Three years on from the introduction of the national health scheme Gesy, the Health Insurance Organisation (HIO), which runs it, is introducing performance criteria for personal doctors as it seeks to address the large number of unjustified referrals it says are one of the main factors behind abuse of system.
In a written statement the HIO said that given that abuse was one of the major issues affecting Gesy it had in March drawn up a special action plan to address the problem.
“One of the abuses observed in the scheme is the large number of unjustified referrals issued by personal doctors to other Gesy providers. As part of its plan of action, the HIO is going ahead with the implementation of a series of measures which concern the improvement of the operation of personal doctors and the referral system,” it said.
These include performance criteria linked to the renumeration of personal doctors and which also relate to their behaviour as regards referrals to specialist doctors, for lab tests and X-rays and other diagnostic examinations, the HIO added.
The HIO is also stepping up quality checks of referrals and will be taking action against those personal doctors who do not comply with its instructions.
Other measures planned are the drawing up of guidelines on referrals, training and age criteria for the participation of doctors in the system.
Personal doctors are crucial to the provision of effective primary health care and guidance to beneficiaries on other Gesy services. Correct operation of the system of personal doctors will ease pressure on specialist doctors by removing cases than do not need specialist care. It will also lead to the more effective use of resources, safeguarding equal access to health care professionals that need it.
Last week, a senior HIO official said that personal doctors and pediatricians working under Gesy would, as from June, no longer be paid exclusively per number of patients.
Under the new formula, part of the renumeration will be calculated on the basis of quality criteria and indicators, such as home visits and call care. Remuneration for personal doctors will also be linked to their issue of referrals to specialist doctors and for diagnostic and lab tests.
For pediatricians, other than the number of patients, renumeration will reflect house visits, on call care and presence at birth.
The formula had still not been finalised, with consultations still under way, she added.
The changes come amid complaints of abuse of the system with some doctors reportedly signing up a large number of patients without providing the follow through care and others too prone to issue referrals to specialists and order scores of tests that may not be needed.
Although the number of unjustified referrals has stabilised, these remained high compared to other European countries, the official added.
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