[PIO] 4 Years of GHS: Investing in strengthening and improving health services

The General Health System (GHS), as the biggest social reform since the establishment of the Republic of Cyprus, has completed 4 years of life, ensuring equal access to quality health services for all our citizens without exceptions, while creating the conditions for a strong, innovative and effective Health System, which is constantly evolving and improving.

Over the past years, the GHS has been confronted with distortions and problems, from which it has nevertheless managed to emerge unscathed and stronger. In its four years of life, the General Health System has succeeded in stabilizing, building a solid foundation and creating a strong and dynamic network of health services.

Building on the universal support of citizens, the General Health System in the past year has focused on strengthening, reinforcing and improving health services, always keeping people at the centre.

The General Health System in numbers

One of the greatest successes of the General Health System, from its first day of implementation, has been its universal support and massive acceptance by all citizens. For 4 years now, thousands of beneficiaries have been receiving quality health services on a daily basis, equally and without discrimination.

In the fourth year of operation of the GHS, there were 943,978 beneficiaries registered in a Personal Physician list[/B] who received, among others, the following services from the GHS:

1. 806,900 beneficiaries have visited their Personal Physicians
2. 692,500 beneficiaries have received medications
3. 611,200 beneficiaries have visited their Specialists
4. 502,300 beneficiaries have undergone laboratory tests
5. 299,900 beneficiaries have visited imaging centres
6. 286,500 beneficiaries have visited dentists

During the same period, 90,500 operations were performed. By way of illustration, some of the operations performed:

1. 16,000 General Surgery Operations
2. 13,300 Orthopaedic Operations
3. 10,500 Cataract Operations
4. 11,700 Gynaecological Operations
5. 8,200 Childbirth
6. 6,800 Otolaryngology Surgeries
7. 4,500 Urology Surgeries
8. 3,300 Neurosurgical Surgeries
9. 2,100 Ophthalmology Surgeries
10. 2,000 Palliative Care Cases
11. 970 Cardiothoracic Surgeries
12. 200 Percutaneous Aortic Valve Implantation Surgeries (TAVI) [*] 140 Robotics interventions

Enriching the services provided by the GIS

As a living System that is constantly evolving and improving, in its fourth year of operation, the Health Insurance Agency has succeeded in enriching and enhancing its services:

1. Introduction of institutional rehabilitation services
2. Inclusion in the Pharmaceutical Products List of eighty (80) or more innovative drugs
3. Implementation of Personal Physician Chaplaincy Services
4. Inclusion of robotic prostatectomy and other procedures
5. Adoption of protocols for screening for iron deficiency anemia,
6. Introduction of protocols for screening for iron deficiency anaemia, hip dysplasia and eye examination in children
7. Targeted physiotherapy services for neurological patients
8. Direct access to midwives
9. Establishment of clinical guidelines for preventive laboratory tests in asymptomatic adults
10. Incorporation of new medical devices and equipment to meet the needs of chronic patients

Improving and upgrading the way we operate

The Agency, as part of improving and upgrading the way we operate, included the introduction of important new features in the IT system, offering additional tools and capabilities to beneficiaries and providers. The IT System now includes information on visits to the PI, the possibility of notifying the beneficiary after a visit to the PI, information on open referrals, prescriptions and the Supplement amount, and information on pre-authorizations received for medical procedures, drugs, physiotherapy, etc.a.

In addition, the Agency adopted and implemented measures to improve the System, upgrade the quality of services and address abuses, with the aim of a more functional and efficient System. Specifically, the OAI proceeded to. [*]Qualitative evaluation of personal physicians' referrals to specialists. [*]Adoption of Clinical Referral Guidelines from personal physicians to specialists for 21 health conditions/diagnoses [*]Determination of indications for reimbursement for multiple medical procedures including fibromyomectomy, hysteroscopy, etc. [*]Evaluation of referrals for imaging tests. [*]Modification of the right to change personal physician every 12 months instead of every 6 months. [*]Strengthening the pre-authorisation framework for costly and frequent medical procedures and for consumables/medical equipment. [*]Develop a quality-based reimbursement model for primary and inpatient health care with the help of experts. [/LIST]

It should be noted that the actuarial study carried out by the ILO (International Labour Organisation) has shown that under current conditions the GHS is sustainable until 2030, with sufficient reserves.

The organisation has also prioritised other essential issues in order to create long-term safeguards and improve the quality of the services provided.

In this context, the Agency undertakes information campaigns to create a culture among beneficiaries for responsible use of the services of the GHS, as well as their rights and obligations in relation to the System.

In cooperation with the Cyprus Patients' Federation (OASAK), the OAS is developing the "Patient's Guide", a website focusing on the information of chronic patients. In the coming months the website will be completed and will be a useful "tool", which will inform the public and in particular chronic patients about all services and how to access the services of the GHS, and will serve as an information and guidance tool for GHS services.

In cooperation with the Pancyprian Medical Association (PIS), the Agency has initiated a collaboration with the NICE Institute of the United Kingdom regarding the adaptation and implementation of clinical guidelines and corresponding quality indicators. The Agency has already completed the consultation process for 46 guidelines, under which, in a first stage, it will proceed to the adoption of 5 guidelines in 2023.

At the same time, the possibility for beneficiaries to evaluate the inpatient health care services they receive within the System, through questionnaires sent to them electronically, has been launched.

Continuous monitoring of providers' compliance

One of the main objectives of the Agency is to conduct continuous audits for providers' compliance with the legal framework for the operation of the GHS, but especially to control and address abuse and fraud. In the fourth year of operation of the GHS, the results of the audits that the Agency has initiated since the first day of operation of the GHS have begun to become apparent.

As part of its audits, the Agency has:

1. Terminated 8 contracts of medical specialists, of which 6 have been reported to the police.
2. Terminated 3 contracts of other providers, of which 2 have been reported to the Police.
3. Terminated 15 laboratory contracts for not having a license in cooperation with the Laboratory Superintendent.
4. Proceeded with rejections of claims, following specific ex-officio audits amounting to EUR 9 million and has imposed administrative fines in 70 cases (amounting to EUR 200 thousand) and has imposed the penalty of recommendation in 60 cases.
5. Around 500 ex-officio investigations are in progress and are expected to be completed by the end of the year 2023.

Next steps

The General Health System is an important asset for all citizens, which we must continuously improve and enrich in order to remain strong and efficient. The Health Insurance Agency is planning a series of actions and plans for the coming period to ensure the quality and shield the financial sustainability of the System. Some of the next steps include. [*]Expansion of services for home care by nurses for people undergoing dialysis or peritoneal dialysis. [*]Strengthen first aid services with the inclusion within 2023 of two private first aid centres in Nicosia and Limassol and start negotiations for new first aid centres in other cities. [*]Inclusion of services by podiatrists. [/LIST]

Further Quality Improvement

1. Specialised training programmes to personal physicians.
2. Purchase of special software for analysis of inpatient cases.
3. Adoption of 2nd opinion for selected surgeries.
4. Implementation of a system to encourage cervical cancer screening.
5. Implementation of direct access to chronic patients such as people with thalassaemia and cancer patients to specialist doctors/centres.
6. Implementation of quality criteria for reimbursement of inpatient services.
7. Completion of the evaluation of innovative therapies and adoption of new treatment protocols
8. Implementation of clinical decision support software for radiology referral based on European Society of Radiology guidelines
9. Evaluation for integration of new technologies that will improve the treatment of various diseases and quality of life.

In addition, having the issue of dealing with abuses as a priority, we continue to implement the roadmap to deal with them more effectively, such as collaboration with foreign experts, implementation of advanced data analysis and artificial intelligence systems, adoption of more complex rules and restrictions in the IT system, etc.

At the same time, because informing beneficiaries and cultivating the right culture towards the System is of primary importance, we are planning larger-scale information campaigns, both for beneficiaries and providers, on the better use of GIS services.

Maintaining unchanged its human-centred character, the General Health System of Cyprus has for four years been serving its citizens uninterruptedly, reaffirming the values of social solidarity, justice and equity on which it is based.

In this important journey, it has all of you as companions and stakeholders for its responsible use. Equally important is the great contribution of all the human resources working in all sectors of the medical and paramedical sector in our country, giving real value to all this effort.

The highest priority of the Health Insurance Organisation is to keep the GHS strong, enhancing its financial sustainability and offering lifelong equitable and seamless access to quality health care services for all.

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