The Health Insurance Organisation (HIO) is investigating sharp increases in laboratory testing and possible abuse within Gesy, while acknowledging that gaps remain in waiting times and the systematic measurement of healthcare quality.
Speaking on Morning Briefing with Katerina Eliadi, HIO Director-General Efi Kammitsi outlined the mechanisms used to monitor service quality, abuse and increasing expenditure under Gesy, while conceding that the system still has shortcomings.
Gaps in measuring quality
Kammitsi said the HIO uses quality and performance indicators, protocols and audits, with some indicators linked to provider payments.
She acknowledged, however, that the system has not yet reached the point where it systematically measures health outcomes among specific groups of patients, such as people with diabetes and heart disease.
A new mechanism is being developed to evaluate the overall effectiveness of the healthcare system.
Waiting times and laboratory tests
On waiting times, Kammitsi said the HIO had not identified a generalised problem, although she acknowledged delays in specialties where the number of available doctors is limited, as well as with individual doctors experiencing particularly high demand.
For urgent cases, a referral system is in place requiring an appointment with a specialist to be arranged within 10 days.
Greater concern surrounds the rising volume of laboratory tests.
Kammitsi described the increases as “very large” and continuous, saying they do not appear to be fully justified by patients’ medical needs.
The HIO is examining ways to reduce the unnecessary repetition of tests while taking into account the requirements of patients with chronic conditions.
Fines, abuse and cases referred to Police
Kammitsi acknowledged that the current maximum fine of €30,000 is not always considered sufficiently deterrent and said legislative changes are being pursued.
In serious cases, the HIO can terminate contracts with healthcare providers.
Cases involving suspected criminal offences have also been forwarded to the Police “several times”, she said.
Provider claims are monitored electronically, while Kamitsi stressed the importance of beneficiaries notifying the HIO when they discover that services they never received have been charged in their name.
Legal obstacles to naming sanctioned doctors
Asked about publishing the names of doctors who have been sanctioned, Kammitsi cited legal obstacles preventing the HIO from doing so.
She nevertheless acknowledged that greater publicity surrounding such cases “would help us” in terms of transparency.
Treatment abroad
Kammitsi also addressed the case of a woman receiving treatment in Germany following a serious road accident.
She said the patient has not returned to Cyprus, despite an HIO decision, subsequently considered by the Appeals Committee, that she should return.
Requests to extend treatment abroad are assessed by experts on the basis of medical reports and the patient’s progress, Kammitsi explained.
The opinion of the doctor treating the patient abroad carries weight, but does not bind the experts responsible for making the final decision.
