Debts exceeding €100 million, with some estimates placing the figure as high as €120 million, have accumulated within the General Healthcare System (GeSY). The amounts relate to double payments for high-cost in-patient medicines made by the Health Insurance Organisation (HIO) to the Ministry of Health and to hospitals participating in Gesy.
The medicines in question are high-cost preparations supplied to hospitals by the Ministry of Health without payment. However, when hospitals seek reimbursement from the HIO for treatments carried out using these medicines, they also receive compensation for the drugs themselves, despite not having paid for them. As the HIO separately pays the Ministry of Health for the same medicines, this results in a double payment for identical pharmaceutical products, once through reimbursement to hospitals and once to the Ministry.
From €10 million to €50 million
According to information available to “P”, in one private hospital the outstanding amount reaches €12 million. In three other private hospitals, debts range between €10 million and €20 million each. For public hospitals, the amount is estimated at €50 million.
For the State Health Services Organisation (OKYPY), the final outstanding figure covering all hospitals under its authority has not yet been agreed and is expected to be finalised in March. March will also be the month when the first deductions for public hospitals are implemented.
Monthly deductions as a solution
The matter has been known to the HIO. According to information provided, it had been identified from the outset that the medicines were being paid for twice. However, time was required to calculate the outstanding amount per hospital, leading to the accumulation of millions of euros in debt.
Following the completion of the relevant calculations, the HIO requested repayment from hospitals. The repayment is not made as a lump sum but through monthly deductions from the reimbursements hospitals receive under GeSY.
According to information from hospital sources, negotiations took place with the HIO to agree both on the total debt per provider and on the monthly deduction amount. The stated aim is to ensure that gradual repayment does not create liquidity problems affecting operations. The same sources indicate that agreements have been reached or are close to being finalised on the individual amounts.
Repayments have begun
In communication with a competent official at the HIO, it was confirmed that the deduction process has already started. The return of funds is expected to last several months.
At the same time, the existing procurement and reimbursement procedure continues unchanged. Hospitals continue to receive the medicines through the Ministry of Health’s Directorate of Purchases and Supplies and, when they are used for GeSY beneficiaries, they submit reimbursement claims to the HIO. The organisation continues to pay the reimbursements and subsequently proceeds, on a monthly basis, with deductions of the corresponding amounts from overall payments to hospitals. In this way, payment and recovery of funds take place sequentially in a continuous cycle.
According to the HIO, immediate monthly deductions were considered the most feasible option at this stage in order to limit further accumulation of amounts.
Why the procedure is not changing
Asked whether the existing system could be modified, and specifically why these medicines are not procured directly by the HIO on behalf of hospitals, the organisation replied that the drugs are expensive preparations requiring a tender and bidding process. It was stated that this procedure cannot currently be undertaken by the HIO. For this reason, procurement continues through the Ministry of Health.
The HIO describes the matter as purely procedural and maintains that it has now been resolved. It also rejects any suggestion of organisational shortcomings or inadequate control in hospital reimbursements, stating that the issue had been identified and that time was simply required to finalise the amounts per provider.
It is noted that the HIO is informed on a monthly basis by the Ministry of Health’s Directorate of Purchases and Supplies regarding medicines sent to hospitals. Based on this information and the reimbursement claims submitted, the relevant offsets are carried out through deductions.
However, the fact that amounts exceeding €100 million accumulated through a practice of double payment and are now being recovered through successive payments and deductions inevitably brings back into focus the structure and operation of financial flows within the healthcare system.