The mechanisms for dealing with embezzlement and controlling procedures in the framework of the YESY, as well as planning for the promotion and completion of the necessary upgrading projects in Cyprus' public hospitals, were the focus of today's discussion of the budgets of the Health Insurance Organisation (OAI) and the State Health Services Organisation (SHSO), during the meeting of the Parliamentary Committee Finance Committee.
In addition to the budgets of the OAI and OCYPY, the Committee also examined the budgets of the Cyprus Addiction Treatment Authority and the Council for Medical Assisted Reproduction, in order for the texts of all four budgets to be put to a vote by the Plenary of the Parliament on 2 December, before the dissolution of the body in view of presidential elections.
Tripartite to tackle abuses at OAI and cuts from the Ministry of Finance
During the meeting, OAI President StavrosMichael presented the main pillars of the Agency's 2023 budget, which amounts to €1.5 billion. Answering questions from MPs, Michael stressed that the Agency's first concern is its sustainability and added that for this "we must not let the budget get out of hand". He noted that due to uncertainty about the Agency's finances, the Ministry of Finance has requested that some cuts be made from the budget, which, he assured, will not prevent the OAI from developing its programming. "In case the programming goes ahead, we will go back (to the Ministry of Finance) for an increased budget," he added.
Regarding the abuses identified in the operation of the GHC in previous years, Michael noted that they are not done by the majority, "but by a small minority of health care providers who exploit weaknesses in the system." The first check to identify them, he said, is done through the accounting system, adding that a system upgrade is also being done for analytics that will allow for the identification of abusers. The second type of audit has to do with on-site visits, and he said there should be an audit of medical acts. "Of course, it is difficult to find doctors in Cyprus who will leave medicine to start investigating their colleagues," Michael explained.
Regarding the status of personal doctors, the OAI president said that meetings will be held with their representatives in the coming days to discuss both their training and how the system is protected. In response to questions regarding the long waiting lists in certain specialties, he said that the Organization is focusing on this, stating that "if there are waiting lists in the GHS, we failed."
He reminded that the OAI is currently awaiting a court decision on the settlement of the cases of doctors who are not contracted with the GHS, but are based in hospitals that are contracted. He also said that the Agency is ready to apply quality criteria for the regulations of cooperation with hospitals. Referring to the effort to provide rehabilitation services by GESY, he said that at this stage there is no legislation covering this and that is why the OAI addressed the organisation to hospitals that already offer rehabilitation services to secure partnerships in Nicosia, Limassol, Larnaca and Paphos. Consultations are currently underway, he added, with the aim of integrating them into the YESY on 1/1/23.
He also referred to the need for an increased number of physiotherapy sessions for specific categories of patients and said that a patient registry is being set up for this purpose, following an evaluation by a committee. Similarly, he said that the committees preparing protocols for drugs have been instructed to intensify the procedures, so that innovative drugs can be included in the system.
Finally, in response to a question about OAI's attitude towards the possibility of hospitals being taken over by monopolistic groups from abroad, he said that the Agency expects assistance from the Competition Commission, as well as from Parliament on the issue.
Hospital upgrades a priority for the HHC
With upgrades to public hospitals a priority in the HHC budget, the Agency has submitted to the Health Committee in the form of an emergency bill to amend the law so that, not limited to the Executive Director, the responsibility for setting up committees to review contracts is not restricted to the Executive Director.
The Executive Director, Cyprus Stavridis, explained to the Commission that under the current law the Board can only delegate powers to the Executive Director of the OCYPY, which, he said, makes him a unilateral body with too many powers, which is not the best for transparency and good governance of the Agency. He said that for the text of the bill they have obtained the concurrence of the Legal Service as well as the Ministry of Health and they aspire for this to be voted on December 2.
In his statements after the meeting, the Chairman of the Board of Directors of the OCYPY, Marios Panagidis, said that the budget has been drawn up taking into account the actual data of the last two years of operation within the YESY, but also the Business Plan of the Agency, and through it the actions to be taken at all levels are defined, with the aim of improving its results and achieving the Agency's objectives.
He said that for 2023, a budget of €123.3 million has been calculated for equipment purchases and infrastructure upgrading and expansion development projects in public hospitals, while for the three-year period 2023-2025 the amount amounts to €311.2 million.
and added that most of the projects will be tendered in the first quarter of 2023.
He explained that the total revenue for 2023, excluding state sponsorship, is estimated at €612.4 million, compared to €501.7 million. in 2022, as revenue from the distribution of medicines in the pharmacies of the OCYPF, amounting to €126 million, is included.The expenses of the Agency, he said, amount to €610.9 million, compared to €505.5 million in 2022, due to expenses for the purchase of medicines, while a decrease has been calculated for operating expenses.
"Taking the above into account, for 2023 the Agency is expected to show an operating cash surplus of €10 million and after deducting depreciation, which is a cash outflow, the accounting operating surplus will amount to €1.7 million," he added. He added that the operating surpluses are expected to increase to €18.6 million in 2024 and to €33.6 million in 2025.
Statements by MPs
In his statements after the meeting, the Chairman of the Committee and DISY MP, Efthimios Diplaros, said that a positive sign was recorded in the fact that both organisations have development budgets. "There is a strategy and a plan both from OKYPY, to upgrade hospitals, and from OAI, to include innovative medicines," he said."
"We must all realise that public hospitals are now the backbone of the YESY," he added, stressing that Parliament's support for OKYPY is a given. "As DISY we support all four organisations, recognising that there are problems and distortions that need to be corrected," he said, noting his satisfaction with the fact that OAI and OKYPY recognise that improvements need to be made, firstly in abuses and process controls and secondly in upgrading the hospitals to make them competitive.
DISY MP, Savia Orphanidou, referred to the budget of the Medically Assisted Reproduction Council, welcoming the announcement by the Ministry of Health that the amendment bill on extracorporeal treatments will be submitted to Parliament immediately and will be debated next March.
AKEL MP Marina Nicolaou said the committee was pleased to hear the OAI say that by 2023 the work on protocols for innovative medicines will be completed, and that the integration of palliative health units and rehabilitation units is underway.
"We asked once again to provide the Commission with the operational plan of OCYP and stressed the need to upgrade public hospitals, as well as the reopening of the THEMEA facility, the only facility in Cyprus that deals with alcohol rehabilitation and has been out of operation recently," he concluded.
DIKO MP Chrysanthos Savvidis noted that with €1.5 billion, the OAI has one of the largest budgets, so the responsibilities of the Board are very large. He said that the problem of embezzlement was highlighted and a specific plan to deal with it was requested. He added that the problem of sending patients abroad was also highlighted, and regarding innovative medicines, he noted that the €40 million budget, but it was not clarified what percentage of medicines it covers.
Regarding the OCYP, he said that the organisation with €659 million, receives €27.8 million from the state, but has a deficit of €65 million, so the OCYP wants an extension of the state sponsorship beyond 2024, due to circumstances such as the pandemic. "As DIKO we have asked for a record of when the funding from the state can end," he said, as part of an effort to make the organisation self-sufficient. "We have also raised the issue of timelines for the development budget," he concluded, regarding the completion of projects."
DPA MP Michael Yacoumi, in statements after the meeting, noted that during the committee's discussion on the OY budget, particular attention was paid to the sustainability of the GHC, as well as to the abuses identified following requests. "We expect to implement the ways of dealing with the abuses, which the OAI referred to today and which mainly involve audits, including on-site audits, as well as conducting an audit of operations, which is expected to immediately eliminate the abuses," he noted.
He also referred to the budget of the Cyprus Dependency Treatment Authority, stating his party's support for the Authority's efforts. Similarly, he said that he also supports "all couples and all women undergoing IVF", asserting support for the budget of the Medically Assisted Reproduction Council. He concluded by saying that the DPA supports "unconditionally the budgets, so that we strengthen all efforts to modernize the system and enrich health services."
In his remarks, EPP MP Marinos Sizopoulos noted that the OAI budget estimated spending of €1.5 billion and explained that it implies a 60% increase compared to the study that was originally done on the provision of services by the OAI. "All this needs to be fully investigated in order to make a rational assessment of whether this expenditure corresponds to the quality of the services offered to citizens," he added.
He also referred to two issues that need attention. He pointed out that "it is not possible for private hospitals to continue to be within the GHS, while their TAPs are outside, and at the same time for the System to cover extra money for on-call clinics." On the other hand, he noted that so far there is no action to limit the waiting time of patients in specific specialties.
With regard to the SHI, he said that the public sector should be upgraded to make it competitive with the private sector, but concluded that it has also been confirmed with the pandemic that the public sector is the backbone and concluded that he submitted proposals, in the hope that they will be properly evaluated, towards achieving financial and administrative autonomy of the SHI.
Source: KYPE
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