Our View: HIO needs to manage more responsibly if free healthcare to remain a reality

ALL IS NOT well with Gesy despite the unwavering efforts by the Health Insurance Organisation (HIO), which administers it, to present it as a smoothly-run operation and play down the major difficulties it is encountering as minor teething problems. This publicity strategy has been very successful, insulating the planning of the HIO from criticism even when it is perfectly justified. It helps that the media have made it their national duty to always present Gesy in a positive light because, like everyone, they see its vital importance for people and want it to succeed.

Gesy, however, will not become a success by lavishing praise on it and dismissing its weaknesses, when they emerge, as being of minor significance that will be dealt with by the HIO which, we are assured, is always on top of the situation. Nor is patching things up temporarily, as seems to be the preferred mode of operation of the HIO, the answer because the problems will re-appear further down the line and be more difficult to deal with. Many of the problems are the direct result of bad planning and an inability of HIO technocrats to study the possible consequences of their decisions.

A shining example of this incomplete thinking is the pay structure for the personal doctors that has caused unrest and resentment and led to a mass exodus of doctors from the state hospitals, which are suddenly understaffed and unable to offer adequate service to patients. The idea behind the unjustifiably high pay offered was to attract doctors from the private health sector to Gesy, but the plan backfired because the HIO never considered the resentment this would cause among hospital doctors who were earning less than a third of the €250,000 ceiling for personal doctors.

It has been said that the earnings will eventually fall as more doctors sign up to Gesy, but the damage has already been done, doctors leaving hospital in droves to join Gesy. The unions of government doctors have turned down the offers of increased pay made to them and are now demanding that 20 per cent of the gross revenue collected by hospitals from the HIO should be distributed among them. The State Health Services Orgnaisation (Okypy) that is in charge of the hospitals offered about 12 per cent. Considering the state hospitals will be subsidised by the state, this loss of revenue would be covered by the taxpayer.

The HIO’s shoddy planning has also allowed large scale abuses of the system by patients. Earlier in the week the HIO announced it would be trying to stop the uncontrolled referrals of patients for lab tests and diagnostic tests. A source at the HIO told Politis newspaper that in the first four-and-a-half months of Gesy’s operation there had been a staggering 820,000 referrals for lab tests, made all the more astonishing considering the total number of people registered with the scheme is 730,000, of which a significant percentage comprises of children. Even more astonishing, were the 519,000 referrals to diagnostic centres, primarily for MRI scans. Because these are free, people are under the impression they are entitled to an MRI scan on demand.

This is another glaring example of the bad planning. The HIO did not consider it necessary to draft protocols for referrals which doctors would have to consult before sending a patient for any type of test. Drafting protocols is a long and arduous task so the planners did not bother with it, one HIO official saying on radio show a few months ago when the issue came up that these could be downloaded from the internet. This is the level of shoddiness prevailing at the organisation that had taken no precautions to safeguard against abuses of the system, a certainty when a service is provided free of charge. The protocols would have put the system on a professional basis, offering guidance to doctors and justification for turning down patients’ demands for referrals.

It is the taxpayer that is picking up the bill for these abuses of the scheme and the excessive pay of personal doctors, while there are also problems surrounding the supply of drugs via the system. These are not teething problems but weaknesses that threaten the long-term viability of the system, which is why it is imperative the HIO reassesses its healthcare model and draws up new plans based on the assumption that there are budgetary constraints. Free healthcare for all is a wonderful thing but it has to be managed much more responsibly than has been the case so far if it is to have a long-term future. The viability of the scheme should be the HIO’s priority, rather than turning it into a free for all.

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