"Equitable Access to Health Services"
The World Health Organization has established 7 April as World Health Day. In addition to the symbolism of this day, it also reminds us that equal, equitable and unimpeded access to quality health services is an inalienable right for all. Almost three years after the launch of the General Health System (GHS) of Cyprus, this was and remains its clear message: Health for all, without exceptions.
The biggest social reform ever since the establishment of the Republic of Cyprus has been universally embraced by society, with the beneficiaries receiving health services every day being the clearest proof. Citizens, for the first time, have a General Health System that offers equal and quality access to health services for all, with the difficult period of the COVID-19 pandemic confirming the necessity of its existence.
It is no coincidence that an overwhelming majority of 82% of beneficiaries consider the quality of the health services provided by the GHC to be very satisfactory, while 80% consider that the GHC has greatly improved their quality of life, according to the results of a nationwide survey conducted by IMR/University of Nicosia on behalf of the OAI in the year 2021.
Throughout its course to date, the GHC has faced difficulties. With the challenges being large and constant, abuses by providers and beneficiaries are one of the biggest problems for the smooth functioning of the System.
Recognizing the existence of the problem, the Health Insurance Agency has recently proceeded to develop an action plan to address the abuses. Within 2022, the Agency, with its increased staffing, plans to intensify the following actions:
- Implement restrictions, guidelines and/or protocols for the submission/approval of claims by providers, the administration of drugs and the performance of inpatient procedures.
- Applying stricter penalties to offending service providers and/or beneficiaries.
- Regular review of the lists of activities, including the weights of each activity.
- Qualitative evaluation of referrals from Personal Physicians to Specialists and Clinical Laboratories.
- Awareness campaign to create a culture among both beneficiaries and providers on the correct use of the GIS and avoiding abuses.
- Collaboration with the UK NICE, the Pancyprian Medical Association (PIS) and the University of Cyprus for the adoption of clinical guidelines.
- Implementation of the remuneration of Personal Physicians on the basis of a mixed remuneration system which will include qualitative performance indicators.
- Extend the implementation of separate budgets per specialty for Specialists.
- Expansion of quality controls on referrals for clinical laboratory tests and imaging examinations by Specialists.
- Intensification of controls in cooperation with external consultants and the Pancyprian Medical Association.
- Start of on-site inspections in cooperation with external consultants.
Like any living organism, the GHS is constantly evolving, aiming for the best version of itself. Every day, the Health Insurance Agency is called upon to oversee, identify and manage a huge number of claims, providers and beneficiaries with the sole aim of providing optimal health care services.
Despite the abuses and any other problems it has to deal with, the GIS is and remains financially viable. The statistics clearly show that in 2021 there were trends of stabilization of the System.
Indicatively, while the total number of beneficiaries registered in the System and in a Personal Physician Directory amounts to 920,000 and the total number of providers participating in the System exceeds 6,100, the number of total visits, units as well as claims has stabilized.
In this early coming of age of the Organization, special emphasis is placed on cultivating the right culture on the part of participants, providers and beneficiaries.
In this context, the Agency has so far investigated dozens of cases of doctors, pharmacists and other providers and has proceeded to suspensions and terminations of contracts, recommendations, imposition of administrative fines in more than 43 cases and rejection of claims worth more than €3 million.
At the same time, in 2022, it is planned to implement a comprehensive information, communication and education programme for beneficiaries of the GIS which, among other things, aims to create a culture for the proper use of the System and the reduction of abuses, as well as information on the rights and obligations of beneficiaries and the importance of the role of PI within the GIS. In addition, one of the main objectives of this programme is also to educate/encourage beneficiaries to report abusive activities.
At the same time, the OAI has set as a priority the integration of additional innovative medicines into the GIS, addressing abuses and improving quality by adapting and adopting international guidelines.
As has been repeatedly stressed, the GHS is a system that is subject to continuous improvement and the aim of OAI is to monitor its development and intervene effectively both to correct any distortions and to further improve the services provided. The beneficiary's needs and quality service are at the heart of the operation of the GIS which remains purely person-centred.
The Board has designated 1 June as GIS Day, when the Agency will conduct an annual review of the System and provide information on planning for the future.
Contents of this article including associated images are owned by PIO
Views & opinions expressed are those of the author and/or PIO
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