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GHS Presentation Eng
GHS Presentation Eng
HEALTH ΑΣΦΑΛΙΣΗΣ
INSURANCE ΥΓΕΙΑΣ
ORGANISATION
Το
Theσύνολο του περιεχομένου
entire content αυτής τηςisπαρουσίασης
of this presentation ανήκει
confidential and αποκλειστικά
belongs στον
entirely to the Οργανισμό Ασφάλισης
Health Insurance Υγείας. Απαγορεύεται
Organisation. It is expresslyρητά οποιαδήποτε
prohibited to copy,αντιγραφή,
reproduce,αναπαραγωγή,
transfer, store,
μεταφορά, αποθήκευση,
process, republish, μεταποίηση,
transmit, distribute,αναδημοσίευση, μετάδοση,
sell, publish perform, διανομή,
download, πώληση,
translate, έκδοση,
modify εκτέλεση,
in any φόρτωση (download),
way, communicate, disseminate μετάφραση, τροποποίηση
or otherwise με οποιονδήποτε
use the content τρόπο,
of this presentation
ανακοίνωση, διάδοση ή οποιαδήποτε
by any means or means άλληfor
χρήση του περιεχομένου
commercial της παρουσίασης
or other purposes in part or inαυτής
wholeμεwithout
οποιονδήποτε τρόπο
the express ή μέσο
prior writtenγια εμπορικούς
consent of theήOrganisation.
άλλους σκοπούς, τμηματικά ή
περιληπτικά χωρίς τη ρητή προηγούμενη έγγραφη συναίνεση του Οργανισμού.
Agenda
1. Introduction
2. GHS Phases
3. Main characteristics of GHS
r 4. Economic Aspects & Financing
5. GHS IT System
6. Summary
r • Chairman
• Director Gen. of Minist. of Health
Health Insurance Organisation (HIO)
• Director Gen. of Minist. of Finance
HIO is a public legal entity. Its mission is the • Government - 2 members
implementation of the General Health System • Employers - 3 members
(GHS) and its main responsibilities include • Employees - 3 members
monitoring and managing the System in order to • Self employed - 1 member
promote social solidarity, equal access and efficient • Patients - 1 member
use of resources.
The composition of the BoD provides
autonomy and protection from political
interventions and promotes consensus in
decision making.
Result
Difficulty in accessing and
receiving the necessary
healthcare services
Public Private
Free healthcare High out-of-pocket
services expenditure
Public Sector Waiting lists Fast provision of service Private Sector
~ 75% of population
6
2
GHS PHASES
GHS phases
1st 2nd
Phase Phase
June June
2019 2020
r
Outpatient health services Full GHS implementation
Universal
• Coverage of the whole population
regardless of income and health status Outpatient Pharmaceuticals
Specialists and vaccines
Social
• Contributions based on income
Personal Doctors
r Solidarity
• Healthy population for the sick Nurses, HIO
Mid-wives Patient/
• The affluent for the poor P
Beneficiary Laboratories
and Allied Health
Professionals
Accessible
• Equal access for beneficiaries
• Free choice of providers in public and
private sector A&E
Departments Hospitals
Comprehensive and
Ambulance
• Provision of comprehensive healthcare
services
HIO Contribution
Beneficiaries Providers Collection Contributors
Services
r GHS Fund
• Cypriots • Personal Doctors • Ministry of Labour, • Employee
• EU nationals • Outpatient Specialists Welfare and Social • Employers
• Third country • Laboratories Security • Self employed
nationals • Allied Health Income • Tax Department • Pensioners
Professionals • Treasury of the • Other income earners
and have their legal • Hospitals Republic of Cyprus (rent, dividends,
ordinary residence in • Accident & Emergency Expenditure
interest)
the areas controlled • Ambulance • Officials
by the Republic of Global Budget • Government
• Pharmaceuticals
Cyprus
• Medical devices
Other categories
under certain conditions
Coverage in the EU
All GHS beneficiaries are entitled to receive healthcare
services in Member States of the European Union.
Electronic Enrolment:
Any person can submit an electronic claim in order to enroll to the GHS in the following ways:
a) personal enrolment (self-enrolment) – Persons who have access to the internet can easily and
quickly navigate through the respective link on the HIO’s website to enroll to the GHS.
r
b) through a third party– any person can submit a request to enroll to GHS, on behalf of other
persons, provided that they know the necessary personal data.
c) through the Personal Doctor on whose list the beneficiary will register – During the
beneficiary’s visit to the Personal Doctor on whose list the beneficiary wishes to register, the
Personal Doctor may proceed to submit ,on the beneficiary’s behalf, an electronic request for
enrolment to the GHS.
r • The Personal Doctor is the patient’s first point of contact and the patient’s
navigator to the System.
Maximum number of
Free choice of PD Change of PD
beneficiaries per PD
ΡΟΗ ΑΣΘΕΝΗ
PATIENT
ΣΤΑ FLOW
ΠΛΑΙΣΙΑIN ΓΕΣΥ
GHS
ΤΟΥ
Dentists Hospitals
Abroad
Laboratories
Beneficiary
Personal Doctors
Special Group of
Outpatient Specialists Hospitals
Outpatient Specialists
Ambulance
r Allied Health
Professionals Hospitals
A&E
Pharmaceuticals
Rehabilitation
Gynaecologists Centers
No co-payment Palliative
Co-payment Centers
Personal Contribution I
Personal Doctor
Dentists for preventive dental care
Direct access Ambulance
Gynecologists (women >15 years old)*
Accident & Emergency Department *
Outpatient Specialists*
r
Laboratories*
Pharmacies*
Access with referral
Nurses, Midwives and Allied Health Professionals*
Hospitals for inpatient services
Palliative and Rehabilitation centers
PERSONAL CONTRIBUTION Ι
HIO reimburses direct access to an Outpatient Specialist, excluding visits to Outpatient Specialists
with a specialty in gynecology/ obstetrics and soldiers who have an exam certificate from a military
doctor which refers to an Outpatient Specialist, provided that the beneficiary pays Personal
Contribution I which is equal to 25 euros per visit.
* Co-payment applies
20 HEALTH INSURANCE ORGANISATION
Referrals
*A long term referral will be issued when the Outpatient Specialist recognizes that the beneficiary
needs continuous specialist follow-up. The long term referral is issued by the Personal Doctor after
recommendation of the treating Outpatient Specialist.
• Personal Doctors
• Outpatient Specialists
• Laboratories
• Employees • Nurses, midwives, clinical
• Employers psychologists, clinical
• Self-employed dieticians, physiotherapists,
• Pensioners occupational therapists,
speech language therapists
• Other income earners
r GHS Fund • Hospitals
• Officials • A&E
• State • Ambulance
• Patients • Pharmaceuticals
Contributions, Co-
payments Global Budget
Claims
* Contribution percentages which will apply from 1st March 2019 for outpatient services
** Contribution percentages which will apply from 1st March 2020 for the full GHS implementation
OBJECTIVES OF CO-
• Responsible use
PAYMENT
• Avoiding abuse and waste
IMPLEMENTATION
Co-payment
Healthcare Provider Services
amount
Per pharmaceutical €1
r
Per outpatient specialist visit excluding visits to radiologists and pathological anatomy/
€6
cytology
Treasury
Tax Department
5
GHS IT SYSTEM
Comprehensive IT System
Systems
Healthcare providers Beneficiaries
Beneficiary
Healthcare provider Healthcare
PD list management management
management provider portal
Beneficiary portal
Electronic patient history Customer relationship management
Claims
Referral Pharmaceutical Laboratory test
management prescription ordering Claim
management
Business Support
Document management Accounting
system
Business Processes
Healthcare Provider
and Beneficiary Transparency and
Expenditure control protection
support
r • Compilation of electronic • Recording, monitoring and • Comprehensive database
medical record controlling the utilisation of with processing and analysis
healthcare services capability
• Electronic prescription,
electronic issuance of • Data analysis and • Monitoring efficiency,
referrals and faster patient implementation of corrective productivity and quality
service measures
• Protection of personal data
• Management of activity • Avoid wastage
catalogues
• Detection and prevention of
• Submission of claims for fraud
reimbursement
6
SUMMARY
Quality healthcare services
o Financial protection,
o Equal access,
o Free choice of doctor,
o Quality healthcare services,
o Reduction of waiting lists,
r o Prevention and detection of disease
o Comprehensive package of healthcare services,
o Supervision Commissioner,
o Compilation of electronic medical record.
www.gesy.org.cy
GESYCyprus
ΗΙΟCyprus