The GESS counts two years of life, which managed to survive despite the difficulties it was called to face. The general manager of the Health Insurance Organization, Athos Tsinontidis, spoke to “P” about the organization's next plans, the abuses, the quality of health and the culture that it is trying to create through GESS.
What do you consider to be the biggest success of GESS?
The social character of the reform is the biggest success in my opinion, because it completely changed the data of the health sector in Cyprus. Now, patients have access to almost all doctors in Cyprus, while through the system, they have access to medicines, clinical laboratories, in the private and public sector, and this was the goal of GESS and its success. In addition, providers are relieved of the stress of whether their patient will be able to pay for the treatment they need. With GESS, the number of professionals who provide free services to citizens has tripled.
If we asked you to describe in one word or one phrase the first two years of GESS life, what would it be and why?
The implementation of GESS was definitely a challenge. One phrase I could use now is “hard work”. These two years are flooded with a mixed sense of satisfaction, joy but also responsibility and many challenges to deal with either any problems that have arisen, or to plan the next steps and keep the train on track.
Was system abuse one of the challenges you were called upon to manage in order to put the “train on track”?
If we take the problem from the beginning, it concerns the development of culture in both patients and providers. They need to know what a health system and free medical care mean. This culture extends to use and abuse and this is done on both sides. On the one hand, patients should use the system where they need it, and on the other hand, providers should offer what the patient needs, nothing more, nothing less. I call this thing culture.
So do you think that the main reason behind the abuses is that there is no or did not exist before the creation of GESS, a culture of health?
I'm not talking about health culture but we certainly had a fragmented health system. There was the public sector that could not cope. In the public sector there is 1/3 of the human resources of health that exists in Cyprus, which before GESS had to serve 80% of the population. Definitely with such a big change you need a period of adjustment. For the first two years, it was expected that there would be abuse, due to the accumulated need of citizens who previously could not easily access health care services. However, there are some abuses that we as an organization aim to address.
Lately we have seen that OAY has started to expel providers or put them on suspension due to abuses. Is there a way to control the behavior of the beneficiaries?
The issue of beneficiary behavior is something we need to invest in. We all need to be educated about what our rights are and what our responsibilities are. In addition, we, the beneficiaries, need to start trusting both our personal doctor and the other providers we visit. The role of the personal physician is to have close contact with each beneficiary, the knowledge of his medical history and his proper guidance within the System, where and where needed, because our personal physician is the physician who will deal with the largest percentage of our medical needs. The personal physician is the first contact with the system, the first medical evaluation of the patient and where and where he needs to refer him below.
It sounds nice to say that the personal doctor is the basis of GESS and that through his good relationship with the beneficiary he can improve the quality of his health, but what about the doctors who have more than 2000 beneficiaries? How does the OAE ensure that patients receive the attention they need?
In principle, the patient has a choice. So, he can choose the personal doctor he thinks can best serve him. Certainly the staff doctors who have more than 2000 beneficiaries on their list are obliged to work much more than the rest. With the exception of the initial stages when no one knew what GESS was and how it would work, now the surgeries of the personal physicians who have a large number of beneficiaries, have been organized in such a way as to serve the patients.
When will quality criteria be included in the way doctors are evaluated?
We are currently in the process of working out how this can be done. This was the initial planning of the GESS after all, but in the context of the consultations before the start of the implementation of the system, it was considered that the environment would not be mature for such a thing to happen. We hope that within the next year its implementation will begin so that you can give a part of the compensation on the basis of quality criteria. These criteria are divided into two categories. One category is quality indicators, where the doctor manages to achieve some goals, such as controlling blood pressure, diabetes, etc. In addition, there are other goals, such as the need for doctors to encourage their patients to participate in prevention programs. , such as the breast cancer screening program. At the moment, in collaboration with the Ministry of Health, a colon cancer detection program is being launched, which will be implemented in collaboration with the personal doctors and the organization. All diagnoses are recorded in a single computer system and we can export data, both for the profile of the Cypriot patient, and for the quality criteria that we will enter. OAY has a wealth of data that we need to use in collaboration with other health authorities, such as the Ministry of Health and the medical community to identify various actions, whether we are talking about prevention programs or disease management programs. .
What are the next goals of GESS? What should we expect from the body in the coming months?
We now need to focus on improving quality. With the implementation of GESS there is more transparency in the provision of health care. There is a possibility when you apply a quality criterion to be applied universally. Now we have before us a single base and a complete system and now we have to work on improving the quality. It is not just a matter for the Agency, but also for the medical community and the Ministry of Health.
And the patients?
Yes definitely. The “patients” factor must be paramount and this must slowly begin to be part of the formulation of health policies. That is why for some years now there has been a representative of OSAK on the Board of Directors of the Organization. In general, however, there must be the participation of all competent and involved bodies in the issue of quality. The next issue concerns the treatment of abuses within the System and we must emphasize that it will be an ongoing struggle, an ongoing project. There are abuses in all health systems. because some can do defensive medicine because there is pressure from patients.
But what about access to more services eg TAEP of private hospitals, palliative care etc?
Of the entire GESS package, the only two issues that have not yet been implemented are palliative health care and rehabilitation services. We hope that by the end of the year this will be possible. We estimate that palliative care will be included in early autumn. We are dealing with a problem with rehabilitation services due to the fact that there is no necessary legislation to cover the centers that provide these services, and here an issue arises. Regarding the Accident and Emergency Departments (TAEP), at the moment the Organization provides these services through OKYPY and a private hospital in Limassol. OAY is making efforts with the aim of integrating a larger number of TAEP in the GESS in order to provide comprehensive health care from the hospitals contracted with the GESS.