The General Health System, seven years after its implementation (June 1, 2019), it is locked in horizontal restrictions and rules unrelated to its structure, philosophy and architecture.
They suffer patients, lead to waiting lists, unnecessary procedures and in some cases have created a vicious circle from which we “urgently need to get out”.
In simple words, GeSY “is trapped in regulations” and the WOWas the organized patients point out, has been trapped in slogans about “abuses” and distorted political positions for its viability.
GeSY, the secretary of the Cyprus Patient Associations Federation and representative of the patients on the Board of Directors of the Health Insurance Organization, Miltos Miltiados, emphasized to “F”, “is the greatest social achievement and is a blessing for all citizens. We say this and we repeat it again this year with the completion of 7 years since its implementation. Neither its architecture, nor its philosophy, nor its structure need change. On the contrary, if you change these, you will “take out the soul” of the System.
“If we have to say something about GeSY for this year’s anniversary, it’s that we have to release it,” he said and explained:
“We must free it from internal rules, restrictions and criteria, which we had applied during the first years in order to manage or suppress phenomena of abuse or incorrect use of the System by providers and beneficiaries who had entered a complex environment completely unknown to all of us. The control of the system and abuses must pass, in a structured and coordinated way, to the control of medical practice and results, and in this the National Center for Clinical Documentation and the Electronic Patient Record should play their role in this, as soon as possible.”
The OAU itself must be freed from the attitude it maintains in many cases, due to attacks and arbitrary calculations and suggestions, mainly from political and even 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 NHS has a very strong Fund which far exceeds the predicted safe limit for its sustainability 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. Miltiados, “while there is financial possibility, rules are applied, restrictions on visits by nurses to bedridden patients, physiotherapy sessions to patients who need much more than those offered, and so on.” There must always be limits, but it is more important that the NHS works for the benefit of the patient and not on the basis of “I need 5, I keep 9 aside so that no one tells me anything”.
“Let’s stop saying only slogans about abuses and about the sustainability of the NHS. If we want the System to improve, we must see the real problems through the eyes of the patients. The rest are political crowns and/or expediencies.”
“Controls to prevent or even prevent abuses are necessary. But on the other hand, the restrictions actually equate those who want to cheat the System, professionals and beneficiaries with those who really need the health services of the NHS and the professionals who respect and function properly within it”.
For example, “while there are no endocrinologists, thousands of chronic patients are directed, through rules and restrictions, to doctors of this specialty 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 point, “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 OAU implements the practice of units by specialty and hospital. When the doctor or hospital goes over the specified units, discounts begin to be applied to their reimbursement amount. This results in either patients’ visits being moved to a future time (waiting lists), or providers refiling 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 reductions in his compensations, even though it is wrong, he tries to increase his income by taking actions which may be unnecessary. This has the effect of increasing the volume of operations of the doctors of his specialty and thus affecting the unit price on the basis of which compensations are calculated. Somewhere here the distortion is created since doctors are now trying to keep their income by offering more services and we are locked in a situation that leads nowhere.”
A similar distortion is found in the case of hospitals. When there is a risk of discounts, either early discharges are given, or unnecessary actions are taken in order to withhold compensation. We are not advocating that there should be no limits, what we are saying is that it is time to see how the existing limits affect the practical application of the NHS”.
“The role of OSAK in the board of directors of OAU is huge. Very often we express our strong disagreement or even protest when we find that the interests and rights of patients are affected, but you realize that things are never simple especially when we are talking about such a large and complex system.
What we gained from GeSY:
“GeSY, within seven years of operation, managed to offer universal access to health services to more than one million beneficiaries.
It contributed substantially 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 added to 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 the acceleration of the inclusion of more treatments in the lists of the NHS, in order to reduce the need for nominal requests and the suffering of patients and doctors”.
Bigger problems are found in basic pharmaceutical preparations: the OSAK Patients’ 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 requirement is that each patient receives what he needs at the time he needs it, without obstacles and complicated procedures.”
