It was June 1, 2019 when the General Health System came into force in Cyprus. After years of discussions and consultations on legislation and how the system works, it became a not-so-easy start. Both the beginning and the continuation of the implementation of the system did not go smoothly. This is not only the fault of the pandemic, but also of the well-known opponents of the system, who do not miss the opportunity to malign it or try to change it. One of the main problems faced by the Health Insurance Organization is the control of abuse and the services provided in general in order to ensure quality. It is one of the problems they know very well there in the OAU and in recent months they have started to take measures under the supervision of the government, specifically the Ministry of Health.
In the last six months alone, the competent bodies have climbed the hill of the Presidential Palace at least 4-5 times, with the President of the Republic, Nikos Anastasiadis, clearly stating that he will not become a patricide and that he will defend with his fingernails and teeth the “social conquest” the name GESS. Despite the assurances, the attitude of the government towards proposals that alter the philosophy of GESS, such as that of the president of EDEK Marinos Sizopoulos, causes concern. Especially now that some of the main problems of GESS are related to abuses. For the sake of truth, “P” collected some of the main problems of GESS and presents the solutions and measures that the OAY and the Ministry of Health take or intend to take.
Abuses
The biggest problem facing the GESS concerns abuses. The main argument of the opponents of the system is that the OAU is unable to control the transactions which it compensates. It is something that the OAY itself admits because of the large volume of claims that it is called to control and then to compensate the organization. Let us not forget that in the first year of operation of GESS more than 784 thousand medical operations were performed within the system, which means that almost all beneficiaries visited their personal doctor at least once. Par & # 8217; All this, in the last period of time, some measures have been taken, with some providers already seeing the exit door, while the goal of OAU is from June 1, 2022 to apply – finally – quality criteria in the compensation of personal doctors.
In relation to the health professionals who have just left the GESS, it is worth noting that only in the first quarter of 2022 a total of 10 doctors were expelled, while there are many providers whose behavior is being examined. Typical are the cases of the gynecologist from Limassol who stated and did other things to her 73-year-old patient, but also to the neurosurgeon from Nicosia, who gave injections to all the beneficiaries who visited him, which cost 7,500 euros each. Apart from GESS, there were also doctors who committed offenses which were not directly related to the benefits they offer within GESS. A typical example is the cardiologist from Larnaca who is accused of issuing fake vaccination certificates.
At the same time that the revelations of the Audit Office for doctors who work more hours than he has 24 hours, but also for those who are paid much more within the GESS, than before, alarmed the government, with the Ministry of Health putting pressure on OAY for more controls. In fact, the inability of the OAU to control the applications made for compensations, resulted on February 22, 2022, in one of the meetings at the Presidential Palace to decide, among other things, the purchase of the services of external auditors. On the same day, the date for imposing quality criteria on the salaries of personal doctors for adults and minors was locked.
Time for quality
Another measure that is expected to help in the better control of the services provided within GESS, is the introduction of quality criteria in the compensations of the doctors. As has been mentioned a few times in the past by representatives of OAY, despite the measures that have been taken, the large referral of beneficiaries continues, either to doctors or to laboratory tests. In the first year of implementation of GESS, 70% of the beneficiaries who visited their personal doctor were referred for examinations or to a specialist doctor. With this percentage gradually declining and falling below 50%, abuses are still being identified, which have to do with the behavior of both providers and beneficiaries.
After three years of implementation of the GESS, the OAY states that it is ready to introduce quality criteria in the compensations. However, a week before the date given by the organization, the talks with the pediatricians have not been completed yet. At the same time, it remains questionable whether the on-duty clinics will be able to operate from June 1, and especially how this will be done.
Despite the delays and problems they have at OAY, one thing is certain: Water has entered the ditch, and those in charge must ensure that it continues to flow. This is not possible when instead of discussing to find solutions to existing problems, they try to create new ones. The strange thing, of course, in this case, is that no matter what measures the OAY takes at regular intervals, the GESS continues to receive attacks. This is, after all, the finding made after the end of the discussion on prescribing outside GESS by the president of OAY Thomas Antoniou.
Within a year, GESS and the operations of OAY received at least four attacks. During the parliamentary elections, during the discussion of the state budget for 2022, after the report of the Audit Office, and now with the timid start & # 8211; cowards of the pre-election period. Studying the attacks received by the GESS, one can easily understand that in no case are they accidental, and that the OAY will not do well in the first election campaign for presidential elections, after the full implementation of the GESS.
