**Title: Our View: Futile Patient System Needs to Change**
The current structure of the General Healthcare System (Gesy) in Cyprus is facing significant scrutiny due to the overwhelming patient load on personal doctors. Presently, there are 170 personal doctors registered within the system, each responsible for an average of 2,500 patients. This results in a total of approximately 425,000 patients being managed by these physicians. The question arises: can a single doctor realistically provide adequate primary healthcare for such a large number of patients while maintaining awareness of individual medical histories and offering preventive care?
Concerns about this arrangement were voiced during a recent meeting of the House health committee, where deputies highlighted the inherent weaknesses and inefficiencies within the current system. Many committee members concurred that the number of patients assigned to each personal doctor should be reduced to ensure a higher standard of care. Given that there are 640 personal doctors available, adjustments to patient distribution could be feasible.
The committee also referenced a report from the World Health Organization, which emphasizes the importance of strengthening primary healthcare and minimizing unnecessary referrals to specialists. The Health Insurance Organisation (HIO) has expressed concern over the high rate of specialist referrals initiated by personal doctors, who are not fulfilling their essential role as gatekeepers in the healthcare system. This practice of liberal referrals not only clutters the system but can also jeopardize patient health, especially when waiting times for specialist appointments can extend to four or five months.
The pressure on personal doctors to facilitate referrals often leads to compliance, as it alleviates their workload and shifts the responsibility of patient care to specialists. This dynamic raises critical questions about the effectiveness of primary care delivery within Gesy.
When Gesy was initially established, the cap of 2,500 patients per personal doctor may have seemed appropriate. However, the system's generous remuneration model—€100 per patient annually, irrespective of healthcare utilization—has attracted many physicians to register as personal doctors. The HIO had anticipated that increasing the number of personal doctors would lead to a more balanced patient distribution. Unfortunately, this expectation has not materialized, resulting in continued strain on the existing doctors.
Moreover, the attractive compensation has prompted many doctors to leave public hospitals, despite receiving significant pay increases, leading to shortages in critical areas such as accident and emergency departments. This trend underscores the urgent need for reform in the healthcare system.
To address these pressing issues, several key changes are proposed:
1. **Reduction of Patient Load**: The maximum number of patients assigned to each personal doctor should be lowered to enable more effective and personalized care.
2. **Linking Remuneration to Patient Interaction**: The compensation structure for personal doctors should be adjusted to reflect the number of patients they actually see, rather than a flat fee based on registration.
3. **Mandatory Training for Personal Doctors**: To enhance the quality of primary care, it is suggested that personal doctors undergo a period of training as general practitioners. This could help mitigate the excessive number of referrals and improve patient outcomes.
While implementing these changes may pose challenges, the existing consensus regarding the necessity for improvements in primary care should be leveraged by the HIO. The health committee's discussions reflect a growing acknowledgment of the need for reform, and the time to act is now.
In conclusion, the current patient management system within Gesy is unsustainable and requires immediate attention. By addressing the patient load, restructuring remuneration, and enhancing training for personal doctors, Cyprus can work towards a more effective and responsive healthcare system that prioritizes patient well-being.