Cyprus Mail

HIO to limit number of visits to specialists amid signs of system abuse

The health insurance organisation (HIO) has begun tightening the noose around the number of visits to specialist doctors it emerged on Monday, amidst growing concerns of abuses in the national health scheme (Gesy).

Gynaecologists, neurologists and dermatologists will be permitted up to 20 patients per day and urologists 15, which has already drawn the ire of doctors who have not received the developments well. Orthopaedic surgeons will be permitted on average 25 patients per day.

HIO director general Athos Tsinontides told Cybc’s morning radio show that the data reveal neither doctors nor beneficiaries have displayed the necessary responsibility

“When there is a patient that visits the same dermatologist 10 times in two months, a patient that visits a doctor more than 35 times per year,” then some conclusions can be drawn, Tsinontides said.

The HIO specified that transvaginal ultrasounds for which doctors receive compensation for should not exceed 30 per cent of the total number of visits that a gynaecologist logs in the system.

Though HIO assured the decisions are constantly re-evaluated, it appears follow-up visits to specialist doctors are an issue the organisation is concerned with as it specified the minimum frequency of follow-up visits per beneficiary for ophthalmologists should not exceed one per week.

The system keeps a 30 day window open were doctors can add further diagnoses, issue prescriptions or lab tests without needing to create a new visit, an HIO announcement said.

As far as neurologists are concerned, the number of EEG’s carried out should not exceed 10 per cent of the total number of visits doctors have every month.

“In a bit to tackle any potential abuse,” the organisation also set a maximum of 25 per cent of monthly patients eligible for MRIs.

Benchmarks have also been introduced for cardiologists limiting stress tests to 15 per cent per monthly visits and routine ECG test to 70 per cent for instance.

Beneficiaries also have a cap of four visits per year to neurologists and gynecologists. There may be exceptions for instance during pregnancy, the announcement specified.

According to reports in Alithia and Politis the developments have not been met well by specialist doctors, and consider the move as an indication that HIO is not doing well financially or is expecting tougher finances in the future.

Asked to comment about budget concerns, Tsinontides said that the budget is rounded, and when activities increase, the price per unit decreases.

“Nothing more and nothing less.”

Patients with appointments are expected to face delays with the introduction of a daily limit of patients as doctors may have to reschedule.

HIO is expected to broaden the scope of restrictions to more specialties in the near future while the Cyprus Medical Association has submitted a proposal for an independent oversight for possible abuses of the system.



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