The performance index applied to personal doctors and concerns the number of referrals issued to specialist doctors has paid off, in terms of compliance, but, as evidenced by the official data of the Health Insurance Organization, visits to specialist doctors have not only not decreased, but have been steadily on the rise, from 2021 until the end of the first half of 2026.
At the same time, the number of long-term referrals issued following requests submitted by specialist doctors to personal doctors seems to be stabilizing, since in this case too, there seems to be compliance of doctors with a relevant index applied by the HIO, imposing, in fact, a penalty of 5% on the total earnings to doctors who exceed the set limits.
As far as the visits carried out with direct access are concerned, i.e. without the issuance of a referral and with the payment of the €25 provided for by law, the data, as they emerge from the GHS software, show that they constitute 3.4% to 3.7% of all visits to specialist doctors. Specifically, in 2024 their rate was at 3.72%, in 2025 at 3.66% and in 2026 until the end of July at 3.37%.
In real numbers, of course, this means that in 2024, 123,000 visits were made without a referral, in 2025, 129,900 visits were made without a referral and in 2026 until July 31, 74, 185 visits were made without a referral.
From 55% to 35%-37% in adults
During the early stages of the operation of the GHS, short-term referrals issued by adult personal doctors accounted for about 55% of visits. That is, half or more of the beneficiaries who turned to their personal doctor, secured a referral for a specialist doctor.
After the implementation of the performance index, which is also taken into account for the reimbursement of personal doctors, the percentage decreased and stabilized in recent years between 35% and 37%.
The indicator examines the relationship between the number of visits to a personal doctor and the short-term referrals issued to specialist doctors.
Greater reduction in paediatricians
The reduction in referrals issued to specialist doctors, as shown by the HIO data, is greater for paediatricians.
Specifically, in the early stages of the implementation of the GHS, the percentage of children referred to children's personal doctors, the corresponding percentage was about 28% at the start of the GHS. It then narrowed down to close to 22% and, after the implementation of the index, its broader course stabilized at around 13%. Data up to June 2026 show that the decrease is maintained, although the monthly rate may fluctuate.
The penalty to the specialist doctors
Of course, the fact that after the application of the specific performance index for personal doctors concerning short-term referrals, a large increase in requests for long-term referrals from specialist doctors was recorded should not be excluded from the equation. In fact, this increase, which, as the HIO found, reached 53.8%, led the Organization to implement a new index, this time for specialist doctors.
This indicator, following its pilot implementation in 2024, was fully implemented on April 1, 2025. Based on the announcement of the HIO at the time, the performance of specialist doctors is evaluated on a quarterly basis and 5% of the total remuneration of specialist doctors who exceed the reference point (which has been determined by specialty), for the specific quarter, is cut.
As we are informed, after the application of the performance index to specialist doctors, the number of long-term referrals stabilized without recording large changes per quarter.
Steady upward trend in visits to specialist doctors
Despite the decrease in short-term referrals issued by personal doctors, the total number of visits to specialist doctors is on the rise.
Specifically and according to the data of the HIO:
In 2021, 2,821,880 visits were made.
In 2022: 2,881,079 visits, an increase of 2.1%.
In 2023: 3,101,197 visits, an increase of 7.64%.
In 2024: 3,319,495 visits, an increase of 7.03%.
In 2025: 3,537,535 visits, an increase of 6.57%.
In the period January 1 – June 30, 2026: 1,864,106 visits.
The increase in visits to specialist doctors is also one of the arguments of the Health Insurance Organization against the complaints of doctors and organized patients who argue that the performance index for short-term referrals of personal doctors affects patients' access to the services they need.
This claim is based on the fact that personal doctors, fearing exceeding the limit set by the HIO, either avoid issuing a referral or postpone it to a later stage, which limits both professionals and patients.
According to the HIO, failure in the index is not activated when a personal doctor is slightly above the specified percentage, which is essentially the average of referrals issued, but a significant deviation is required to be recorded compared to the general behaviour of doctors.
For example, in June 2026, the adult personal doctor, with the lowest percentage among those doctors who failed, recorded 53%, compared to an average of 37%. The corresponding personal doctor of children recorded 36%, compared to an average of 18%.
At the same time, the HIO argues that this indicator is not applied with the aim of limiting doctors who, despite the limits set, retain the right to refer their patients when they deem it necessary.
In 2022: 2,881,079 visits, an increase of 2.1%.
In 2023: 3,101,197 visits, an increase of 7.64%.
In 2024: 3,319,495 visits, an increase of 7.03%.
In 2025: 3,537,535 visits, an increase of 6.57%.
In the period January 1 – June 30, 2026: 1,864,106 visits.
The increase in visits to specialist doctors is also one of the arguments of the Health Insurance Organization against the complaints of doctors and organized patients who argue that the performance index for short-term referrals of personal doctors affects patients' access to the services they need.
This claim is based on the fact that personal doctors, fearing exceeding the limit set by the HIO, either avoid issuing a referral or postpone it to a later stage, which limits both professionals and patients.
According to the HIO, failure in the index is not activated when a personal doctor is slightly above the specified percentage, which is essentially the average of referrals issued, but a significant deviation is required to be recorded compared to the general behaviour of doctors.
For example, in June 2026, the adult personal doctor, with the lowest percentage among those doctors who failed, recorded 53%, compared to an average of 37%. The corresponding personal doctor of children recorded 36%, compared to an average of 18%.
At the same time, the HIO argues that this indicator is not applied with the aim of limiting doctors who, despite the limits set, retain the right to refer their patients when they deem it necessary.
