By implementing a series of measures, The Health Insurance Agency (HIA) is proceeding with a series of measures to improve the functioning of the institution of the Personal Physician and the referral system.
In a statement today, the Agency said that with abuses being one of the major issues affecting the GHS, it posted a special Action Plan last March, seeking to effectively address abuses.
As one of the abuses observed in the system is the large number of unjustified referrals issued by PIs to other GHS providers, he says, noting that under the Action Plan, the OAI is proceeding with the implementation of a series of measures to improve the functioning of the PI institution and the referral system.
According to OAI, the measures include, inter alia, the implementation of performance indicators linked to the remuneration of PIs, which relate to the behaviour of PIs in relation to referrals issued to Specialists.
In addition, it also reviews referrals for laboratory tests and radiological diagnostic examinations.
At the same time, the OAI is intensifying the quality control of referrals issued by PIs, as well as the process of taking action against PIs who do not comply with the Agency's instructions.
In addition, other measures to improve the institution of PIs are being promoted, such as implementation of referral guidelines, training, age criteria for physicians' participation in the System, and so on.
The OAI notes that the proper functioning of the PI institution is particularly important, since its purpose is to provide effective primary health care, as well as guidance to beneficiaries in obtaining the services they need from the other providers of the GHS.
The proper functioning of the institution and the referral system leads to the discharge of Specialists from cases that do not require specialized treatment.
According to OAI, it also achieves a more efficient use of the System's resources, ensuring equitable access to health care services to beneficiaries in need.
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