The entity charged with running Gesy has announced major changes to the way in which the healthcare system will function, such as a time limit being imposed on how often patients can switch GP.

Wednesday’s announcement by the Health Insurance Organisation (HIO) comes in the wake of a rolling scandal of reported abuse and misuse which has led to criminal charges and doctors being fired from the system. The proposed changes place equal burden for the survival of Gesy on both its beneficiaries and providers.

As such, as the HIO announced an “action plan” to tackle these issues – with key changes such as changing the way GPs are renumerated for their services, efforts to reduce referrals to specialist doctors and tougher protocols for when claims are made by providers, along with the handing out of medicines and carrying out of operations.

In the first case, GPs will now have 30 per cent of their pay linked to the quality of their services – rather than simply seeing a patient or having one enrolled. It is not immediately clear how the assessment of their services will be graded.

It has previously been reported that there will be a series of quality indicators (to assess GPs), assigned by a company that will bid for a contract to evaluate them.

The overall aim is to lower further referrals elsewhere (burdening specialists and leading to long waiting times) and dealing with chronic illnesses at the first point of contact.

The HIO said, that on average, every 100 consultations with a GP lead to 40 referrals to specialists, a figure far higher than in other development healthcare systems.

As for specialist doctors, the HIO is reviewing the services on offer and will categorise them according to their value. Separate budgets will be set up according to a doctor’s specialisations.

The HIO said it will also deepen its cooperation with Britain’s National Institute for Health and Care Excellence (Nice), which works with the NHS to evaluate medicines and other health technologies. The aim is to provide evidence-based services in a cost-effective way.

The HIO also said it will beef up its checks on claims made and services provided to stamp out misuse and abuse, adding that to date dozens of doctors have been investigated.

It stated that it receives over a million claims a month, and has so far suspended four specialist doctors, a clinic, a pharmacy, a physician, a healthcare worker while it has also terminated the contracts of one specialist doctor, two GPs and two labs – with more investigations underway.

And while the focus in the media has been on some doctors riding the “gravy train” of Gesy – with one specialist doctor having made a whopping €870,000 during 2020, and a pair of gynaecologists having raked in €1.4m – the HIO also placed responsibility on Gesy beneficiaries.

It aims to improve the “culture” of beneficiaries, which as the HIO stated, often call up GPs and pressure them to issue referrals by phone – threatening to leave to another GP unless their demands are met.

As such, the HIO is set to impose a time limit as to how often a patient can switch GPs and will also be required to state a reason for leaving. It was not immediately clear what the time constraint will be.

The HIO announcement follows weeks of debates in parliament with the finance minister weighing in, the auditor general releasing a scathing report and the health minister seeking to mediate.