At the heart of the Health System
Present from the first day of implementation of the General Health System, cardiologists have been committed to providing important health care services to all beneficiaries, without exceptions, reinforcing the philosophy of the General Health System.
A particularly important specialty, which is covered by one of the largest numbers of contracted specialists within the GHC-they number 197-they are able to perform all medically necessary procedures that fall under the list of activities. This list specifies the services available under the GHS and has been drawn up by the Health Insurance Agency (HIA) in collaboration with the scientific society.
Importantly, the list of activities is reassessed at regular intervals, with the participation of the scientific society, so that it includes all medical procedures that can be performed by cardiologists
THE GENERAL FRAMEWORK
As is the case for all specialties, with the exception of Obstetrician-Gynaecologists, access to cardiology services can be obtained by beneficiaries following a referral from a staff or specialist doctor of another specialty. Alternatively, beneficiaries can have direct access to cardiology services (without the use of a referral) by paying a fee of €25 to the doctor they visit. In this context, the General Health System reimburses all medically necessary procedures, while procedures related to prevention (for example in the absence of disease, clinical symptoms or personal/family history) or arising at the patient's request without documented medical necessity are not reimbursed by the General Health System. However, in cases where there is a medical indication, any medical procedures performed are considered medically necessary.
In order to ensure the quality of the services provided and to avoid exploitation, the Agency, after consultation with the scientific society, has introduced restrictions on certain medical procedures. Those restrictions are in no way intended to prevent access to those services by beneficiaries of the General Health Service, but are intended to optimise the provision of health care services by doctors of the specialty.
The Agency proceeded with those restrictions pending the implementation of the guidelines for the management of various conditions. Finally, the Agency has also defined, for certain medical procedures, indications for which it reimburses these services (e.g. ultrasound) on the basis of international guidelines.
More specifically:
As regards beneficiaries, the Agency's objective is, through proper information, to make them understand that every time they seek health care services from a cardiologist without needing them, they are depriving someone else who really needs them.
WHAT'S WRONG WITH APPOINTMENTS
Based on serious evidence from daily practice, the evidence we have available suggests that a major contributor to the difficulty in obtaining appointments is the over-visit of beneficiaries to specialists. We assess that a significant proportion of these visits are unnecessary and could be avoided if the beneficiary visited his or her personal physician. For this reason, the Agency has implemented quality performance indicators for personal physicians which include the issuance of referrals to specialists. In addition, the Agency is finalising the first referral guidelines from personal physicians to specialists, with the aim of ensuring that primary health care takes on the cases that concern it and can be managed at the primary level, without unnecessary referrals to specialists.
INTERMEDIATE IMPROVEMENT PROCESS
The Agency, in collaboration with NICE in the United Kingdom, has adapted and implemented guidelines by therapeutic area, including cardiology.
To this end, the Agency has involved many partners in the process, including the competent scientific society, other health professionals, academics, patient representatives, etc. in order to ensure that the guidelines to be implemented and the indicators to be monitored are the most appropriate and adapted to the Cypriot reality. In addition, an equally important element is the definition of minimum requirements for the medical reports that accompany certain medical procedures, in order to ensure that these procedures are properly documented and that beneficiaries and other providers who have access to this information through the GHS IT system are properly informed.
(SX)
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