The YESY has completed three years, two of which coincided with the health crisis. When this great effort was launched, more than a few people had doubts. And several predicted its collapse. How does the Agency assess these first three years?
Let's start with the basics. We have provided health insurance for the entire population, which is particularly important considering that before the YESY, most people were not insured and about 50% of health care costs were borne directly by the household. Primary care has also been significantly strengthened. Every citizen now has his or her own personal physician, an important element in the prevention, early diagnosis and better management of chronic diseases. In addition, citizens can easily access the pharmacies and laboratories in their neighbourhood, putting an end to the queues of the old system. All citizens now, regardless of their financial means, have equal access to the conservative majority of providers, given that more than 90% of doctors and other providers have joined the GHS. And that's not all. With GHS we have made a huge leap forward in terms of digitising the health sector, as all work within GHS is recorded through the single centralised GHS IT system and the patient's electronic health record is automatically updated. This is particularly important for setting the right strategies and decisions, conducting more effective audits, better performing the work of our providers, avoiding unnecessary tests and, of course, keeping beneficiaries much better informed. The operation of the IT system has ranked our country from a tail to a pioneer in the digitisation of the health sector and the operation of electronic health records.
There are, of course, other important side benefits. For example, for years it was felt that there was significant tax evasion in the health sector. Now the issue has to a very large extent been settled, which is very important both for the sense of justice of citizens and, of course, for the strengthening of public finances.
A summary of what I have just mentioned is the citizens' own opinion of the GHC as reflected last month by a market survey conducted by the Association of Research and Polls, which showed that of all institutions without exception, the GHC ranks first in terms of the degree of satisfaction and trust. I would also be remiss if I did not mention the recent Commission report showing that all important indicators in the health sector have improved since the implementation of the GHS. There is the issue of abuse, delays in serving beneficiaries in certain specialties. How do you rank the priorities?[/B]
It is true that there are major challenges that need to be addressed. We are working on them simultaneously. Each sector has its own specificities, sensitivities and needs. We have of course made it a priority to reduce abuses which will help the System in many ways. It will help to improve the quality of services, protect the GHS fund, help to cultivate culture and generally further enhance the confidence of citizens in the GHS.
At times, the finances of the GHS come and go in the news, some even doubt its viability. How are things?
Following the arrangement reached with the Ministries of Health and Finance regarding the cost of certain services currently provided by the Ministry of Health, we can safely report that the sustainability of the Fund is at a very good level. Based on our own projections, using of course the parameters of the Ministry of Finance in terms of the growth of the economy, it is demonstrated that the System is financially viable. Of course, you understand that the economy is affected by many exogenous factors, many of which cannot be accurately predicted, which in the future may also affect the contributions of the GFS, i.e. its revenues. However, even in such cases, we must monitor developments and intervene where and when necessary to protect the viability of the System. In any case, I consider it quite important that the System, despite predictions to the contrary, is financially viable at a time when the economy has had a difficult time, either because of the pandemic or now because of the war in Ukraine. But we remain vigilant as the sustainability of health systems in general is one of the biggest challenges, as the need for health services is constantly increasing but resources are permanently limited.
There are some open issues where developments are expected in the coming period, such as the issue of the remuneration of personal physicians. Where does this issue stand?
The way personal physicians are paid as of June 1 is being differentiated. Instead of their entire fee being based on the number of beneficiaries on each personal physician's list, it will now be 80% of the total fee and the remaining 20% will be given based on qualitative or other measurable data. That is, if previously a personal physician received €100 per year for each beneficiary on his list for the entire year, he will now receive an average of €80 and the remainder, an average of €20, will be based on indicators. That was the original design anyway, with the aim, among other things, of reducing the unnecessary issuing of referrals. However, I make it clear that the overall budget for GPs remains unchanged, which means that the variation in the way they are paid will not affect their average income. I have no doubt that this regulation, like the others we are implementing, will find its way through the process. We have a very good working relationship with our physicians. We will implement this new method and we will evaluate it accordingly and adjust it if necessary.
Another issue is the physicians who are outside the GIS and who provide hospital services within the system.
First of all, let us clarify that these physicians, who are only about thirty, do not provide hospital services within the system but only outside the system. That is, in no way do they charge the GHS fund. The Agency's view, which we put to all the agencies and of course the Ministry, was that the presence of these physicians in the integrated hospitals did not create a substantial problem. In fact, the Agency had also obtained a legal opinion on this matter from its legal adviser. However, following the positions of the Auditor General and the Commissioner of Supervision and subsequently the legal opinion from the Attorney General, we were asked by the Minister of Health that the Agency align itself with the Attorney General's recommendations. Thus, based on the general instructions of the Minister, the Agency prepared an amendment to the relevant Circular which stipulates that all new hospitals to be included in the GHS will operate exclusively within the GHS. Based on the relevant provision of the amended Circular, all physicians of the new hospital will participate in the GHS, while existing hospitals will be given until the end of the year to become exclusively GHS. The amendment has been sent to the Minister and once he confirms to us that it reflects the general instructions he has given verbally to the Agency, then it will be made public and sent to the nursing homes for appropriate action. We therefore believe that the matter has been initiated.
A parallel issue is the private hospitals that are contracted with the OAS but their first aid departments are outside the GHS.
With regard to Accident and Emergency Departments (AEDs), the Agency's position is that the integrated hospitals cannot operate some of their units outside the GHS. Therefore, they will be given the option to integrate their ICUs into the GHS. Otherwise they will have to close them. This was not done earlier as the Agency felt that this dilemma should not have been raised during the very sensitive period of the pandemic. At the same time, it was intervened by the fact that from 2 November 2021, the Minister of Health sent written instructions to the Agency not to contract with any new hospitals or PHCs until the issue of non-GSF doctors was clarified. Therefore, the option to join the TAPs of these hospitals could not be given anyway. Since, as I mentioned earlier, this issue has been initiated and only the Minister's response remains, I believe that very soon the Minister will lift the ban so that we can consult on the inclusion of these private ICUs in the GHS.
The GHS is a dynamic system, a reform without end. What other new services will enrich the menu of options for beneficiaries?
At this moment it is important that the system gains even more stability. The enrichment of the package can be achieved either by improving existing services or by including new services. We are working to significantly reduce unnecessary referrals in order to give better access to those who really need it. At the same time we are increasing the number of providers, which increases choice for citizens and causes a better spread of patients. We recognize that more effort is needed in some areas, especially such as palliative care, rehabilitation and TPAs. There are also specific requests for the inclusion of podiatrists, school counselors and additional dental services. Without being negative about the inclusion of new services, it is important to clarify that the current financial planning was done on the basis of the original planning in terms of the GHS service package, so you understand we will need to be very careful with any additional services given that in the current plans there is no question of increasing GHS contributions.
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