Referrals to the General Health System seem to be evolving into a constant occasion for a quarrel between personal doctors and patients, with doctors no longer succumbing so easily to the pressures of their beneficiaries and some have begun to proceed with deletions from their lists in order to save themselves from the constant murmuring.
At the same time, of course, this act of theirs causes problems for patients, who in some cases are not even informed about their deletion, as a result of which they suddenly find that not only do they not have the referral to a specialist doctor they requested, but they do not even have a personal doctor in the GHS.
Added to all this is the quality criterion applied by the Health Insurance Organization, including for the purposes of reimbursement of personal doctors, according to which personal doctors must not exceed a set number of referrals to specialist doctors each month.
This restriction makes doctors still cautious, with the result that some of them, when they reach or are very close to the limit set by the HIO, postpone the referral of their patients to the specialist doctors they need.
Indicative is the case of a patient who contacted the Patient Rights Observatory of the Cyprus Federation of Patients' Associations.
The patient, after visiting a specialist doctor, felt the need to get a second opinion. Therefore, he turned to his personal doctor to issue him a referral again.
"During their communication with the personal doctor for the issuance of the referral, they were informed that it is not possible to issue it immediately, as the allowed number of referrals (of the personal doctor) has been completed and they should expect the issuance of a new referral at a later time."
He deleted both the referral and the beneficiary
Regarding the deletion of beneficiaries by personal doctors, the Patient Observatory also received relevant complaints:
· "A patient with chronic lung disease and a history of breast cancer asked her personal doctor to issue a referral for examination regarding her history. However, when she contacted to arrange an appointment, she found that a referral to a general surgeon had been issued instead of a plastic surgeon. During her communication with the personal doctor on this issue, as she claimed, she received aggressive behaviour and was suggested by him to change her doctor if she was not satisfied. Two days later, during her visit to a specialist doctor, she was informed that the relevant referral, as well as the referral to the general surgeon, had been cancelled. He then found that the personal doctor had also deleted her from his list, listing "inappropriate behaviour" as a reason.
· In the second case, a citizen reported that he requested a referral for a scheduled evaluation at an oncology center, where he is monitored every six months. The personal doctor refused to issue this referral and informed him that both he and his wife would have to register with another personal doctor and that he intended to remove them from his list within a week. The patient stated that he asked to visit the personal doctor's office in order to discuss the issue and resolve the dispute, but the doctor refused."
The complaints that reach OSAK, the president of the federation, Miltos Miltiadous, told "F", "are indicative of a situation that unfortunately has been observed since the very first days of the implementation of the GHS. Of course, the majority of personal doctors and beneficiaries, on the basis of studies, have found the balance between them, but we observe that some phenomena still exist and we consider it appropriate to point them out."
The institution of the personal doctor "is one of the main features of the GHS. We all say that we need to strengthen it. In order to be able to really strengthen it, we need to analyze the problems that seem to exist one by one. On the one hand, beneficiaries cannot decide on their own that they need a referral, on the other hand, the doctor cannot delete them or threaten them with expulsion. Also, the doctor cannot say that the patient needs a referral but this will be done at a later stage because he has reached the number set by the HIO as the upper limit. This also makes it difficult for the doctor and certainly has an impact on the timely service of patients, so for this issue we may have to turn to the HIO."
In any case, "the relationship between the personal doctor and the beneficiary is perhaps the key to the smooth and proper operation of the entire GHS. The phenomena that are still being recorded must be viewed with special attention. Possibly a way for continuous evaluation of each doctor is for the beneficiaries to fill in a questionnaire at regular intervals, according to the standards of the declaration of satisfaction applied to hospitals."
A total of 44 complaints were registered in June.
Last month, the Patient Observatory received a total of 44 complaints from patients or relatives of patients or health professionals.
As OSAK points out, "most of the incidents concerned issues of patient access to health services, such as difficulty scheduling appointments, delays in the provision of services and obstacles to timely patient service".
At the same time, "a significant number of complaints were related to the quality of health services, the behaviour and service of medical and nursing staff, as well as issues related to benefits and social benefits, financial burdens, medicines and, to a limited extent, incidents of possible medical negligence.
The complaints mainly concerned hospitals, doctors and the Health Insurance Organization (HIO). In addition, complaints were submitted concerning the Department of Social Inclusion of Persons with Disabilities (TKEAA), the Ministry of Health, the Ministry of Labour and Social Insurance, as well as individual cases concerning radiology centers and other institutions.
"The overall picture of June complaints shows that citizens continue to face challenges in both access and provision of health services, while the need for better information on rights, social benefits and available procedures remains strong."
