It was about time the Health Insurance Organisation (HIO), which runs the national health scheme Gesy, tried to address the weaknesses of the scheme that incur higher costs and also cause very long waiting lists.
The HIO has finally decided that performance criteria should be introduced for personal doctors, who, for the first three years of the scheme’s operation, were paid in accordance with the number of patients registered. It did not matter how many of the registered patients were offered healthcare, the personal doctor would still receive €100 per patient each year. The patients’ limit was 2,000, which meant a personal doctor could be paid €200,000 per year to offer primary healthcare.
It is doubtful any other health system in the world rewards its GPs (the truth is that personal doctors do not even have GP training) so generously, regardless of performance. In fact, the agreement between the HIO and personal doctors is causing big delays in the system. Personal doctors, either because of indolence or lack of confidence in their diagnostic abilities, referred an unjustifiably high number of their registered patients to Gesy specialists for lab tests, x-rays and other diagnostic examinations. The result was that people who genuinely needed to be seen by a specialist or to have a diagnostic examination had to wait for months.
The HIO said it has drawn up an action plan to deal with this problem as well as with the pay of personal doctors, but it has yet to be finalised. There will now be performance criteria influencing their pay, which will be based on quality criteria and indicators such as home visits and call care. Pay will also be linked to the issue of referrals, said HIO, which would presumably reduce the pay of doctors who sign too many referrals.
As the formula has not yet been finalised it is entirely possible that the scheme will not work. The HIO should also take into account patients, many of whom demand to be referred to a specialist and put pressure on their personal doctor to do so. The abundance of easily-accessible so-called specialists in Cyprus, before Gesy, meant people were accustomed to being seen by a so-called specialist for many routines cases that could have been treated by a GP – but there were no GPs in the past. Now we have GPs, people are still demanding they are seen by an ear-nose-throat specialist if they have sore throat.
It will be very difficult to change this attitude of patients. Perhaps HIO, apart from training personal doctors on going easy on referrals, should also embark on an information campaign to educate patients, who cannot be allowed to decide if they need to see a specialist.