GeSY: Brake on abuse

b vc Radiodiagnostic examinations, GESY, Laboratory Tests, OAY, Restrictions, Medicines

The large volume of laboratory and other tests that the new health system is still recording is a matter of concern, with the Health Insurance Agency (OAS) focusing its efforts on implementing protocols and introducing restrictions so that the system is not abused. The… flea jump referral of beneficiaries to diagnostic centers or chemistry poses serious risks to the overall budget of the system, although to date the costs are within the forecasts of the actuarial study of Mercer & Co.

At the beginning of 2020, new rules are set, based on European and international guidelines for limiting radiological examinations, while restrictions on prescribing drugs and laboratory tests have already been implemented. One question that has been asked many times lately is how to control and monitor the system. Opponents of the GESS claim that there is no safe way to control medical procedures. Hence, as they claim, from the first months of the implementation of the system, the prescriptions of the medicines and the orders for laboratory and / or other examinations had turned red. The Health Insurance Agency and the Ministry of Health, however, respond to this question by listing specific measures that have started to be implemented or will be implemented in the near future. As mentioned in a note delivered by the Minister of Health Konstantinos Ioannou to the parliamentary Committee on Health, the supervision of the system is based on two pillars: The control of the software system during the practice of the medical procedure and the control of the requirements of the health providers. The note notes that the software system of GESS, by itself, is designed to set restrictions so that for a number of tests (eg MRI), drugs and laboratory tests to allow the issuance of a referral only by specific medical specialties. "Initially the process was more relaxed for the smooth introduction of the plan and for the convenience of the patients. "Gradually, however, more restrictions are applied, shielding the GESS", the note points out. With regard to restrictive measures, the following are mentioned:

- As of September 15, prescription restrictions were imposed for 218 pharmaceutical products, while from October, prescription protocols for 200 drugs were implemented.
- Restrictions for 630 laboratory tests were set in September and protocols for other tests are now being implemented
- There are 3.500 rules with various combinations that prevent the issuance of a referral for radiodiagnostics, restrictions per specialty are applied based on the practices of other countries, while at the beginning of 2020 the guidelines of the European Radiology Organization for all specialties are adopted.
- There are 4.000 rules that prevent the submission of a requirement by specialist doctors and 2.000 rules that prevent the requirement for a diagnosis based on gender and age.

Requirements check

In addition, according to what the Minister of Health states in his note, all claims are evaluated by the company that undertook the software of GESS, while a special team of OAU officers checks claims prone to abuse. Three-member committees have also been set up (with the participation of doctors and OSH) to examine differences in claims, while at regular intervals the system issues reports showing the unusual cases of activities that point to possible abuse. From the first months of implementation of the GESS, cases have already been recorded where part of the compensation was withheld until the completion of their investigation by the competent committees.

Gesy doctors
Quality also requires organization

The possible abuse of the new health system was one of the issues discussed during its first founding meeting, last Thursday, by the Association of Doctors of GESS. The doctors of GESS consider that this problem is largely due to the mentality of the people and a portion of health professionals, while during the meeting the need for the implementation of protocols and other restrictive measures was stressed. The assembly, as "P" is informed, was also concerned with the problem that arises in the registration of the association after an objection submitted by the Pancyprian Medical Association.

The association is proceeding normally with its priorities and at the same time it is "looking" for the issue of its registration as an association with the help of legal advisors. One of the priorities of the association, as expressed in the assembly, is the provision of quality services to patients.

The doctors of GESS have already created working groups which deal with individual issues related to the implementation of GESS and / or with the problems that arise, which are recorded and in cooperation with the Health Insurance Organization their solution is promoted.

Source: politis