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Next A. Tsinontidis: Three years of GESS- The reform that changed our lives HOME • INSIDER • BRAND VOICE • A. Tsinontidis: Three years of GESS- The reform that changed the …
Interview with the General Director of the Health Insurance Organization, Athos Tsinontidis The Cypriot citizen can now with dignity ensure equal, fair and unhindered access to quality health services
“Through the GESS, the Cypriot citizen can now with dignity ensure equal, fair and unhindered access to quality health services”, says the general director of the Health Insurance Organization, Athos Tsinontidis, making an assessment of the three years of implementation of the General System.
Three years after the implementation of the GESS do you consider that the system has escaped the great dangers? Is its viability guaranteed?
The General Health System has withstood the most difficult conditions, such as the pandemic and the financial crisis it brought, so we can safely say that it has escaped any dangers, including its viability. At the same time, in these very difficult conditions, GESS managed to ensure the access of the beneficiaries to health care services and at the same time to contribute substantially to the management of the pandemic. & nbsp; I note that 2021 closed without a substantial deficit and the 2022 budget stipulates that the expected costs will be covered by the expected revenues, while the surplus created by the Organization will help maintain the viability of the System if necessary. p> What is your assessment for the three years of GESS?
The large number of beneficiaries who receive daily health services & nbsp; are the strongest proof that the GESS was embraced by the citizens and the society. Indicatively, the GESS has registered all & nbsp; Cypriot and foreign citizens who have their permanent residence in Cyprus, which exceeds 915 thousand. Beneficiaries receive health services throughout the day, with the result that the Agency receives more than one million claims per month. & nbsp; Therefore, we could only be happy with the report of the three years and this gives us the strength to continue with the same zeal so that the GESS we met improved, facing all the challenges.
The above is confirmed by the survey conducted on behalf of OAY, which shows that & nbsp; 82% of beneficiaries consider the quality of health services provided as very satisfactory and 80% believe that GESS has greatly improved their quality of life. . In addition, the satisfaction of the citizens with the services provided by GESS was confirmed by the independent research of the Association of Survey Surveys, which ranks GESS first among the institutions of the Republic.
What has the Cypriot gained? citizen from the implementation of GESS?
With GESS we managed to unify the Health Sector utilizing almost all human resources and infrastructure in health. In this way we gave the opportunity to the citizens both to choose a provider and a complete package of services. Through GESS, the Cypriot citizen can now with dignity ensure equal, fair and unhindered access to quality health services.
The Health System of Cyprus, as it has been shaped, offers a complete package of health services which includes health care services by Personal and Specialist Doctors, in-hospital health care, laboratory tests, pharmaceuticals, medical devices and health items which are included in the relevant catalogs. GESS, health care by nurses and midwives, health care by clinical dietitians, clinical psychologists, speech therapists, occupational therapists and physiotherapists, preventive dental health care, palliative health care, medical rehabilitation in care cases and care transfer
In addition, with the implementation of GESS has & nbsp; organized primary health care, through the institution of the Personal Physician, the benefits of which have only just begun to appear. An integrated computer system has also been introduced which gives each health care provider a complete and complete picture, at any time he needs it, of his patient's state of health. In this way the provider has the ability to monitor and manage more effectively the development of the patient's health. & Nbsp; At the same time, the beneficiary himself has gained full and detailed access to his medical history as well as information about all the services he receives such as medical reports, laboratory tests, medicines, etc.
What are the biggest issues (π .x. abuses) that need to be addressed to improve GESS and how this will be done?
One of the biggest issues facing the Agency is that of abuse and overuse by both beneficiaries and providers. Something expected due to the lack of culture of citizens and providers in relation to a Health System. Although this behavior does not pose a risk to the viability of the GESS, as long as the GSS's budget is global and the costs cannot exceed its budgeted expenditures, it nevertheless poses a problem for the access of those patients who are in urgent need of health services. p>
The cultivation of culture and the proper education of the citizens in relation to their rights but also the obligations and responsibilities towards GESS is very important for the confrontation of the problem. Therefore, the Agency is planning a major information and education campaign that will start this year and will continue in 2023. Of course, both providers and organized patients must be involved in this.
At the same time, the Organization takes measures at the level of Personal Doctors, where it has proceeded to the quality evaluation of the referrals they issue to both specialist doctors and for laboratory and imaging examinations. At the same time, from June 1, 2022, quality indicators are introduced in relation to the behavior of PIs in the system and the referrals they issue. This enhances the better implementation of primary care, the reduction of the pressure that the PIs receive from the patients and the better navigation of the patients in the system. We also enforce restrictions, guidelines and protocols for the submission and approval of claims by service providers, the administration of medicines and the performance of in-hospital procedures.
Regarding Specialist Physicians, we have extended the implementation of separate budgets by specialty, modifications to the remuneration method to discourage the provocative [SC1] & nbsp; demand as well as the extension of quality controls to referrals to radiodiagnostic centers. At the same time, we have intensified the controls in collaboration with external consultants, as well as the Scientific Societies and the Pancyprian Medical Association (PIS). We take measures to strengthen the control mechanism as effectively as possible.
Through the process of sample checks but also through complaints from patients, the Organization identifies cases which it investigates in its entirety. To date, the Agency has investigated dozens of cases of doctors, pharmacists and other providers and has proceeded to suspend and terminate contracts with more than 10 providers, impose administrative fines in more than 45 cases and reject claims whose value exceeds 3 & nbsp; million euros. Finally, it is important to mention that on April 8 we signed a Memorandum of Cooperation with the University of Cyprus where in collaboration with the Institute of Clinical Excellence of the United Kingdom (NICE) and the Pancyprian Medical Association (PIS) we will proceed with the adaptation and & nbsp; Adoption of clinical guidelines.
What are the next steps and objectives of the Organization?
The needs of the beneficiary and its quality service are at the heart of the operation of GESS. & nbsp; OAY has made it a priority to tackle abuse, integrate additional innovative medicines and treatments into the GESS and improve quality by adapting and adopting international guidelines.
To be able to meet needs of patients GESS must be open to improvements and the purpose of the OAY is to intervene effectively both to correct any problems that arise and to further upgrade the services provided.
Without a doubt, the people not only embraced GESS, but also benefited from it. & Nbsp; But we must always keep in mind that as we embraced it, we must preserve it. We should use health services responsibly when and if we need them, always with the guidance of health professionals. Developing a culture, both for patients and providers, is a major challenge for the Organization. I believe that it is imperative for each of us to develop that culture, which will allow us to always behave in the light of medical need. The Organization will continue to work diligently and dedicatedly in order to support and improve the GESS and address the challenges in order to continue to meet the needs of the Cypriot citizen.
CONTACT DETAILS
Health Insurance Organization (OAY)
Klimentos 17-19, 1061 Nicosia
PO Box 26765, 1641 Nicosia
Tel .: +357 22557200
Fax: +357 22875021
El. Mail: [email protected]
www.gesy.org.cy
GESS Service Center:
Tel .: 17000 (free call)
Email: [email protected]
