Prioritising patients could cut waiting times says minister

People seeking appointments at medical specialists may soon be split into categories according to how urgent their needs are to help fight waiting times, Health Minister Popi Kanari said on Tuesday.

She said solutions are being hammered out to address the problem, among them the introduction of a system to categorise appointments by urgency and dismantle a “patient culture” of pressuring personal doctors for referrals.

The proposed prioritisation for appointment times by urgency would see three levels, Kanari said, with cases classed as “extremely urgent” to be seen within 24-hours, “urgent” to be seen within 1-2 days, and “follow-up/routine” to be seen within a week.

Personal doctors would decide the degree of urgency, while specialists will be asked to set aside 2-3 slots weekly for cases which may come their way, in the “extremely urgent” category, the minister explained.

“Of course, the health insurance association (HIO) will need to monitor the implementation of this system to prevent any misuse,” Kanari said, such as providers marking too many cases as top priority.

The anticipated upgrade to a digital appointments system will also help curb misuse, the minister added.

Speaking to state broadcaster CyBC, the minister said additional solutions are needed beyond the obvious one of extending outpatient clinic working hours – a move which came after a meeting on Monday attended by all social stakeholders, including the state health services organisation (Okypy), the HIO, and the medical and patients’ associations.

Kanari said extended outpatient clinics’ working hours will mainly impact the most sought-after appointments in Gesy hospitals, for specialties such as cardiology, nephrology, and endocrinology.

The earliest appointment for an endocrinologist is currently February 24, the minister said, adding that there were enough specialists employed within the system.

Okypy spokesman Charalambos Charilaou took issue with the fact that public specialist providers had been accused of “being 30 per cent of the total but seeing 11 per cent of cases.”

Charilaou took pains to explain that the 11 per cent touted was actually higher, as it did not take into account a large number of non-Gesy beneficiaries who must also be seen by these providers.

Additionally, he argued these specialists make up about 20 per cent of the available providers, totaling fewer than 650 since those working at A&E clinics, and not in outpatient services, ought to be counted out.

Charilaou also noted that the appointments’ system for specialists in public clinics was being upgraded to offer possibility for patients to choose their doctor based on his or her bio, and select an appointment time which an operator would confirm by phone within 48 hours.

Moreover, the operating hours for phone appointment centre staff are also to be extended to improve the speed with which appointments can be booked.

He maintained that most public specialist doctors do have availability, within about a week, and not months as has been claimed.

Among other suggestions, personal doctors had proposed cutting out the need for a specialist to order lab tests deemed routine, and being given greater rein to write prescriptions for certain conditions.

Addressing findings that patients tend to pressure doctors for unnecessary specialist appointments, sometimes seeing two specialist providers – even on the same day – for separate opinions, Kanari said “this is something that happens only in Cyprus.”

An information campaign by the health ministry and Okypy to change the patient culture of over-reliance on specialists, is to be launched at the end of October the minister said.

The campaign will seek to encourage patients to at least wait for results from a first opinion before seeking out a second one and will also aim for beneficiaries to understand that even when paying out of pocket for a second opinion, the slot they take up could be better used for a more urgent case.

Some estimates suggest that up to 50 per cent of current referrals are redundant.

“Of course in cases where a second opinion is justified patients should have access to this,” the minister conceded.

Other possibilities floated for tackling the issue are charging more for a second referral and reducing the number of permitted referrals per year, currently at 12 visits, in certain cases.

Kanari was optimistic that starting this month, upgrades to A&E departments would be noticeable to the public in terms of seeing greater efficiency.