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Our View: HIO move on referrals will do little to solve the problem

Paymaster of Gesy the Health Insurance Organisation (HIO) has decided to tackle one of the many abuses of the system – the endemic referrals of patients to specialists by personal doctors – that is proving very costly. The surprise is that it has taken the HIO so long to deal with a weakness of the system that it has been complaining about for months.

Until July this year, 1.3 million referrals had been entered into the HIO data system. This meant that personal doctors were signing referrals for 70 per cent of their patients, a staggeringly high percentage considering that according to international specs the average is between 20 and 25 per cent. From now on, the HIO announced, a patient would only be able to visit a specialist twice with referral instead of three times which had been the case so far.

Does the HIO actually believe this would make a difference and save money? Logically, a referral should cover only one visit, even though the specialist could argue that a second visit would be needed to check if the patient was responding to treatment. Needless to say that the specialist, probably, also exploits the system by insisting a patient visits him/her the maximum permitted three times, even if there is no need, because this increases earnings.

Decreasing the referral visits is no solution but is intended to show the HIO is doing something, while it ignores the root cause of the problem which is of its own making – the role of the personal doctor. First, it has allowed anyone registered as a doctor to be a personal doctor and second, the reward system it has put in place offers zero incentive for a personal doctor to do any work.

Very few of the personal doctors are GPs, therefore they have little confidence in their ability to treat patients. To be on the safe side and avoid any responsibility they refer the patient to a specialist. This does not affect their earnings as they are paid €100 per patient registered with them, even if they never see them. They have no incentive to treat their patients – they will be paid regardless – so they refer them to specialists.

Based on the HIO’s stats, personal doctors treat only 30 per cent of the patients that visit them and could be paid as much as €250,000 a year for it. This is the root cause of the referrals’ abuse and it will continue to be an unnecessary drain on Gesy finances as long as the HIO refuses to deal with it. The reward system of personal doctors needs to be drastically changed for the abuses to stop and it would also help if some type of GP training became a requirement for anyone to work as a personal doctor.

 

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