The appointment with a specialist should take place no later than 10 days after issuing an “urgent” referral through the General Healthcare System (GHS), according to new procedures.
Additionally, the Health Insurance Organization (HIO) has expedited procedures for two more measures aimed at reducing patient waiting times to see a GHS doctor.
The new “categorized” referrals will be implemented starting tomorrow.
They will be issued by doctors (personal and specialists) to specialist GHS doctors, and their designation will be visible in the system software.
Specifically, from February 1st onwards, two categories of referrals will be available in GHS. “urgent” and “routine”.
Each doctor, depending on the characteristics, peculiarities, and health issue of their patient, will assign to the referral the designation they deem appropriate.
For referrals designated as “urgent,” priority will be given by specialist doctors who, according to the HIO’s plan, must arrange appointments with the specific patient within a period of up to ten days.
Initially, the HIO, in consultation with GHS doctors, has prepared general guidelines that must be followed in designating referrals as “urgent” or “routine”.
The urgency of a case will be determined by the doctor, who will take into account specific criteria.
At the moment, the Health Insurance Organization is in contact with the Federation of Cyprus Patient Associations to ensure that citizens are properly informed and follow their doctors’ recommendations without pressure to obtain an urgent referral.
In a subsequent stage, the HIO, in collaboration with scientific societies of various medical specialties, will proceed with the development of more specialized guidelines for different diseases and patient categories, so that the designation of referrals as “urgent” or “routine” is made in an even more evidence-based manner.
The implementation of referrals in two categories was decided last autumn during meetings held at the Ministry of Health, which focused on the long waiting time required for appointments with GHS specialist doctors.
In addition to referrals, the HIO will attempt to reduce patient waiting times by implementing two more measures.
As we are informed, GHS doctors have already been asked to document cases where visits to specialist doctors could be avoided, as the patient can safely be served by their personal doctor.
For example, some groups of chronic patients, whose condition is irreversible or variable, are currently required to visit specialist doctors for prescription renewals or referrals for specific laboratory tests that constitute a “routine” for them.
With the new procedure that the HIO is attempting to promote, these patients will be able to be served by their personal doctors without burdening the schedules of specialist doctors, if there are no other medical reasons.
According to information, several doctors have submitted their recommendations to the HIO, and the organization is currently in the process of processing all the data.
This process will be time-consuming, as on the one hand, the HIO must study one by one the limitations currently applied in GHS, and on the other hand, it must engage in consultation with the scientific societies of doctors to make the right decisions.
Finally, the Health Insurance Organization continues the process of compiling patient registries with the aim of providing facilities to chronic patients who require frequent visits to specialist doctors.
Already, within the framework of patient registries, the issuance of referrals to oncologists for cancer patients who are undergoing treatment and to thalassemia specialists who frequently need monitoring has been abolished.
According to our information, the next stage is the completion of patient registries for those undergoing hemodialysis and peritoneal dialysis, who will be granted direct access to nephrologists as well as to daily hospitalization for hemodialysis.
The introduction of quality criteria and performance indicators into the reimbursement system for GHS personal physicians seems to have been successful, as stated by Maria Avramidou, Vice President of the scientific society of personal and family physicians, to Phileleftheros .
She mentioned, “From this entire effort, both we as physicians and GHS emerge as winners.”
Explaining that personal physicians under GHS now do not receive 100% of their compensation as per capita income, meaning depending on the number of beneficiaries registered with them, but “only 80% per capita and the remaining 20% based on quality criteria and performance indicators,” Ms. Avramidou explained that “two of the criteria applied concern physician education and physician collaboration for scientific analysis of specific cases. As we see, our physicians have responded. The halls of educational scientific conferences are now filling up, and this can only benefit us physicians and certainly the General Healthcare System. At the same time, we see that physicians have formed groups among themselves and apply the quality criterion of presenting and discussing cases.”
The response of personal physicians to the implementation of quality criteria is also reflected in the requests they have submitted to GHS for compensation.
As stated to Phileleftheros by the director of the organization, Efi Kamitsi, “We see that our physicians have submitted their requests claiming the amounts they are entitled to for the implementation of the quality criteria we have included in their reimbursement method, and this is very positive.”
Beyond the two criteria concerning education, a criterion regarding the recording of equipment in physicians’ offices, the recording of medications available in their offices, and others are applied.
According to Ms. Kamitsi, for some of the criteria, it has been decided that “the reimbursement to physicians will be made upon the completion of 2023, while for some others, the evaluation period is 12 months. When the submission process currently concerns the criteria for which the time has elapsed.”
Some of the criteria for which physicians will be reimbursed after 12 months include, among others, flu vaccination of beneficiaries, blood pressure measurement for adults, or Body Mass Index measurement for children.
GHS and personal physicians are expected to engage in dialogue again in the near future to agree on additional quality criteria to be included in the reimbursement method. It is reminded that the goal is for the compensation of personal physicians to be paid 70% per capita and 30% based on quality criteria and performance indicators over time.
