Positive provisions, but also important weaknesses, are found in the new law on Primary Health Care (PHC) and the Personal Doctor, four scientific companies, which submitted their relevant commentary, in the public consultation of the bill “Reformation of the institution of the Personal Physician – Establishment of University Health Centers and other provisions”which ended yesterday Tuesday (8/10).
These are the scientific companies: Hellenic Academy of General/Family Medicine and Primary Health Care, Society of General/Family Medicine of Greece “Ippokrates”, Hellenic Society for Research and Education in Primary Health Care and Hellenic College of General Medicine.
The positives
As reported by the representatives of the four scientific companies, the positive aspects of the new law include:
The expansion of the categories of doctors who provide Personal Doctor services with the participation of private doctors in the PHY system.
The effort to make use of all the experienced and trained doctors of the PHY.
The one-time financial incentive for young doctors to choose the specialties of General/Family Medicine and Internal Pathology.
The establishment of seven University Health Centers.
The intentions to establish an effective system of evaluation of Personal Doctors, based on performance indicators.
“We express our satisfaction that despite voices to the contrary, the Ministry of Health did not open the institution of PI to specializations unrelated to PHY, but only to General/Family Medicine, Internal Pathology and Pediatrics, as is the case worldwide”, they report the doctors and add that at the same time there are several concerns in individual provisions of the bill.
The objections
The doctors submit their objections and corresponding proposals, which are summarized in the following points:
Personal Doctor: Commentary and Arguments of Scientific Societies on the PPH Bill
Private Doctors and Contracts with EOPYY:
There is an inexplicable policy change, which puts contracted private doctors on the back burner, only “where public PHC service units do not fully cover their population of responsibility”.
The previous reform doubled the number of private GPs due to attractive contracts. However, with the current arrangement: Citizens can choose a purely private Personal Doctor, who will be paid by them.
This could have been avoided with a little further improvement in the terms of the GP contract, they say:
“The small increase in compensation (from €27/citizen/year) could increase the registration of doctors in the system and therefore the pool of doctors”, comment the representatives of the 4 scientific companies and add that the new regulation causes complications .
“What is the incentive for the citizen to declare as PI a purely private doctor who will pay himself? After all, the disincentives included in the previous law for someone who remained without PI were removed. Why should he change the episodic use of private doctors he already does? What is the motivation for a purely private doctor to accept a citizen to declare him as his PI and what obligations-commitments for which specific services does the doctor accept to the citizens who declare him as their PI? Will the performance of these doctors be evaluated like the rest? How to prevent the creation of a multi-speed PHC system, which instead of reducing will strengthen the inequality in access according to income?”, they ask.
Separation of Private Doctors into two categories:
Two categories of private doctors are foreseen, the scientific associations comment: Those contracted with EOPYY with a registered population, and purely private, who do not contract with EOPYY and are freely chosen by the citizen at his own expense.
“Any maintenance of the complete separation of the two categories of private doctors creates a very strong disincentive to a contract with EOPYY and a mass exit from the contracts”, the doctors comment.
Geographical restrictions and Citizen registration
The registration of citizens to the Personal Doctor is foreseen exclusively at the level of a municipality or neighboring municipalities, except in the case of purely private doctors which is also allowed at the level of a Regional Unit.
However, the doctors comment on the following: “We believe that for all categories the geographical restriction should be set at the Regional Unity level. In addition, if it is qualified to be done at the level of a municipality – neighboring municipalities, insured persons who have already registered with a Personal Doctor and make use of his services, should not be forced to forcefully change their Personal Doctor. Patients who have not used their Personal Doctor can be removed, possibly after sending them a warning message.
Also, problems are identified with the change of Personal Doctor through pharmacies without the citizen’s consent, “There are complaints from citizens who found that a change was made in the Personal Doctor registered by a pharmacy, without even being asked. Finally, we do not understand why there is no possibility for the Personal Doctor to remove a citizen from his list for a serious and justified reason”, they point out.
Personal Physician home services and on-call attendance: A reimbursement framework is required for home-based services.
There is so far no on-call obligation for contracted Personal Physicians in public structures and the absence of obligation played a heavy factor for many colleagues in their choice to contract with EOPYY. At this stage it could only be accepted on a voluntary basis.
Appointment Time and Maximum Number of Citizens per Personal Physician: The 15-minute appointment should be increased when there is no multidisciplinary team to support.
The number of citizens per Personal Doctor must not exceed 1500.
Incentives for New Doctors and Avoiding Regional Settlement: Financial incentives for new doctors are necessary, but they must be linked to staying in the NHS for a period of time, otherwise they will train and go abroad.
Additional incentives are needed for doctors in barren areas, to avoid desertification of barren areas.
Inadequate training and segmentation of PHY: New doctors (rural/rural doctors) are asked to serve as
Personal Doctors, after just one month of training.
“Second class” patients are created with inadequately trained doctors
University Health Centers and Interdisciplinarity
The participation of Public Health experts and the interdisciplinary approach is necessary. However, it is proposed to create faculty positions specializing in General.Family Medicine, Public Health (not necessarily a medical degree) and Nursing positions.
“The reform of the Personal Doctor was a leap for the organization of PHY in the country. We hope that our proposals will find fertile ground and that the 2nd phase of the reform will bring us closer than ever to the universal coverage of the population by patient-centered PHY services”, conclude the doctors of the four scientific associations.
Source: iatropedia.gr
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