The Health Insurance Organization is running to stop the abuses in the General Health System, since the increasing trend that was observed in September in the use of GESS services and continued until the first two weeks of October, was still recorded in the software until yesterday. The analysis of the data, moreover, helped the ODA to determine its priorities and the restrictions that should be included in the system in the next few days have already been decided.
Specifically, following the instructions of the system's health professionals, "cutters" will be introduced in the software to first limit the uncontrolled referral of patients to laboratory tests (by October 15, 820.449 orders for laboratory tests had been registered with the number of beneficiaries. to be 737.000). Subsequently and after the analysis of the data of the system software, it was decided and the process of application of restrictions has been promoted in other medical procedures, for which the software of GESS has given indications for excessive use with the problem concerning, at the moment, mainly the specialties of cardiology, gynecology, orthopedics, ophthalmology and gastroenterology.
The process, as stated in "F" by the senior official of the Health Insurance Organization, Konstantinos Panagidis, "will be continuous and where abuses or unjustified use of GESS services are observed, always in cooperation with our professionals, the necessary restrictions will be set ». These restrictions, he explained, "will work for the benefit of health professionals themselves" since, among other things, abuses affect the amount of their compensation, in some cases.
"Indication guides"
Based on the data provided to OAU by the analysis of the data recorded in the software during the month of September, from the previous days the process of application of restrictions concerning the way of "ordering" laboratory examinations from the various medical specialties began.
"This means that not all medical specialties will be able to refer patients for all categories of laboratory tests", said Mr. Panagidis and explained that "for example, some endocrinological examinations, with the restrictions that have started to be set, ophthalmologist to refer a beneficiary of GESS uncontrollably ". In addition, "indication guides" are prepared and integrated into the software, that is, the doctor will have at his disposal guidelines in the form of questions and answers about when a patient is referred to specific laboratory tests.
In practice, this means that "the doctor will know under what conditions he will be able to refer his patient for specialized tests or even for other diagnostic tests. That is, for each of these examinations, it will be determined which other examinations or medical operations must have preceded and what indications these previous examinations must have given us ".
These "indication guides" will be, as Mr. Panagidis argued, "a kind of defense and safety for doctors, who, as they themselves tell us from their experience so far in the GESS, often receive pressure from them. patients and can not easily impose their scientific opinion. "By applying these conditions, doctors will feel safer to do as they see fit."
Source: philenews