The Health Insurance Organisation is taking steps aiming to put the brakes on selective patient care in hospitals – private or state – that are General Health Scheme (Gesy) members.
A major result will be the end of the practice by hospitals of rejecting patient cases deemed unprofitable, Philenews reports.
The HIO has already begun recording data from the relevant software and – with the implementation of the new contracts – both the age of a patient and the complexity of their cases treated by hospitals will be the main factors behind reimbursements.
The recording of data for preparation purposes on the part of the HIO began last week and will be ongoing, and four basic relevant parameters will be taken into account for the level of compensation of hospitals.
The circular sent to all hospitals in the Gesy said that in continuation of the consultations carried out on the introduction of quality criteria in inpatient health care in order to improve the services provided, the Health Insurance Organisation informs providers that – since May 1 – the evaluation of the following data is taking place:
—Average age of patients
—Percentage of patients with more than five comorbidities
—Percentage of patients over 80 years old
—Percentage of pathological cases