Hospitals and doctors are furious with the Health Insurance Organisation (HIO), with the Employers and Industrialists Federation (OEV) raising the need for consultation as a matter of principle and the organisation calling meetings to calm tensions.
The dispute stems from the organisation’s decision to revise the list of specialist procedures carried out within the General Healthcare System (GHS) and remove a total of 54 diagnoses (placing them in the “normal” list), without first consulting or seeking the views of hospitals and doctors, according to the Cyprus Association of Private Hospitals.
The list of specialist procedures was created when it became clear that including them in the “normal” inpatient care list worked against patients.
This was because hospitals avoided carrying them out in order to reduce the discount rates imposed by the HIO when hospitals exceed the number of “units” set in their contract with the organisation.
For each hospital, depending on its characteristics, a specific number of units is set. At the same time, each medical procedure corresponds to a specific number of units, which is counted in calculating compensation.
When hospitals exceed the set number of units, the organisation begins imposing discounts, essentially paying lower compensation. Given that specialist procedures correspond to a large number of units each, carrying them out within the “normal” list made them unprofitable, and the organisation therefore created a separate list to exclude them from the overall calculation.
Last week, the organisation suddenly sent written notification to hospitals that 54 of these procedures were being removed from the specialist list, and this will certainly lead to financial destabilisation of hospitals, association president Marios Karaiskakis told Phileleftheros.
The removed procedures, without any prior consultation, include serious neurosurgical and cardiac operations and other procedures for which a hospital needs equipment, specially trained staff and special infrastructure, he said.
Employers and Industrialists Federation president Giorgos Pantelides raised, as a matter of principle, the need for consultation before simply announcing decisions. This issue will be raised by the federation at the organisation’s board through its representative, he told Phileleftheros.
On substance, he said, it is troubling that tertiary health services such as neurosurgical and cardiac cases are being excluded by the organisation from the specialist category.
This possible development does not align with the prerequisites required for providing these services, such as specialised staff and infrastructure, enhanced and specialised support services and so on.
At the same time, he said, it does not send the right message that Cyprus’s health system supports the continued development of services and the backing of specialised medical procedures. Such cases were sent abroad in the recent past, he noted.
After strong protests from doctors and hospitals, the organisation called a meeting yesterday to consult with stakeholders and jointly decide how the relevant list will be revised.
Doctors, hospitals and patient organisations all recognise the need to revise the specialist cases list, but stress that neither service quality nor hospital viability should be affected.