The General Health System, seven years after its implementation (June 1, 2019), is trapped in horizontal restrictions and rules that are not related to its structure, philosophy and architecture.
They afflict patients, lead to waiting lists, unnecessary actions and in some cases have created a vicious circle from which "we urgently need to get out".
Simply put, the GHS "is trapped in regulations" and the HIO, as organized patients emphasize, is trapped in slogans about "abuses" and distorted political positions for its viability.
The GHS, the secretary of the Federation of Cyprus Patients' Associations and patient representative on the Board of Directors of the Health Insurance Organization, Miltos Miltiadous, stressed to "F", "is the greatest social achievement and is a blessing for all citizens. We say this and repeat it again this year with the completion of 7 years since its implementation. Neither its architecture, nor its philosophy, nor its structure need to be changed. On the contrary, if you change these, you will "take out the soul" of the System."
"If we have to say something about the GHS for this year's anniversary, it is that we have to get rid of it," he said and explained:
"We need to free it from internal rules, restrictions and criteria, which we had applied in the first years in order to manage or even suppress phenomena of abuse or incorrect use of the System by providers and beneficiaries who had entered a completely unknown complex environment for all of us. The control of the system and abuses must pass, in a structured and coordinated way, to the control of the medical practice and the results, and the National Clinical Documentation Center and the Electronic Patient Record should play their role in this as soon as possible."
The HIO itself must "free itself from the attitude it takes in many cases, due to attacks and arbitrary calculations and suggestions, mainly from political or professional circles, about the finances of Health in Cyprus, and start investing in the Cypriot patient".
"We say this because we find that while the GHS has a very strong Fund which far exceeds the prescribed safe limit for its viability and constantly creates surpluses, in practice, there is difficulty and hesitation either in offering new services (always within the framework of the legislation) or in expanding existing ones for fear of invoking distorted data by some."
For example, said Mr. Miltiadous, "while there is financial possibility, rules are applied, restrictions on nurses' visits to bedridden patients, physiotherapy sessions to patients who need much more than those offered, and so on. There must always be limits, but more important is that the GHS works for the benefit of the patient and not on the basis of "I need 5, I keep aside 9 so that no one tells me anything."
"Let's stop saying only slogans about abuses and about the viability of the GHS. If we want the System to improve, we need to see the real problems through the eyes of patients. The rest is political crowns and/or expediencies."
''Controls to prevent or even prevent abuses are necessary. On the other hand, however, the restrictions actually equate those who want to deceive the System, professionals and beneficiaries with those who really need the health services of the GHS and the professionals who respect and operate properly within it."
For example, "while there are no endocrinologists, thousands of chronic patients are directed, through rules and restrictions, to doctors of the specific specialty at a time when they could be served by their personal doctors who, at the same time, do not have the right to prescribe specific laboratory and diagnostic tests that could lead to a safe diagnosis without the need to refer their patients to other doctors of various specialties".
The issue "is not the relaxation of controls but the implementation of more effective and targeted mechanisms".
In some cases, a vicious circle is created
Some other rules concern the movements of doctors within the System. "The HIO applies the practice of units by specialty and hospital. When the doctor or hospital exceeds the specified units, discounts begin to be applied to the amount of their compensation. As a result, either patient visits are transferred to a future time (waiting lists), or providers post-date their claims for reimbursement and we have already seen cases where these delays have affected the patients themselves.
At the same time, if the doctor sees discounts on his reimbursements, wrongly but this is done, he tries to increase his income by proceeding with actions that may be unnecessary. As a result, the volume of operations of doctors in his specialty increases and thus affects the unit price on the basis of which the compensations are calculated. This is where the distortion is created since doctors are now trying to contain their income by offering more services and we are trapped in a situation that leads nowhere."
A similar distortion is found in the case of hospitals. When there is a risk of discounts, either discharges are given before their time, or unnecessary actions are taken in order to withhold the compensations. We are not arguing that there should be no limits, what we are saying is that it is time to see how the existing limits affect the practical implementation of the GHS."
"The role of OSAK in the board of directors of the HIO is enormous. Very often we express our strong disagreement or even protest when we find that the interests and rights of patients are affected, however you realize that things are never just special when we are talking about such a large and complex system."
What we gained from the GHS:
"In seven years of operation, the GHS has managed to offer universal access to health services to more than one million beneficiaries.
It has made a substantial contribution to the reduction of private health expenditure, almost completely reduced unmet needs and ensured free access to inpatient services.
In recent years, serious services have been included in the System, such as the administration of specialized medicines, the sending of patients abroad, while registers for chronic patients are gradually being created.
Our firm position remains to accelerate the inclusion of more treatments in the GHS lists, in order to reduce the need for nominal requests and the inconvenience of patients and doctors."
Bigger problems are found in basic pharmaceutical preparations: the OSAK Patient Rights Observatory often receives complaints about drug shortages, while the issue of increased contributions to specific drugs remains open."
As OSAK, "we have identified several problems and distortions, we are the first to shout and we will continue to shout and protest there and as we should until the necessary corrections are made. Our demand is that every patient receives what they need when they need it, without obstacles and complicated procedures."
