards the patient. It is unthinkable that the patient is asked to pay for the extra money out of his own pocket."
In the event that the attending physician "considers that there is no reason to extend the hospitalization but the patient insists, then he must be discharged. Otherwise, the law and perhaps the philosophy of the GHS itself is violated."
For this reason, "we as OSAK say that the HIO must also investigate and re-evaluate some practices it implements, because as we see, more and more, lately, on the basis of these practices, phenomena have begun to appear that distort both the philosophy and character of the System and for us this cannot be accepted, whether it is done by any provider, or beneficiary, or indirectly and by the Organization itself".
A second complaint, which was submitted to the OSAK Patients' Rights Observatory, concerns the financial burden of a beneficiary within the GHS. In this case, the citizen stated that "while in the previous months he had made visits to specialist doctors, the doctors have not submitted the relevant claims for compensation to the System, with the result that these visits have not been taken into account in the total amount of co-payments he has paid for the year and would normally have reached the ceiling of €150". Because of the delay, he said, "he continues to pay supplements for visits and examinations."
It is reported that due to the restrictions applied by the HIO on the number of visits made by doctors, many doctors delay submitting their claims and transfer them to the next month's entries in order to avoid cuts.
"When restrictions and rules are decided and applied," said Mr. Lambrianidis, "the possible effects on patients must also be taken into account. And this issue must be studied by the HIO in order to determine ways of security for the beneficiaries who, without being responsible for anything, pay, when normally they should not."
