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GPs, paediatricians joining Gesy offered higher rates

The Health Insurance Organisation (HIO) announced on Friday a series of concessions regarding the fees of GPs and paediatricians who have expressed an interest in joining the national health scheme (Gesy).

Following extensive discussion with medical professionals, it said that the framework of participation for doctors in Gesy as issued on January 14 has been revised to offer higher pay.

Fees per patient will remain as decided until May 31, 2022, though the HIO noted that in the case of unallocated funds, fees may see an increase of up to 15 per cent.

As announced in January, paediatricians will earn a specific amount per head depending on the age of the child: for each patient up to three years old, paediatricians will earn €210; €155 for patients between the ages of four and seven; and €91 for patients between eight and 18.

Personal doctors for adults will earn €83 per patient between the ages of 16 and 50; €117 for patients between 51 and 70; and €145 for patients over 70.

Revising its previous condition that stated that a patient would be included in a doctor’s fees only after their first visit, the HIO said on Friday that the amount will instead be added to the doctor’s fees the moment the doctor accepts the patient in his list through the electronic system.

To tackle the potential issue of overvisitation, the HIO said that if a patient exceeds the allowed visitation limits, they will have to pay their doctor €15 per visit, though it noted that patients with chronic illnesses, low-income pensioners, beneficiaries of the guaranteed minimum income and their children, are exempt from this additional charge.

The maximum number of visits on an annual basis to paediatricians by patients aged 0-1 is ten. Eight visits are allowed for patients aged 1-3, seven visits for ages 3-5, four visits for ages 6-10, and three visits for children aged 11-18.

Patients between the ages of 16-18 are entitled to three visits to their GP, those in the 18-40 age group are entitled to four visits, those in the 41-50 age group are allowed six visits, those aged 51-65 are allowed eight visits, while patients over 65 are allowed ten visits on an annual basis.

The fee doctors will receive for each patient that is a beneficiary of a national health scheme of another European member state has been raised from €35 to €45.

Additionally, the HIO clarified that in cases that doctors prescribe vaccinations that are not included in the national vaccination scheme, the doctor can charge as he likes as is currently commonly practiced.

The HIO also said that each district will have one or two outpatient clinics that will be operational outside normal working hours, specifically on weekdays from 6pm until 11pm, and on weekends and public holidays from 9pm until 11pm.

Tenders will soon be announced for the outpatient clinics, in which private healthcare centres are also eligible to apply.

The first phase of the National Health Scheme (Gesy) will be launched with the introduction of outpatient care on June 1.

Inpatient care – phase two – is expected to roll out on June 1, 2020.

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